Urinary incontinence

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What is it

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 13 million American adults 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 urine escapes, usually just 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 over distended, 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.


  • 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 it

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 is a complex set of actions and reactions coordinated by the central nervous system. The kidneys produce urine and send it through tubes called ureters to the bladder. The bladder is highly elastic, able to contract and expand to accommodate the collection of 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 at any point 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 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

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

In cases of mild stress incontinence associated with exercise, a tampon inserted into the vagina can compress the urethra and prevent urine leakage.

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.

Schedule toileting every two hours

When you are awake, whether you have to go or not. Maintain the schedule even when you are not at home. Every other day, extend the interval between toileting by 30 minutes, aiming for four-hour intervals. If you have an urge to urinate in between your scheduled visits to the bathroom, stay still. relax, and do a Kegel contraction. After the urge has passed, move slowly to a bathroom.

Be careful of drinking too much fluid

Although you need to consume a sufficient amount of 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.

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