Urinary Incontinence
Urinary incontinence is the inability to control leakage of urine. It's one of those
embarrassing problems people don't like to talk about -- even with their doctors.
But there is help for incontinence. In most cases the problem is treatable. It can
usually be improved, if not completely cured.
Figure 1.--Front view of bladder and sphincter muscles
Types of Urinary Incontinence
There are four types of incontinence. Each has its own symptoms and causes.
Figure 2.--Side view of female pelvic muscles
Stress Incontinence
Stress incontinence can occur when you cough, sneeze, laugh, lift heavy objects,
exercise, or even get up from a chair. Sometimes the muscles that hold the bladder
in place are weak. Then the muscle that controls the flow of urine may not be able
to do its work.
Stress incontinence can occur at any age, but it is most common in women who
have borne children, because childbirth can weaken pelvic-floor muscles. Often,
stress incontinence occurs after menopause because the decrease in estrogen can
lead to thinning and weakening of the pelvic muscles and surrounding tissues.
Treatment for mild incontinence usually includes pelvic-floor exercises (Kegel
exercises are described below). In moderate or severe cases of incontinence, other
treatments may be necessary. These therapies include use of estrogen creams,
collagen injections, and surgery.
Urge Incontinence
Urge incontinence is also known as detrusor instability. The bladder wall is a muscle
called the detrusor muscle. This muscle may contract more often and more strongly
than it should. That can cause a sudden need to urinate. The contractions may be
strong enough to cause urine loss before you reach the bathroom.
Urge incontinence is often linked to bladder infections or disorders, anxiety,
dementia, or stroke. Excess caffeine intake can also play a role.
Urge incontinence is treated most successfully without surgery. Nonsurgical
treatment options include electrical stimulation, "timed voiding" (urinating at
scheduled intervals), and reductions in caffeine. Certain medications may also be
helpful. In some cases, surgery may be required. One operation for women moves
the bladder, allowing the bladder neck to return to its normal, closed position.
Overflow Incontinence
Overflow incontinence occurs when the bladder does not empty all the way. With
this problem, you can leak small amounts of urine all day long. You may feel the
need to go to the bathroom and then urinate only a little. You may not feel
completely "empty" after you finish. This may be more common at night.
In general, men seem to experience overflow incontinence more than women.
Some disorders, such as diabetes, stroke, paralysis, and multiple sclerosis, may
prevent people from sensing when their bladder is full. Chronic use of muscle
relaxants or antidepressants can also interfere with bladder control.
To treat overflow incontinence, doctors first try to treat whatever disorder is
causing the incontinence. They may also prescribe medications that relax the
bladder outlet. In men, surgery may be recommended to remove part of the
prostate gland that may be blocking urination.
Functional Incontinence
Functional incontinence happens in people who have physical limitations and cannot
get to the bathroom before urination occurs. It is particularly common in hospitals
and nursing homes and in any setting where a person may be unfamiliar with his or
her surroundings. It can also be a side effect of certain medications.
Treatment for functional incontinence depends mostly on society's help. Betterstaffed nursing homes and better public restrooms can help, as can adjusting doses
of medications to accommodate an individual's schedule. Providing an easy or
shorter route to the bathroom is another easy way to assist those with functional
incontinence.
Self-Care Steps for Urinary Incontinence
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You need not be embarrassed by incontinence. Urinary incontinence is
common in women. All types of urinary incontinence can be treated.
Incontinence can be treated at all ages.
Do Kegel exercises as often as you can.
Use an absorbent undergarment.
Keep a list of your symptoms. It will help your doctor find the exact problem.
Dietary Considerations
1. Weight Control. In women, pelvic floor muscle tone weakens with
significant weight gain, so women are urged to eat healthful foods in
moderation and to exercise regularly.
2. Fluid Intake. A common misconception among people with incontinence is
that drinking less water will prevent accidents. In reality, limiting fluid intake
has the following effects:
o The lining of the urethra and bladder becomes irritated, which may
actually increase leakage.
o Concentrated urine also has a stronger pungency, so drinking plenty of
fluids can help reduce odor.
Some experts recommend drinking two to three quarts a day.
People with incontinence, however, should stop drinking beverages two to
four hours before going to bed, particularly those who experience leakage or
accidents during the night.
3. Fiber-Rich Foods. Constipation can exacerbate urinary incontinence, so
diets should be high in fiber, fruits, and vegetables. A diet rich in these foods
is highly recommended anyway for overall well being.
4. Fluid and Food Restrictions. A number of foods and beverages have been
reported to increase the incidence of incontinence. Some experts suggest
that people who eat or drink the following items should try eliminating one a
day over a 10-day period and check to see if removing them improves
continence:
o Coffee and tea and other caffeinated beverages or medications.
o Citrus fruits and juices.
o Tomatoes and tomato-based foods.
o Spicy foods.
o Chocolate.
o Sugars and honey.
o Milk and milk products.
Kegel Exercises
Kegel exercises are designed to strengthen the pelvic-floor muscles, the muscles
used to stop the flow of urine. There are many different ways to do Kegel exercises.
All types involve tightening the pelvic floor muscles and then releasing them.
Some people have difficulty identifying and isolating the muscles of the pelvic floor.
Care must be taken to learn to contract the correct muscles. Typically, most people
contract the abdominal or thigh muscles, while not even working the pelvic floor
muscles.
These incorrect contractions may even worsen pelvic floor tone and incontinence.
Several techniques exist to help the incontinent person identify the correct muscles.
To determine which muscles you need to strengthen, try doing a Kegel exercise the
first time you urinate after waking. While your bladder is full, start and stop the
flow of urine. Let out only small amounts of urine at a time. Start and stop the flow
of urine in this way until your bladder is empty. Do not contract your abdominal,
thigh, or buttox muscles while performing the exercise.The muscles that you use to
stop urination are the same ones that you will be tightening and releasing for Kegel
exercises.
Another approach to help you identify the correct muscle group is to insert a finger
into the vagina (in women), or rectum (in men). You should then try to tighten the
muscles around your finger as if holding back urine. The abdominal and thigh
muscles should remain relaxed.
Two Ways That You Can Do Kegel Exercises
Exercise 1: Contract the pelvic muscles as far as possible. Hold tightly for 3
seconds. Release and repeat 20 to 25 times. You can do these exercises anywhere - while doing the dishes, brushing your teeth, reading the paper,. If you do a set of
20 to 25 exercises three to five times a day, you should notice a difference within a
few months.
Exercise 2: Think of the pelvic floor as an elevator. Tighten the pelvic-floor
muscles slightly to reach floor one. Hold for several seconds. Without releasing this
hold, tighten the muscles again, this time moving to floor two. Pause again for
several seconds. Continue to move up floor by floor until you reach floor five. At
this point, the muscles should be fully contracted. Gradually release the muscles
floor by floor in the same way you did to tighten them.
A word of caution, some people feel that they can speed up the progress by
increasing the number of repetitions and the frequency of exercises. However, this
over-exercising may instead cause muscle fatigue and increase your leakage of
urine.
You should not feel any discomfort in your abdomen or back while performing these
exercises. If you do, you are probably performing the pelvic floor exercises
incorrectly. Some people have a tendency to hold their breath or tighten their chest
while trying to contract the pelvic floor muscles. Relax and concentrate on
contracting just the pelvic floor muscles.
When properly performed, Kegel exercises have been shown to be 50-80% effective
in curing/improving urinary continence.
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