Urinary incontinence is the involuntary loss of urine. This condition afflicts 15 to 30 percent of older people who live at home, and about half of those in long-term institutional care, such as nursing homes. Younger people, too, can be affected by incontinence, especially women who have had children, because childbirth may weaken pelvic floor muscles that support the bladder. Because of anatomical differences, incontinence is twice as prevalent in women as in men. In all, an estimated 17 million Americans are incontinent.
Despite its prevalence, however, urinary incontinence is not normal at any age, and is not an inevitable consequence of getting older. This condition is very treatable and often curable through behavioral techniques and in some cases surgery.
Some cases of incontinence are temporary, caused by urinary tract infections, constipation, or medications. More commonly, however, incontinence is a persistent, or chronic, condition. There are four main forms of persistent incontinence, and in many patients more than one of these patterns occur simultaneously.
- Stress incontinence. More common in women than in men, stress incontinence results from weak pelvic muscles or problems with the urethra. Abdominal contractions that occur when you sneeze, cough, laugh, or lift something increase pressure on the bladder. The muscles of the pelvic floor are not strong enough to override this increase in pressure and so urine escapes, usually a few drops, but sometimes a larger amount. This is the most common type of incontinence.
- Urge incontinence. Also called detrusor instability (detrusor is the anatomical term for part of the bladder muscle), urge incontinence is the result of an overactive bladder. The bladder goes into spasm, triggering a sudden strong urge to void and an almost immediate release of a large amount of urine.
- Overflow incontinence. In this type of incontinence, the bladder fills until it becomes overdistended, but there is no signal to urinate and the detrusor muscle may not contract. Eventually, however, the bladder gets so full that it overflows.
- Functional incontinence. This term is used to describe incontinence that occurs as the result of some degenerative conditions or illnesses, such as severe arthritis, or mental disorders that restrict movement or otherwise make it difficult for a person to reach a bathroom.
- Mixed incontinence. This involves two or more types of incontinence listed above.
Symptoms of Urinary Incontinence
- Sudden loss of urine, often triggered by activity that increases abdominal pressure (laughing, sneezing, exercise), or in some cases a change in position.
- Dribbling of urine
- Strong, imminent urge to urinate
What Causes Urinary Incontinence?
Incontinence that begins suddenly (which is called transient incontinence) usually has very specific causes, including genitourinary infections (such as urinary tract infections and vaginitis) and various medications (especially diuretics, sleeping pills, and tranquilizers).
With persistent incontinence, the cause is typically linked to muscles and nerves involved in urination—a process that we take for granted, yet it is a complex set of actions and reactions coordinated by the central nervous system. Urine produced by the kidneys collects in the bladder, which is able to contract and expand to accommodate the urine. A ring-like muscle called a sphincter prevents urine from leaving the bladder until a sufficient amount accumulates, and muscles of the pelvic floor help support the bladder and urethra (the tube through which urine passes out of the body). Once the bladder reaches a certain level of fullness, it sends a message to the spinal cord, which in turn relaxes the sphincter and signals the muscles in the bladder to contract to force urine through the urethra.
During childhood, we learn to identify and control this reflex by tightening the muscles of the pelvic floor until a toilet is reached. But disruption in the process can cause incontinence.
Stress incontinence often affects women because childbirth weakens the muscles of the pelvic floor. In addition, the drop in estrogen levels that occurs with menopause contributes to the thinning of pelvic muscles and other tissues in the vaginal area and loss of tone of the urethra. In men, prostate or bladder surgery can contribute to stress incontinence.
Overflow incontinence is typically brought about by a physical blockage of urine flow, as can occur in men with prostate problems. It may also be caused by the nerve damage that sometimes results from diabetes, or by certain medications, such as diuretics, antidepressants, sleeping pills, and high blood pressure drugs.
Urge incontinence may be caused by a neurological imbalance—which may be the result of a stroke, for example—but often this condition has no known cause.
What If You Do Nothing?
In most cases, ignoring symptoms of incontinence just makes the problem worse and can also lead to complications. For example, what begins as occasional stress incontinence when sneezing may become more frequent and associated with other activities as the pelvic floor muscles weaken further over time. Being damp all the time, even if absorbable pads are used, can cause skin irritation and lead to sores. There is also an increased risk of developing a urinary tract infection because bacteria breed more effectively in a moist environment. Residual urine that remains in the bladder in the case of overflow incontinence may lead to bladder infections.
There are also psychological consequences of incontinence, including a loss of self-esteem and depression. And people who are incontinent may become socially isolated because they are embarrassed about odor or afraid of not being close to a toilet.
Home Remedies for Urinary Incontinence
In many cases, home remedies can eliminate or significantly improve incontinence.
- Lose weight if overweight. Excess weight increases intra-abdominal pressure, which can contribute to stress incontinence.
- Women should wear a tampon while exercising. Some women experience mild stress incontinence when they exercise. If you have this problem, a tampon inserted into the vagina can compress the urethra and help prevent urine leakage. Remove the tampon after the workout.
- Strengthen pelvic muscles. Specialized exercises called Kegel exercises are easy to learn and can be performed anywhere. They are helpful for stress and urge incontinence.
- Cross your legs to prevent accidents. If you know you leak urine when you sneeze or cough, crossing your legs or squeezing your pelvic muscles may stop it from happening.
- Practice bladder training. This strategy helps you regain control of the urinary process. It involves a commitment of time and effort, but is very effective.
- Start by going to the toilet every two hours. When you’re awake, use the bathroom on this schedule, whether you have to go or not. Maintain the schedule even when you are not at home.
- Every other day, extend the interval between bathroom visits by 30 minutes. Aim to achieve four-hour intervals.
- If you have an urge to urinate in between scheduled bathroom visits, relax. Do a Kegel contraction to deal with the urge. After the urge has passed, move slowly to a bathroom.
- Be careful of drinking too much fluid. Although you need to consume enough water to stay healthy, you may want to cut back on the extra can of soda or fruit juice—especially before bedtime or when you are away from home without ready access to a bathroom.
- Avoid or minimize caffeine intake. Caffeine is a natural diuretic—that is, a chemical that clears fluid from the body through increased urine output. Too much coffee, tea, or cola can stimulate frequent urination.
- Get regular exercise. Physical exercise can help prevent weight gain and also helps keep all of the muscles in the body well-toned.
- Perform Kegel exercises. Strengthening the pelvic muscles can help prevent as well as cure incontinence.
- Get medical attention for any bladder or urinary tract problem. Untreated bladder or urinary tract infections may lead to incontinence.
- Consider hormone replacement therapy (HRT). Treatment with female hormones—either estrogen or a combination of estrogen and progestin—after menopause has a number of benefits, including improving the tone of the pelvic muscles, which in turn can help ease or eliminate incontinence.
Strengthening Your Pelvic Muscles
Kegel exercises are highly effective at strengthening the pelvic muscles that support the bladder. They can be used to treat both stress and urge urinary incontinence, and may help prevent stress incontinence. The exercises are easy to do and can be performed anywhere. Most people see improvement in 8 to 12 weeks.
- The first step is to locate the proper muscles. When you are urinating, tighten up and try to stop the flow. If you cannot do this, try tightening your anal sphincter. Because of its proximity to the bladder sphincter, this helps identify the muscle necessary for maintaining continence.
- Contract and relax these muscles three times a day, performing 15 to 20 squeezes each time. Your goal should be to hold each contraction for 10 seconds.
- Practice Kegels during different activities—sitting, lying down, standing, walking.
- Occasionally monitor your progress by stopping and starting the flow of urine. Do not regularly practice Kegels while urinating or
Beyond Home Remedies: When To Call Your Doctor
If you experience stress incontinence, you may be able to cure the problem by doing Kegel exercises. However, most people who develop signs of incontinence, and especially older people, should see a doctor for an evaluation. Many people are ashamed to tell their doctor that they are incontinent, but there is much your doctor can do to help alleviate the problem.
Note: If you suspect that a medication you are taking is contributing to the problem, don’t stop taking it until you consult your doctor.
What Your Doctor Will Do
The doctor will take a detailed medical history, asking questions about the frequency of urination, the approximate volume of urine, and how urgently you feel the need to urinate. (You may be asked to keep a detailed diary recording this information for a few days to provide a better idea of the nature of the problem.) In addition, you should report any medications you take.
A physical exam will check for rectal, genital, and abdominal abnormalities that may contribute to the problem. Laboratory tests, such as urinalysis and culture, are done to check for urinary tract infections or other diseases. The doctor may also order a special test to determine if your bladder is truly emptying after you urinate.
If no underlying cause, such as an enlarged prostate, is found, treatment generally begins with the self-help measures outlined above because they are highly effective and safe. If this regimen does not cure incontinence, the doctor may prescribe medications that can relax an overactive bladder or tighten the urinary sphincter. There are also medications for men who experience overflow incontinence caused by an enlarged prostate. For stress incontinence, doctors sometimes prescribe weighted vaginal cones designed to increase the effectiveness of Kegel exercises.
Several FDA-approved devices may be appropriate for some women with stress incontinence, including women who experience exercise incontinence. So-called barrier devices such as the Reliance Urinary Control Insert and the FemSoft Insert are placed in the urethra to block urine flow; the insert must be removed before urinating and cannot be reused. An intravaginal device, the Introl Bladder Neck Support Prosthesis, is positioned so that it restores the bladder to its normal anatomical position; it can be left in during urination, but must be removed periodically for cleaning. These devices are available only by prescription and require careful fitting by a physician.
Collagen implants and a nerve stimulation implant (which sends impulses to nerves that help control bladder contractions) are other nonsurgical options for treating incontinence.
Surgery may be considered to correct anatomical problems causing incontinence. Clinical guidelines from the American Urological Association (AUA) state that surgery may even be considered as an initial treatment for stress incontinence in women. The types of surgery with the best long-term outcomes are retropubic suspension and sling procedures. A third procedure called transvaginal suspension is not as effective over the long term, but it has a lower rate of complications than the other two and the recovery period is shorter, according to the AUA.
You need to discuss with your doctor which treatment—or combination of treatments—is best suited for you.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media