Incontinence

Incontinence is a problem of the urinary system, which is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. A circular muscle, called the sphincter, controls the activity of the urethra. It is not a part of the urinary system but can play a role in incontinence.

Normally, the bladder stores the urine that is continually produced by the kidneys until it is convenient to urinate, but when any part of the urinary system malfunctions, incontinence can result.

• Stress incontinence occurs when pelvic muscles have been damaged, causing the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder.
• Urge incontinence , the urgent need to pass urine and the inability to get to a toilet in time, occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited. Urge incontinence is a major symptom of Over Active Bladder.
• Mixed incontinence is very common and occurs when symptoms of both stress and urge types of incontinence are present.
• Overflow incontinence refers to leakage that occurs when the quantity of urine produced exceeds the bladder’s holding capacity.
• Reflex incontinence , the loss of urine when the person is unaware of the need to urinate, may result from an abnormal opening between the bladder and another structure, or from a leak in the bladder, urethra or ureter.
• Incontinence from surgery follows such operations as hysterectomies, caesarean sections, prostatectomies, lower intestinal surgery, or rectal surgery.

Approximately 13 million Americans are incontinent; 85 percent of who are women. Incontinence is most common among the elderly. Fifty percent or more of elderly persons living at home or in long-term care facilities are incontinent. Sufferers may experience emotional as well as physical discomfort. Many people affected by loss of bladder or bowel control isolate themselves for fear of ridicule and lose self-esteem. Adults often find employment impossible.

Approximately 80 percent of those affected by urinary incontinence can be cured or improved. Diagnosis includes a medical history and a thorough physical examination. Tests such as X-rays, cystoscopic examinations, blood chemistries, urine analysis, and special tests to determine bladder capacity, sphincter condition, urethral pressure, and the amount of urine left in the bladder after voiding may be required.

Because incontinence is a symptom and not a disease, the method of treatment depends on diagnostic results. Sometimes simple changes in diet or the elimination of medications such as diuretics can cure incontinence. More frequently, treatment involves a combination of medicine, behavioral modification, pelvic muscle re-education, collection devices, and absorbent products.

Despite the high success rates in treating incontinence, only one out of every 12 people affected seeks help. The three major categories of treatment are: behavioral, pharmacological and surgical.

Behavioral techniques sometimes include the following:

• Scheduling Toileting - The caregiver prompts the incontinent patient to go to the bathroom every two to four hours. This puts the patient on a regular voiding schedule. The goal is simply to keep the patient dry and is a frequently recommended therapy for frail, elderly, bedridden or Alzheimer’s patients.
• Bladder Re-training - Bladder retraining involves scheduled toileting but the length of time between bathroom trips is gradually increased. This therapy trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge and mixed incontinence.
• Pelvic Muscle Rehabilitation - This technique involves pelvic muscle exercises (PME). PME may be used alone or in conjunction with biofeedback therapy, vaginal weight training, pelvic floor stimulation, and magnetic therapy.

Pharmacologic therapy (medications or drugs) is another common treatment for incontinence. Physicians can prescribe medications to help control incontinence, and sometimes they will take a person off a drug that is causing or contributing to incontinence. Of course, only your healthcare professional should tell you to stop using a drug he/she has prescribed.

Surgical treatment should be performed only after receiving a thorough diagnosis from a healthcare professional. All appropriate nonsurgical treatments should be tried before deciding on surgery. There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of your incontinence. Some of the more common procedures performed to treat urinary incontinence include: bladder neck suspension or sling procedures, periurethral bulking injections (collagen injections around the urethra), or implantation of an artificial urinary sphincter or sacral nerve stimulator. Your healthcare professional will thoroughly discuss any procedure you might need.

For those people whose incontinence cannot be cured or for those who are awaiting treatment, there are other devices or products to help manage incontinence. These include catheters, pelvic organ support devices, urethral inserts (plugs), external collection systems, penile compression devices, and absorbent products.

• National Institutes of Health, National Kidney and Urologic Diseases Information Clearinghouse
  http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/index.htm