Introduction to Urinary Incontinence: The process of producing urine, storing urine, and eliminating urine is amazingly complex. It involves the function and co-ordination of the brain and the spinal cord, intact nerves and muscles, a functioning bladder, and the unobstructed flow of urine through the lower urinary tract.
Urinary incontinence is a devastating problem affecting some 10 million Americans. The major approaches to the management of urinary incontinence are long-term efforts through an interdisciplinary approach. A multitude of incontinence products play a vital role in the treatment and management of the various types of urinary incontinence. There are many modalities of treatment which depend upon the "type" of urinary incontinence as well as the individual attributes of the patient. Appropriate use of incontinence products are essential adjuncts to successful treatment and/or management of the incontinent person.
Many people with incontinence pull away from their family and friends. They try to hide the problem from everyone, even their doctors. The good news is that in most cases urinary incontinence can be treated and controlled, if not cured. The bad news is that caregivers may not know that treatment is a choice. They may think that nursing home care is the only answer for an older person with incontinence.
Incontinence does not happen because of aging. It may be caused by changes in your body due to disease. For example, incontinence may be the first and only symptom of a urinary tract infection. Curing the infection may relieve or cure the problem. Some drugs may cause incontinence or make it worse.
If you are having trouble with incontinence, see your doctor. Even if it can't be completely cured, modern products and ways of managing incontinence can ease its discomfort and inconvenience.
Symptoms of urinary incontinence can range from light drainage of urine to complete uncontrolled release. The Agency For Health Care Policy and Research and the American Urological Association have determined six distinct "types" of urinary incontinence. Of utmost importance is the understanding that more than one "type" of incontinence can occur simultaneously in the same individual. Therefore, diagnosis and treatment of so called "mixed" incontinence is somewhat more challenging.
Stress Incontinence: Stress incontinence occurs when some physical exertion such as exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder and produces leakage of urine. The cause of stress incontinence is the weakening of the pelvic musculature which commonly occurs in women after having children and in post- menopausal women. It is the most common type of incontinence and can almost always be cured.
Urge Instability Incontinence: In this type of incontinence, the bladder contracts spontaneously WITHOUT the control of the individual. This uncontrolled bladder contraction results in the leakage of urine. With urge incontinence, however, the individual has the sensation to urinate, but cannot reach the bathroom in time. Sensation is usually followed by immediate release of urine. Although healthy people can have urge incontinence, it is often found in people who have diabetes, stroke, dementia, Parkinson's disease, or multiple sclerosis. It can also be a warning sign of early bladder cancer. In men, it is often a sign of an enlarged prostate.
Reflex Instability Incontinence: In reflex incontinence, the bladder empties itself at unpredictable times causing gross leakage of urine. In this instance, however, the individual does NOT have sensation or urgency. Neurological disorders and injuries to the upper spinal cord are the most common reasons for reflex incontinence.
Overflow Incontinence: Leakage or wetness occurs because the bladder is unable to empty effectively. This type of incontinence is associated with high residual volumes of urine after voiding. Individuals may also complain of nocturnia (urination at night) and the feeling that the bladder does not feel empty after urination. Some causes of overflow incontinence are chronic retention of urine and bladder outlet obstruction. In older men, this can occur when the flow of urine from the bladder is blocked.
Continuous Incontinence: This type of incontinence is associated with leakage of urine proximal to the lower urinary tract. Continuous incontinence occurs with urinary fistula, birth defects of the urinary tract, and urinary diversion such as urostomy.
Functional Incontinence: This type of incontinence is the one most commonly associated with the elderly. It may be caused by obstacles in the environment which make it difficult for the elderly person to make it to the bathroom on time as well as by cognitive and physical functional degeneration as seen in Alzheimer's Disease. There is no associated pathophysiology of the urinary tract in an individual with functional incontinence.