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Urinary incontinence

• Overview
• Treatment

Definition:

Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine.

The two main types of urinary incontinence are:

• Stress incontinence -- occurs during certain activities like coughing, sneezing, laughing, or exercise.
• Urge incontinence -- involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don't have enough time between when you recognize the need to urinate and when you actually do urinate.

Bowel incontinence , a separate topic, is the inability to control the passage of stool.

Alternative Names:

Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary

Considerations:

Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.

Infants and children are not considered incontinent, but merely untrained, up to the time of toilet training. Occasional accidents are not unusual in children up to age 6 years. Young (and sometimes teenage) girls may have slight leakage of urine when laughing.

Nighttime urination in children is normal until the age of 5 or 6.

NORMAL URINATION

The ability to hold urine is dependent on having normal anatomy and a normally functioning urinary tract and nervous system. You must also possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.

The process of urination involves two phases:

1. The filling and storage phase
2. The emptying phase

Normally, during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine.

The first sensation of the urge to urinate occurs when approximately 200 ml (just under 1 cup) of urine is stored. A healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.

The average person can hold approximately 350 to 550 ml (over 2 cups) of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable, expandable bladder wall muscle (detrusor).

The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. At the same time, your body must be able to relax the sphincter to allow the urine to pass out of the body.

Common Causes:

Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:

• Bedrest -- for example, when recovering from surgery
• Certain medications (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies, and antihistamines for allergies)
• Increased urine amounts , like with poorly controlled diabetes
• Mental confusion
• Pregnancy
• Prostate infection or inflammation
• Stool impaction from severe constipation, causing pressure on the bladder
• Urinary tract infection or inflammation
• Weight gain

Causes that may be more long-term:

• Alzheimer's disease
• Bladder cancer
• Bladder spasms
• Depression
• Large prostate in men
• Neurological conditions such as multiple sclerosis or stroke
• Nerve or muscle damage after pelvic radiation
• Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vaginal space, often related to having had multiple pregnancies and deliveries
• Problems with the structure of the urinary tract
• Spinal injuries
• Weakness of the sphincter, the circular muscles of the bladder responsible for opening and closing it; this can happen following prostate surgery in men, or vaginal surgery in women

References:

American College of Obstetricians and Gynecologists. Urinary incontinence in women. Obstet Gynecol . 2005; 105(6): 1533-1545.

Madersbacher H, Madersbacher S. Men's bladder health: urinary incontinence in the elderly (Part I). J Mens Health Gend. 2005; 2(1): 31-37.

Kielb SJ. Stress incontinence: alternatives to surgery. Int J Fertil Womens Med . 2005; 50(1): 24-29.

• Review Date: 7/23/2007
• Reviewed By: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care, Denville, NJ. Review provided by VeriMed Healthcare Network.

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