Incontinence

Bladder control is a common yet complex problem that can seriously affect a person's life. Fortunately, with today's high-tech procedures and powerful drugs, a diagnosis may simply mean the road to bladder control is challenging, rather than impossible. The urinary tract is similar to a plumbing system, with special pipes that allow water and salts to flow through them. The urinary tract includes the kidneys, two ureters, the bladder and the urethra.

Urinary incontinence is the involuntary loss of urine. It is not a disease but rather a symptom that can be caused by a wide range of conditions, such as diabetes, a stroke, multiple sclerosis, Parkinson's disease, some surgeries or even childbirth. More than 15 million Americans, mostly women, suffer from incontinence. Although it is more common in women over 60, it can occur at any age. Most health-care professionals classify incontinence by its symptoms or the circumstances in which it occurs. In the normal population, 25 percent of women over age 65 experience incontinence, while only 15 percent of men do.

What are the various types of urinary incontinence?

Stress incontinence: Stress urinary incontinence is the most common type of leakage. This occurs when urine is lost during activities such as walking, aerobics or even sneezing and coughing. The added abdominal pressure associated with these events can cause urine to leak. The pelvic floor muscles, which support the bladder and urethra, can be weakened, thus preventing the sphincter muscles from working properly. This can also occur if the sphincter muscles themselves are weakened or damaged from previous childbirth or surgical trauma. Menopausal women can also suffer from small amounts of leakage as a result of decreased estrogen levels. In men, the most common cause of incontinence is surgery on the prostate. This is more frequent after radical prostatectomy for cancer than after transurethral surgery for BPH.

Urge incontinence: Also referred to as "overactive bladder," urge incontinence is another form of leakage. This can happen when a person has an uncontrollable urge to urinate but cannot reach the bathroom in time and has an accident. At other times, running water or cold weather can cause such an event. Some people have no warning and experience leakage just by changing body position (e.g., getting out of bed). Overactive bladder is also associated with strokes, multiple sclerosis and spinal cord injuries.

Overflow incontinence: This type of incontinence occurs when the bladder is full, is unable to empty and yet leaks. Frequent small urinations and constant dribbling are symptoms. This is rare in women and more common in men with a history of surgery or prostate problems.

Functional incontinence: This type of incontinence is the inability to access a proper facility or urinal container because of physical or mental disability.

Mixed incontinence: Mixed incontinence refers to a combination of types of incontinence, most commonly stress and urge incontinence.

How is the diagnosis made?

As with any medical problem, a good history and physical examination are critical. A urologist will first ask questions about your habits and fluid intake as well as your family, medical and surgical history. Your doctor will conduct a thorough pelvic examination, looking for correctable reasons for leakage, including impacted stool, constipation and hernias. At the first evaluation the urologist may also perform a urinalysis and cough stress test. If some findings suggest further evaluation, other tests may be recommended.

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