Diseases & Conditions
incontinence is the inability to control the release
of urine from your bladder.
Although common, urinary incontinence isn't
necessarily a normal part of aging or, in women, an
inevitable consequence of childbirth or changes
after menopause. It's a medical condition that can
have many different causes, some relatively simple
and temporary and others more involved and long
If you're having trouble with incontinence, don't
hesitate to see your doctor. In many cases,
incontinence can be eliminated. Even if it can't be
completely eliminated, modern products and ways of
managing urinary incontinence can ease your
discomfort and inconvenience.
Signs and symptoms
incontinence is the inability to control the release of urine from your
bladder. The problem has varying degrees of severity. Some people
experience only occasional, minor leaks or dribbles of urine. Others
wet their clothes frequently. For a few, incontinence means both urinary
and fecal incontinence the uncontrollable loss of stools.
incontinence is classified by your symptoms or the circumstances at the
time you leak urine. The five main types of urinary incontinence and
their characteristics are:
This is loss of urine when you exert pressure stress on your
bladder by coughing, sneezing, laughing, exercising or lifting
something heavy. It has nothing to do with psychological stress. The
problem is especially noticeable when you let your bladder get too
full. Stress incontinence is the most common type of incontinence,
often affecting women. Physical changes resulting from pregnancy,
childbirth and menopause can cause stress incontinence. In men,
removal of the prostate gland can lead to this type of incontinence.
This is a sudden, intense urge to urinate, followed by a loss of
urine. Your body may give you a warning of only a few seconds to a
minute to reach a toilet. With urge incontinence, you may need to
urinate often. The urge to urinate may even wake you up several
times a night. Some people with urge incontinence have a strong urge
to urinate when they hear water running or after they drink only a
small amount of liquid. Simply going from sitting to standing may
even cause you to leak urine. Urge incontinence may be caused by a
urinary tract infection or by anything that irritates the bladder.
It can also be caused by bowel problems or damage to the nervous
system associated with multiple sclerosis, Parkinson's disease,
Alzheimer's disease, stroke or injury. In urge incontinence, the
bladder is said to be "overactive" it's contracting even when your
bladder isn't full. In fact, urge incontinence is sometimes called
overactive bladder or irritable bladder.
If you frequently or constantly dribble urine, you may have overflow
incontinence. This is an inability to empty your bladder, so it
overflows uncontrollably and you leak urine. With overflow
incontinence, you may feel as if you never completely empty your
bladder or that you need to empty your bladder but can't. When you
try to urinate, you may produce only a weak stream of urine. This
type of incontinence is common in people with a weak bladder or
blocked urethra and in men with prostate gland problems. Nerve
damage from diabetes also can lead to overflow incontinence. Some
medications can cause or increase overflow incontinence.
This means having more than one type of incontinence, typically
stress incontinence and urge incontinence. Usually one type is more
bothersome than the other is. The cause of the two forms may or may
not be related.
Many older adults, especially those in nursing homes, experience
incontinence simply because a physical or mental impairment keeps
them from making it to the toilet in time. For example, a person
with severe arthritis may not be able to unbutton his or her pants
in a hurry. Someone with Alzheimer's disease may not think well
enough to plan a timely trip to the bathroom. This type of
incontinence is called functional incontinence.
You may hear other
terms to describe incontinence. Reflex incontinence occurs when people
with neurologic injury such as those with paralysis from a spinal cord
injury that affects nerves that run to the bladder experience urine
loss without any sensation or warning at all. An abnormal opening
(fistula) between the bladder and another structure or a leak in the
urinary system also may cause incontinence.
is a term that's sometimes used to describe continuous leaking of urine,
day and night, or periodic large volumes of urine and uncontrollable
leaking. Some people have this type of incontinence because they were
born with an anatomic defect. It can also be caused by a spinal cord
injury or by injury to the urinary system from surgery.
is the medical term for nighttime bed-wetting. Some children, mainly
boys, who are otherwise toilet-trained wet the bed at night for a
variety of reasons. Adults can lose control of their bladder at night,
too, possibly because of alcohol or medications. The aging bladder also
is more likely to have difficulty storing urine at night because of an
abnormally high production of urine during nighttime.
incontinence isn't a disease itself. It indicates some underlying
problem or condition that likely can and should be treated. A thorough
evaluation by your doctor can help determine what's behind your
Your urinary tract
collects, stores and eliminates urine from your body. When you eat and
drink, your body absorbs liquid. Excess fluid and liquid waste
accumulate in your bloodstream. Your kidneys a pair of bean-shaped
organs filter your blood, removing liquid waste to make urine.
Adult-sized kidneys eliminate about a quart and a half of urine each
From your kidneys,
urine travels down a pair of long tubes called ureters and empties into
your bladder a muscular, balloon-like sac that stores urine. Connected
to the bottom (neck) of your bladder is a short tube called the urethra.
Urine exits your body through the urethra. In women, the urethral
opening is located just above the vagina. In men, the urethral opening
is at the tip of the penis.
When you urinate,
several things happen. First the pelvic floor muscles relax, allowing
urine to pass out of your body easily. Then your bladder muscle (detrusor
muscle) contracts, pushing urine out of your bladder and through the
urethra. Between episodes of urination, your bladder muscle relaxes,
allowing urine to be stored in your bladder. At the same time, the
pelvic floor muscles lightly contract, holding in the urine and
supporting your bladder from underneath.
Nerves that run
from your spinal cord to your bladder coordinate the action of these
muscles. When you feel the urge to urinate, nerves in your bladder have
sent a signal to your brain that your bladder is full. Your brain is
responsible for keeping your bladder from contracting without your
permission. But certain neurologic conditions such as Alzheimer's or
stroke may impair the brain's ability to keep the bladder from firing
and causing leakage.
The bottom line is
that good bladder control isn't simple. You learn how to hold on until
you get to the bathroom as a child. But urination is a complex process
that involves relaxing part of the pelvis while contracting another
part. The many organs, tubes, muscles and nerves in your urinary system
must work together. If any part malfunctions, incontinence can result.
incontinence has many possible causes. Some causes are temporary and can
be managed with simple treatment. Examples include:
alcohol to excess.
Alcohol is a diuretic. It causes your bladder to fill quickly,
triggering an urgent and sometimes uncontrollable need to urinate.
In addition, alcohol can temporarily impair your ability to
recognize the need to urinate and act on that need in a timely
lot of fluid.
Drinking a lot of water or other beverages, particularly in a short
period of time, increases the amount of urine your bladder has to
deal with and may result in an occasional accident.
drinking enough fluid.
If you have urge incontinence, you may try to limit your fluids to
reduce the number of trips to the bathroom. However, if you don't
consume enough liquid to stay hydrated, your urine can occasionally
become overconcentrated. This collection of concentrated salts can
irritate your bladder and worsen your urge incontinence.
is a diuretic. It causes your bladder to fill more quickly than
usual so that you suddenly and perhaps uncontrollably need to
foods and beverages that irritate your bladder.
Carbonated drinks, tea and coffee with or without caffeine may
irritate your bladder and cause episodes of urge incontinence.
Citrus fruits and juices and artificial sweeteners also can be
sources of aggravation.
Sedatives, such as sleeping pills, can sometimes interfere with your
ability to control bladder function. Other medications including
water pills (diuretics), muscle relaxants and antidepressants can
cause or increase incontinence. Some high blood pressure drugs,
heart medications and cold medicines also can affect bladder
function. After surgery, some people experience temporary overflow
incontinence from the lingering effects of anesthesia.
This very common condition can cause bladder irritation and
ultimately incontinence. This infection involves your urinary tract,
usually your bladder in which case it's called a bladder infection
(cystitis). Germs from the outside enter your urethra and bladder,
then start to multiply. The resulting infection irritates your
bladder, causing you to experience strong urges to urinate. These
urges may result in episodes of incontinence, which may be your only
warning sign of a urinary tract infection. Other possible signs and
symptoms include a burning sensation when you urinate and
The rectum is located near the bladder and shares many of the same
nerves. Unmoved stools in your rectum cause these nerves to be
overactive, causing you to leak urine.
urinary incontinence is a persistent condition caused by some underlying
physical problem weakened muscles, nerve problems or an obstruction in
your urinary tract. Factors that can lead to chronic incontinence
may experience stress incontinence because of hormonal changes and
the increased weight of an enlarging uterus. In addition, the stress
of childbirth can weaken the pelvic floor muscles and the ring of
muscles that surrounds the urethra (urinary sphincter). The result
is often stress incontinence urine escapes past the weakened
muscles whenever pressure is placed on your bladder. The stress of
childbearing also can damage bladder nerves or lead to a dropped
(prolapsed) bladder a cystocele. With a cystocele, your bladder
gets pushed out of position and protrudes into your vagina. Signs
and symptoms include the feeling of a protrusion in your vagina and
often incontinence. Incontinence related to childbirth may develop
right after delivery or not until many years later.
changes following menopause.
After menopause, a woman's body produces less of the hormone
estrogen. This drop in estrogen can contribute to incontinence. In
women, estrogen helps keep the lining of the bladder and urethra
healthy. With less estrogen, these tissues lose some of their
ability to close meaning that your urethra can't hold back urine
as easily as before. Meanwhile, aging of the bladder muscle affects
both men and women, leading to a decrease in the bladder's capacity
to store urine.
In women, the bladder and uterus (womb) lie close to one another and
are supported by the same muscles and ligaments. Any surgery that
involves a woman's reproductive system for example, removal of the
uterus (hysterectomy) runs the risk of damaging muscles or nerves
of the urinary tract, which can lead to incontinence.
This inflammation of the bladder wall is a cause of painful and
frequent urination, and possibly incontinence. This chronic
condition usually affects women. Its cause isn't clear.
In rare cases,
this common condition in men can cause incontinence. Prostatitis is
inflammation of the prostate gland an organ about the size and
shape of a walnut located just below the bladder. The prostate,
which produces seminal fluid, actually surrounds the urethra. If it
becomes infected or inflamed, it can occasionally swell and
constrict the urethra. This can block normal urine flow, leading to
urinary urgency and frequency. Rarely, this also causes
In older men, incontinence often stems not from irritation but from
enlargement of the prostate gland, a condition also known as benign
prostatic hyperplasia (BPH). Around age 40 in men, the prostate
begins to enlarge slightly. As the gland enlarges, it can constrict
the urethra and block the flow of urine. For some men, this problem
results in urge or overflow incontinence.
In men, incontinence can be associated with untreated prostate
cancer. However, more often, incontinence is a side effect of
treatments (surgery or radiation) for prostate cancer.
Incontinence, urinary urgency and burning with urination can be
signs and symptoms of bladder cancer. Other signs and symptoms of
bladder cancer include blood in the urine and pelvic pain.
Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a
spinal cord injury can damage the nerves of your bladder, your
nervous system and muscles.
A tumor anywhere along your urinary tract can obstruct the normal
flow of urine and cause incontinence, usually overflow incontinence.
Urinary stones hard, stone-like masses that can form in the
bladder may be to blame for urine leakage.
Obesity is another
risk factor for incontinence, especially for women. Being overweight
puts constant and higher pressure on your bladder and surrounding
muscles, weakening them and allowing urine to leak out when you cough or
A chronic cough
can cause episodes of incontinence or aggravate incontinence with other
causes. Constant coughing puts stress on your urinary sphincter.
Longtime smokers often experience stress incontinence for this reason.
such as running, basketball or gymnastics can cause episodes of
incontinence in otherwise healthy women. These vigorous activities put
sudden, strong pressure on your bladder, allowing urine to leak past
your urinary sphincter. However, no data links high-impact sports to an
increased risk of chronic stress incontinence.
injury or disability that keeps you from getting to the toilet in time
also is a potential cause of incontinence.
urinary incontinence may have several causes. Children who wet the bed
at night may be slower to develop the brain control needed to allow
storage of urine all night. These children may also produce more urine
at night or their brains may lack the ability to recognize that the
bladder is overfilled when they're asleep. Most children naturally
outgrow nighttime incontinence. Children who experience daytime
incontinence should undergo evaluation as they may have a urinary tract
infection or a developmental abnormality. Some children simply may hold
their urine longer than they should.
With so many
possible causes, it's not surprising that incontinence is common.
Women are twice as
likely as men are to have incontinence. Pregnancy and childbirth,
menopause, and the structure of the female anatomy account for this
difference. Men with prostate gland problems are at increased risk of
incontinence. Bed-wetting in children can run in families.
Age is a risk
factor for loss of bladder control. As you get older, the muscles in
your bladder and urethra lose some of their strength. Changes with age
reduce how much your bladder can hold. However, that doesn't mean that
you'll have incontinence just because you're getting older. Incontinence
isn't normal at any age except during infancy.
Other risk factors
for incontinence include kidney disease, obesity, diabetes, smoking and
the use of certain medications.
When to seek
You may feel
uncomfortable discussing incontinence with your doctor. But seeking
medical advice for incontinence is important for several reasons.
incontinence may indicate a more serious underlying condition, such as
cancer or a nerve disorder. Second, incontinence may be causing you to
restrict your activities and limit your social interactions to avoid
embarrassment. In addition, urinary incontinence may increase the risk
of falls in older adults as they rush to make it to the bathroom.
A few isolated
incidents of incontinence don't necessarily require medical attention.
But if incontinence is frequent or affecting your quality of life, talk
to your doctor.
The first step in
diagnosing urinary incontinence is to see your doctor for a complete
Your doctor will
ask about your symptoms and medical history. How often do you need to
urinate? When do you leak urine? Do you have trouble emptying your
bladder? Are you experiencing any symptoms in addition to incontinence?
Your answers to these questions will help your doctor determine what
type of incontinence you have.
physical examination, focusing on your abdomen and genitals also may
give clues to your incontinence. Your doctor will look for reasons for
your incontinence, such as a urinary tract infection, mass, hernia or
compacted stool. If the reason for your incontinence is harder to find,
your doctor may want to do some tests. These include:
Your doctor may go over a bladder diary that he or she has asked you
to complete at home over several days. You simply record how much
you drink, when you urinate, the amount of urine you produce,
whether you had an urge to urinate and the number of incontinence
episodes. To measure your urine, your doctor may give you a pan that
fits over your toilet rim. The pan has markings like a measuring
A sample of your urine is sent to a laboratory, where its checked
for signs of infection, traces of blood or other abnormalities. For
the sample to be collected, you're asked to urinate into a
container. A urine culture is a lab test that specifically checks
for signs of infection in your urine. A urine cytology involves a
check of your urine for cancer cells.
Your doctor may have a sample of your blood drawn and sent to a
laboratory for analysis. Your blood is checked for various chemicals
and substances related to causes of incontinence.
If further testing
is needed, you'll likely be referred to a doctor who specializes in
urinary disorders in men and women (urologist). Women might also be
referred to a doctor who focuses on urologic problems in women (urogynecologist).
At the specialist's office, you may undergo additional testing such as:
residual (PVR) measurement.
This test helps your doctor determine whether you have difficulty
emptying your bladder. For the procedure, you're asked to urinate
(void) into a funnel-like container that allows your doctor to
measure your urine output. Then your doctor checks the amount of
residual urine in your bladder using a catheter a thin, soft tube
that's inserted into your urethra and bladder to drain any remaining
urine or an ultrasound device. For the ultrasound test, a
wand-like device is placed over your abdomen. The device sends sound
waves through your pelvic area. A computer transforms these sound
waves into an image of your bladder, so your doctor can see how full
or empty it is. A large amount of leftover (residual) urine in your
bladder may mean that you have an obstruction in your urinary tract
or a problem with your bladder nerves or muscles.
Ultrasound also may be used to view other parts of your urinary
tract or genitals to check for abnormalities.
For this test, you're asked to cough vigorously or bear down as your
doctor examines you and watches for loss of urine.
These are tests that measure pressure in your bladder both at rest
and when filling. A doctor or nurse inserts a catheter into your
urethra and bladder. The catheter is used to fill your bladder with
water. As your bladder fills, pressure within your bladder is
recorded. Normally, pressure increases by only very small amounts
during filling. However, in some people with incontinence, the
bladder goes into spasms as it fills. This test also helps your
doctor measure the strength of your bladder muscle.
In this special X-ray of your bladder, a catheter is inserted into
your urethra and bladder. Through the catheter, your doctor injects
a fluid containing a special dye. As you urinate this fluid back out
of your body, images show up on a series of X-rays. These images
help reveal problems with your urinary tract.
In this procedure, a thin tube with a tiny lens (cystoscope) that
allows your doctor to see the inside of your urethra and bladder is
inserted into your urethra. With the aid of this device, your doctor
can check for and potentially remove abnormalities in your
urinary tract, such as bladder stones.
incontinence can cause rashes, skin infections and sores from constantly
wet skin. Incontinence can also contribute to repeat urinary tract
infections. But more distressing than these physical problems may be the
effect incontinence can have on your quality of life.
incontinence may keep you from participating in activities. You may stop
exercising, quit attending social gatherings or even refrain from
laughing because you're afraid of an accident. You may even reach a
point where you stop traveling or venturing out of familiar areas where
you know the locations of toilets.
incontinence may negatively affect your work life. Your urge to urinate
may keep you away from your desk or cause you to have to get up often
during meetings. The problem may be so distressing that it disrupts your
concentration at work. Urinary incontinence may also keep you up at
night, so you're tired most of the time.
distressing is the impact incontinence can have on your personal life.
Your family may not understand changes in your behavior or may grow
frustrated at your many trips to the bathroom. You may avoid sexual
intimacy because of embarrassment caused by urine leakage. It's not
uncommon to experience anxiety and depression along with incontinence.
urinary incontinence depends on the type of incontinence, the severity
of your problem and the underlying cause. Your doctor will recommend the
approaches that are best suited to your condition. Often a combination
of treatments is used. Most people treated for urinary incontinence see
a dramatic improvement in their symptoms.
for urinary incontinence fall into four broad categories behavioral
techniques, medications, devices and surgery.
Behavioral techniques and lifestyle changes work well for certain types
of urinary incontinence. They may be the only treatment you need.
may also involve double voiding urinating, then waiting a few minutes
and trying again. This exercise can help you learn to empty your bladder
more completely to avoid incontinence. In addition, bladder training may
involve learning to control urges to urinate. When you feel the urge to
urinate, you're instructed to relax breathe slowly and deeply or to
distract yourself with an activity.
training may be reinforced with devices such as moisture alarms, which
wake you up when you begin to urinate. They are particularly helpful for
children who wet the bed at night. The devices consist of a
fluid-sensitive pad worn in pajamas, a wire connecting to a control, and
an alarm that sounds or vibrates when moisture is first detected.
Moisture alarms help children learn to awaken when their bladder is
full, in time to go to the bathroom.
This means timed urination going to the bathroom according to the
clock rather than waiting for the need to go. Following this
technique, you go to the toilet on a routine, planned basis, usually
every two to four hours.
floor muscle exercises.
These exercises strengthen your urinary sphincter and pelvic floor
muscles the muscles that help control urination. Your doctor may
recommend that you do these exercises three or four times a day to
treat your incontinence. They are especially effective for stress
incontinence, but may also help urge incontinence.
To do pelvic floor
muscle exercises (Kegels), imagine that you're trying to stop from
passing gas. Squeeze the muscles you would use and hold for a count of
three. Relax, count to three again, then repeat. You can do these
exercises almost anywhere while you're driving, watching television or
sitting at your desk at work.
With Kegels, it
can be difficult to know whether you're contracting the right muscles.
In general, if you sense a pulling feeling when you squeeze, you're
using the right muscles. Men may feel their penis pull in slightly
toward their body. To double-check that you're contracting the right
muscles, try the exercises in front of a mirror. Your abdominal, buttock
or leg muscles shouldn't tighten if you're isolating the muscles of the
pelvic floor. You can also test yourself by trying to stop your urine
midstream, although most people with incontinence can't stop their urine
midstream, so don't lose hope if you can't. Another way to be sure
you're doing Kegels correctly is a simple finger test. Place a finger in
your anus or vagina (for women). Then squeeze around your finger. The
muscles you contract are your pelvic floor muscles.
If you're still
not sure whether you're contracting the right muscles, you can ask your
doctor for help. Your doctor can refer you to a physical therapist for
biofeedback techniques that will help you identify and contract the
months of doing pelvic floor muscle exercises correctly, you should
notice improvement in your urinary control. To further strengthen their
urinary and pelvic floor muscles, women can use "vaginal weights." These
are tampon-shaped cones of increasing weight that women can insert into
their vaginas and try to hold in place.
In this procedure, electrodes are temporarily inserted into your
rectum or vagina to stimulate and strengthen pelvic floor muscles.
Gentle electrical stimulation can be effective for stress
incontinence and urge incontinence, but it takes several months and
multiple treatments to work.
In some cases, you can simply modify your daily habits to regain
control of your bladder. You may need to cut back on or avoid
alcohol or caffeine, if either cause you incontinence. If acidic
foods irritate your bladder, cutting back on such triggers may rid
you of your problem. For some people, reducing liquid consumption
before bedtime is all that's needed. Losing weight also may
eliminate the problem.
For stress incontinence, contracting your urinary muscles to hold
urine in or crossing your legs at certain times such as when you
feel a sneeze coming may help significantly.
times, urinary incontinence can be corrected with the help of
medication. Drugs commonly used to treat incontinence include:
Anticholinergic (antispasmodic) drugs.
These prescription medications calm an overactive bladder, so they
may be helpful for urge incontinence. Examples include tolterodine (Detrol),
oxybutynin (Ditropan) and hyoscyamine (Levsin). These drugs can be
very effective at controlling incontinence, but a side effect is dry
mouth. To combat dry mouth, you may be tempted to drink more water.
But that may not help your incontinence. Your doctor may recommend
that you suck on a piece of candy or chew gum instead to produce
This antidepressant may be used to treat incontinence. It causes the
bladder muscle to relax, while causing the smooth muscles at the
bladder neck to contract.
In the past, some doctors recommended medications that contain
pseudoephedrine (Dimetapp, Sudafed) to treat mild to moderate stress
incontinence. These cold medications slightly tighten the urinary
sphincter. However, these products can cause dangerous, rapid
heartbeats, so they're no longer used for incontinence.
After menopause, a woman's body produces less of the hormone
estrogen. This drop in estrogen can contribute to changes in the
skin lining the urethra and vagina, which can contribute to the
development of incontinence in some women. Applying estrogen in the
form of a vaginal cream, ring or patch may help relieve some of the
symptoms of incontinence in these women. Oral estrogen may not have
the same benefits as topical creams and ointments. Taking HRT as a
combination therapy estrogen plus progestin can result in
serious side effects and health risks. Work with your doctor to
evaluate the options and decide what's best for you.
nighttime incontinence may be due to a shortage of the nighttime
production of a hormone called antidiuretic hormone (ADH). This hormone
slows the making of urine. The body normally produces more ADH at night,
so the need to urinate is lower. If a child doesn't produce enough ADH
at night, the making of urine doesn't slow down and the bladder
overfills. If the child doesn't sense the bladder filling and awaken to
urinate, he or she wets the bed. A synthetic version of ADH known as
desmopressin (DDAVP) is available as a nasal spray or pill for children
to use before bedtime.
If your incontinence is due to a urinary tract infection or an
inflamed prostate gland (prostatitis), your doctor can successfully
treat the problem with antibiotics.
Your doctor may prescribe drugs that actually relax your urinary
sphincter or make your bladder contract more, depending on the
underlying cause of your incontinence.
If you're a man
with incontinence caused by an enlarged prostate gland, your doctor may
prescribe medications or other therapies to treat your condition. The
goal may be to relax muscles around your urethra so that you can urinate
with more control or to shrink the size of your prostate.
Drugs can be
effective at treating urinary incontinence. But they may have side
effects. Ask your doctor about what to expect from a treatment.
If a medication
you're taking such as a sedative is the cause of incontinence, your
doctor may lower the dosage or change the medication to relieve that
medical devices are available to help treat incontinence. They're
designed specifically for women and include:
These are small, tampon-like disposable devices or plugs that a
woman inserts into her urethra the tube where urine exits the body
to prevent urine from leaking out. Urethral inserts aren't for
everyday use. They work best for women who have predictable
incontinence during certain activities, such as while playing
tennis. The device is inserted before the activity. Whenever the
woman needs to urinate, she simply removes the device. Urethral
inserts are available by prescription.
Your doctor may prescribe a pessary a stiff ring that you insert
into your vagina and wear all day. The device helps hold up your
bladder, which lies near the vagina, to prevent urine leakage. You
need to regularly remove the device to clean it. You may benefit
from a pessary if you have incontinence due to a dropped (prolapsed)
bladder or uterus.
other treatments aren't working, there are nearly 100 variations of
surgical procedures used to fix problems that cause urinary
incontinence. In men, surgery may be necessary to remove an enlarged
prostate gland that's constricting the urethra. Surgical removal of a
tumor in the bladder or a uterine fibroid also may eliminate
If your bladder or
uterus has slipped out of position, a surgeon can put the structure back
in place with a variety of techniques. Rarely, surgery to treat urinary
incontinence may involve enlarging the bladder or correcting a birth
defect. Or surgery may be needed to bolster weakened urinary sphincter
Some of the more
common procedures include:
This small device is particularly helpful for men who have weakened
urinary sphincters from treatment of prostate cancer or an enlarged
prostate gland, and it's rarely used for women with stress
incontinence. Shaped like a doughnut, the device is implanted around
the neck of your bladder. The fluid-filled ring keeps your urinary
sphincter shut tight until you're ready to urinate. To urinate, you
press a valve implanted under your skin that causes the ring to
deflate and allows urine from your bladder to be released. This
surgery can cure or greatly improve incontinence in more than 70
percent to 80 percent of men with incontinence. Complications
include malfunction of the device which means the surgery will
need to be repeated and infection, but infection is uncommon.
Some women with stress incontinence benefit from urethral injections
of bulking agents. This procedure involves injecting bulking
materials usually animal or human collagen into the tissue
surrounding the urethra or the skin next to the urinary sphincter.
The injection tightens the seal of the sphincter by bulking up the
surrounding tissue. The procedure is done with minimal anesthesia
and typically takes about two to three minutes. It usually needs to
be repeated every six to 18 months, because the bulking agents that
are currently available don't remain effective over time. There is a
risk of rejection or infection, and the procedure is generally not
as effective as open surgery.
This small device acts on nerves that control bladder and pelvic
floor contractions. The device, which resembles a pacemaker, is
implanted under the skin in your abdomen. A wire from the device is
connected to a sacral nerve an important nerve in bladder control
that runs from your lower spinal cord to your bladder. Through the
wire, the device emits electrical pulses that stimulate the nerve
and help control the bladder. The pulse doesn't cause pain and may
improve or cure 50 percent to 75 percent of people with
tough-to-treat urge incontinence or urinary retention leading to
overflow incontinence. Possible complications include infection, but
the device can be removed.
The most popular surgery for women with stress incontinence is the
sling procedure. During this procedure, a surgeon removes a strip of
abdominal tissue and places it under the urethra. Or the surgeon may
use a strip of synthetic material or a strip of tissue from a donor or cadaver. These strips act like a hammock, compressing
the urethra to prevent leaks that occur with the activities of daily
The success of
your treatment depends on the right diagnosis. Talk to your doctor about
the specifics and possible complications of any treatment. Ask questions
and express concerns to help find out which treatment is right for you.
Absorbent pads and
medical treatments can't completely eliminate your incontinence or you
need help until a treatment starts to take effect you can try products
that help ease the discomfort and inconvenience of leaking urine.
pads are available to help you manage urine loss. Most products are no
more bulky than normal underwear and can be worn easily under everyday
clothing. Men who have problems with dribbles of urine can use a drip
collector a small pocket of absorbent padding that's worn over the
penis and held in place by closefitting underwear. Men and women can
wear panty liners or pads in their underwear to collect urine. Adult
diapers are available in both disposable and reusable forms and come in
a variety of sizes. Some people find wearing plastic underwear over
their regular underwear helps keep them dry. Others opt for washable
underwear and briefs with waterproof panels. Incontinence products can
be purchased at drugstores, supermarkets and medical supply stores.
incontinent because your bladder doesn't empty properly, your doctor may
recommend that you learn to insert a soft tube (catheter) into your
urethra several times a day to drain your bladder. This may give you
more control, especially if you suffer from overflow incontinence.
In some cases
people have to keep a catheter in constantly. The catheter is connected
to an external bag to hold urine. As needed, the bag is emptied.
or may not be something you can prevent. Oftentimes the cause of
incontinence is out of your control.
However, you may
be able to decrease your risk of urinary incontinence by taking good
care of yourself and keeping or getting your weight under control.
Because pregnancy and childbirth can weaken the urinary sphincter and
pelvic floor muscles, doctors may advise pregnant women to do Kegel
exercises during pregnancy as a preventive step.
limiting certain foods and drinks may help prevent incontinence. For
example, if you know that drinking more than two cups of coffee makes
you have to urinate uncontrollably, cutting back to one cup of coffee or
forgoing caffeine may be all that you need to do.
fiber in your diet or taking fiber supplements can help prevent
constipation, which can be a cause of incontinence. Your doctor may
recommend that you drink more or less water as a preventive measure,
depending on your bladder problem.
urine leakage may require you to take extra care to keep your skin clean
and dry. You may need to use a washcloth to clean and dry yourself.
Products such as powders, moisturizers and deodorizing tablets are
available that can help you feel clean and eliminate urine odor.
People cope with
urinary incontinence in a variety of ways. Some people choose to wear
absorbent pads and never mention the problem to anyone. Perhaps you cope
by always carrying an extra set of clothes with you, in case of an
accident. Or you manage by staying at home or only going to places that
have easily accessible toilets. You may even cut back on drinking
liquids and risk dehydration to avoid wetting episodes.
But there are
better ways to manage urinary incontinence, and new treatments for
incontinence are continually being discovered. That's why it's important
to see your doctor.
Many people feel
embarrassed about incontinence. But it's a common problem. And
fortunately, the stigma surrounding this condition is slowly eroding.
Many people are discussing it with more openness. Pharmaceutical
companies are now advertising medications for overactive bladder on
television, increasing awareness of the problem.
Talk to your
doctor about treatments for incontinence. You'll be on your way to
regaining an active and confident life and control of your bladder.
of bladder control
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