Urinary Incontinence (Part One)

Definition

Urinary incontinence or the loss of bladder control to hold urine is a disturbing and common problem. The causes of incontinence vary at different ages, in men and women. In childhood, bladder control develops earlier in girls than in boys and bedwetting is more common in boys than in girls. However, in adulthood, women are more predisposed than men to the development of urinary incontinence due to anatomical differences in the pelvic region as well as changes from pregnancy and childbirth. Nevertheless, many men suffer from incontinence. With age, it increases, but it is not an inevitable part of aging.

Symptoms

Some people get wet less often and rarely, others are constantly wet. There are several forms of urinary incontinence:

• Stress Incontinence. This consists of involuntary leakage of urine during coughing, sneezing, laughing, doing physical exercises, or lifting heavy weights, actions that convey abdominal tightening to the bladder.
• Urge Incontinence (urgency). It is an involuntary leakage of urine as a result of a sudden strong urgent feeling to urinate that you cannot stop. It may arise the need to urinate frequently including at night. Urgency incontinence can be caused by minor causes such as infection, or by more serious causes such as neurological disorders or diabetes.
• Overflow Incontinence. The patient may have frequent or continuous leakage of small amounts of urine as a result of not completely emptying the bladder.
• Functional Incontinence. A physical or mental impairment can make it difficult for the patient to reach the bathroom in time. E.g., if the patient has severe arthritis, he/she is not able to quickly unbuckle his/her pants.
• Mixed Incontinence. It means that the patient suffers from several types of urinary incontinence.

When to visit the doctor

The patient may be afraid to discuss his/her concern about not controlling urination with the doctor, but if incontinence is frequent or affects the quality of life, it is important to seek advice, as the presence of urinary incontinence may:

• Indicate that there is a serious underlying problem
• Limit activities, or restrict social interactions
• Increase the risk of falls in the elderly when they rush to go to the bathroom.

Causes

Urinary incontinence is not a disease, but a symptom. It can cause unseen medical or physical problems. Consulting a doctor can reveal what lies behind the incontinence.

Temporary urinary incontinence

Some drinks, foods, and medications can act as diuretics (water dischargers), stimulating the bladder and increasing the volume of urine. These include:

• Alcohol
• Caffeine
• Tea and decaffeinated coffee (without caffeine)
• Carbonated drinks
• Artificial sugar
• Corn syrup
• Spicy and acidic foods or those with a lot of sugar, especially citrus fruits
• Medications for heart disease or high blood pressure, sedatives, and muscle relaxants
• High doses of vitamin B and C

Urinary incontinence can also be caused by diseases that are easily treated such as:

• Urinary tract infections. Infections can irritate the bladder causing a strong, urgent, urination feeling and sometimes incontinence. Other signs of a urinary tract infection are: burning during urination and urine with a strong smell.
• Constipation. The rectum is located close to the bladder and many of its nerves are common to both organs. The strong and compact feces found in the rectum, irritates these nerves, making them overly active as a result increases the frequency of urination.

Continuous urinary incontinence

Urinary incontinence can also be continuous, caused by physical problems, or other changes, such as:

• Pregnancy. Hormonal changes and the increased weight of the uterus can cause stress incontinence.
• The process of childbirth. Natural childbirth through the vagina can weaken the muscles that serve to control the bladder as well as can damage the bladder nerves and supporting tissues leading to pelvic floor prolapse. This causes the bladder, uterus, rectum, and a part of the small intestine to sink below their normal position entering the vagina. This condition can be accompanied by incontinence.
• Age-related changes. Aging of the bladder muscle can reduce the bladder's capacity to store urine.
• Menopause. After menopause, women produce less estrogen, a hormone that helps keep the bladder and the urethra healthy. The worsening of these tissues can aggravate incontinence.
• Hysterectomy (Removal of the uterus). The bladder and uterus are supported by almost the same muscles and ligaments. Any surgical intervention performed on the reproductive system including the removal of the uterus can damage the pelvic floor supporting muscles leading to incontinence.
• Enlarged prostate. Especially in older men, incontinence is often the result of the enlargement of the prostate gland known as benign prostate hyperplasia (BPH).
• Prostate cancer. In men, stress incontinence or urgency incontinence may accompany untreated prostate cancer, but more often it is noticed as a complication of treated cancer.
• Obstruction. A tumor anywhere along the lower part of the urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones that are solid masses formed in the bladder, sometimes give involuntary urine leakage.
• Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, brain tumor, or a spinal cord injury can disrupt the nerves that control the bladder causing urinary incontinence.