Although urinary incontinence can occur in both men and women of any age, it is more common in women and older people, affecting about 30% of older women and 15% of older men. Incontinence is more common among older people, but incontinence is not a common factor in aging. It can be sudden and temporary, such as when you are taking a drug that has a diuretic effect, or it can be long-lasting (chronic). Even chronic incontinence can sometimes be relieved.
Types of incontinence
There are several types of incontinence.
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urge incontinence
Uncontrollable numbness (moderate to massive) that occurs immediately after you feel an urgent, uncontrollable urge to urinate. Waking up to urinate at night (nocturia) and nocturnal incontinence are common.
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stress incontinence
Numbness in the urine caused by a sudden increase in pressure in the abdomen (for example, when coughing, sneezing, smiling, bending over or lifting objects). The tingling of urine is usually low to moderate.
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overflow incontinence
Retention of urine from an overfilled bladder. The amount is usually small, but the numbness is constant and can result in massive numbness when viewed as a whole.
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functional incontinence
A numbness in the urine that results from a thought or physical disturbance that is not related to urination control. For example, a person with dementia because of Alzheimer’s disease may not be able to notice the urge to urinate or not know where the toilet is. People who sleep in bed may not be able to go to the bathroom or reach the toilet.
However, often one person has more than one incontinence. These are called people with complex incontinence.
cause
Several mechanisms can lead to incontinence. Often there is more than one mechanism.
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Weakness of the urethral sphincter or pelvic muscles (called bladder outlet insufficiency)
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Factors that block the exit pathway for urine to exit the bladder (called bladder outlet obstruction)
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Spasm or overactivity of the muscles in the bladder wall (sometimes called overactive bladder)
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Weakness or under-activity of the bladder wall muscles
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Poor coordination between bladder wall muscle and urethral sphincter
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increased urine output
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functional problem
Weakness or underactivity of the bladder wall muscles, obstruction of the bladder outlet, or especially both, can lead to inability to urinate (urine retention). Urine retention can paradoxically lead to overflow incontinence because urine leaks from an overfilled bladder.
Increased urine output (due to diabetes, use of diuretics, or consumption of excessive alcohol and caffeinated beverages, for example) can increase the amount of urine leaking and can trigger episodes of incontinence, or even temporary incontinence. However, this does not result in chronic incontinence. Functional problems increase the amount of urine lost, usually among people with incontinence. However, functional problems are rarely the only cause of permanent incontinence.
Overall, the most common causes of incontinence are:
- Weakness of the pelvic muscles in women due to childbirth
- Bladder outlet obstruction in middle-aged men
evaluation
Urinary incontinence is not usually a life-threatening condition. However, incontinence can also contribute to poor quality of life by causing embarrassment or unnecessarily restricting people’s activities. Also, although rare, sudden incontinence may be a symptom of a spinal cord disorder. The following information can help people decide when they need an evaluation from a doctor and help them know what to expect during the evaluation.
warning signs
In people with incontinence, certain symptoms and characteristics are the cause of anxiety. These include:
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Signs of a spinal injury (for example, weakness in leg strength or loss of sensation in the legs or around the groin or anus)
If you need to see a doctor
Anyone with warning signs should go to the emergency room immediately. People without warning signs should see a doctor. Doctors decide how soon to see a doctor based on other symptoms and other known abnormalities. Usually, a delay of a week or so is not harmful if incontinence is the only symptom.
Most people find it embarrassing to tell their doctor about incontinence. Some believe that incontinence is a natural aging process. However, even incontinence that has been around for a while or is present in the elderly can be helped by treatment. You should see a doctor if your incontinence symptoms are bothersome and interfere with your daily activities or limit your social activities.
what doctors do
Doctors first ask questions about the person’s symptoms and medical history. After that, a physical examination is done. Things found during a history listening and physical exam often suggest a cause of incontinence and the tests that need to be done.
Doctors ask about numbness in the urine, including the amount of urine, time of day, and triggers (such as coughing, sneezing, or straining). Ask if you can feel the urge to urinate, and if you can, is the sensation normal or sudden and urgent? You may be asked to estimate your urine output. They may also ask you if you have additional problems with urination, such as pain or burning while urinating, frequent urination, difficulty starting urination, or a weak stream of urine.
Doctors ask about numbness in the urine, including the amount of urine, time of day, and triggers (such as coughing, sneezing, or straining). Ask if you can feel the urge to urinate, and if you can, is the sensation normal or sudden and urgent? You may be asked to estimate your urine output. They may also ask you if you have additional problems with urination, such as pain or burning while urinating, frequent urination, difficulty starting urination, or a weak stream of urine.
Ask if they have other conditions known to cause incontinence, such as dementia, stroke, urolithiasis, spinal cord or other neurological diseases, and prostate disease. Some medications cause or contribute to incontinence, so you need to know which medications you are taking. Ask the woman about the number and type of deliveries and complications. Ask everyone if they have had any previous pelvic and abdominal surgeries, especially prostate surgeries for men.
A physical examination can help doctors narrow down possible causes. Doctors examine the strength, sensation, and reflexes of the legs, as well as sensation in the groin and around the anus, to look for nerve and muscle problems that can make it difficult to remain incontinence-free.
In women, doctors look for abnormalities that can cause incontinence, such as vaginal contractions (menopausal changes that can cause the lining of the vagina to thin and dry, lose elasticity and accompany changes in the urinary tract) or pelvic muscle weakness. Do a pelvic examination. Both men and women do a rectal examination to look for signs of constipation or nerve damage that leads to the rectum. In men, a rectal examination can be done to confirm the prostate, as an enlarged prostate or sometimes prostate cancer can contribute to incontinence. Check for stress incontinence by coughing with a full bladder. In women, doctors repeat this procedure during a pelvic exam to see if some of the pelvic support structures can remove the tingling in the urine (with a finger).
test
Often findings during the physical examination can help doctors determine the cause or factors contributing to incontinence. However, some tests are often needed to make a diagnosis. Routine tests include:
- Urinalysis and urine culture
- A blood test for renal function and sometimes other tests
- Residual urine volume after urination (A catheter or ultrasonography probe is used to determine how much urine is left in the bladder after urination.)
- Sometimes urodynamic tests
The urodynamic examination includes bladder manometry, urine flow rate test, and bladder manometry, and if the cause of urinary incontinence is not revealed by clinical evaluation and the above tests, the urodynamic examination is performed.
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Cystometry is done to check for urge incontinence and to determine if the cause is an overactive bladder. A bladder catheter is inserted through the urethra. Doctors measure how much water can be poured into the bladder until a person has an urge to urinate or until the bladder contracts.
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In men, peak urine flow is measured to determine if bladder outlet obstruction (usually due to prostate disease) is the cause of incontinence. Men urinate on a special device that measures the rate of urine flow and the amount of urine excreted (urometer).
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If other evaluations do not reveal the cause of incontinence, cystometry is done. Bladder manometry is a test that measures bladder pressure when the amount of water in the bladder varies. In addition to electromyography, a test that can evaluate sphincter function, intravesical pressure is often measured. Some centers with special equipment may measure bladder contractility simultaneously with urethral sphincter and other bladder pressures.
Although urodynamic tests are important, their results do not always predict drug treatment response or assess the relative importance of various causes.
Cure
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Treatment of specific causes
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Sometimes drugs to treat some types of incontinence
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Common measures to reduce the discomfort of incontinence
The specific cause of incontinence is often treatable. There are also general measures that can be suggested to everyone to reduce the discomfort of incontinence.
If a drug is causing the problem, doctors may change to a different drug or change the dosing schedule to relieve symptoms (for example, they may change the timing of diuretics so that a bathroom is nearby when the drug takes effect) . However, you should talk to your doctor before you stop taking the drug or change your dose or dosing schedule.
Drugs are often useful for certain types of incontinence, but they should be used as complementary therapy rather than a replacement for common measures. Drugs include drugs that relax the bladder wall muscles and drugs that increase urinary sphincter tone. Drugs that relax the urethral sphincter may be used to treat bladder outlet obstruction in men with urge incontinence or overflow incontinence.
common way
Usually, regardless of the type and cause of incontinence, some general measures are helpful.
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change water intake
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bladder training
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pelvic muscle exercise
You can limit hydration to specific times of the day (for example, before going out or 3 to 4 hours before going to bed). Your doctor may advise you to avoid beverages that irritate the bladder (such as caffeinated beverages). However, concentrated urine irritates the bladder, so you should drink 48 to 64 ounces (1500 to 2000 mL) of water per day.
Bladder training is a technique in which you follow a fixed urination schedule while you are awake. Doctors work with people to urinate every two to three hours and schedule them to suppress the urge to urinate at other times (for example, by relaxing or breathing deeply). Gradually increase the interval as the urge to urinate becomes better controlled. People caring for people with dementia or other cognitive problems may use a similar technique called urination stimulation. For this technique, you are asked if you need to urinate and whether you should urinate at a specific time.
Pelvic muscle exercises (Kegel exercises) are often especially effective for stress incontinence. Be sure to exercise the right muscles, those around the urethra and rectum that block the flow of urine. Tighten these muscles for 1-2 seconds, then relax them for about 10 seconds. Repeat this exercise 3 times a day, about 10 times. You can increase the amount of time you tighten the muscles little by little until you can hold the contraction for about 10 seconds for each rep. Because it can be difficult to learn how to control the right muscles, your doctor may need to give you guidance or recommend using biofeedback or electrical stimulation (an electronic version of a pelvic floor exercise that uses electrical current to stimulate the right muscles).
Urge incontinence
The purpose is to relax the bladder wall muscles. Try bladder training, Kegel exercises, and relaxation techniques first. Biofeedback can also be tried. When you feel an urgent need to urinate, you may try relaxing, standing, sitting, or tightening your pelvic muscles. The most commonly used drugs are oxybutynin and tolterodine. Oxybutynin is available in pills as well as skin patches or skin gels. Newer drugs include Mirabegron, Fesoterodine, Solifenacin, Darifenacin, and Trospium.
If other treatments for urge incontinence do not work, additional treatments may be tried, such as a pacemaker-like device, gently electrical stimulation of the sacral nerve (if the cause is a spinal or brain injury), injecting chemicals into the bladder, or, rarely, surgery.
Stress incontinence
Treatment usually begins with bladder training and Kegel exercises. Avoiding physical stresses that cause numbness in the urine (such as lifting heavy objects) and losing weight can help control incontinence. Pseudoepinephrine may be useful for women with bladder outlet insufficiency. If stress incontinence and urgency incontinence coexist, or for each, imipramine may be used separately. Duloxetine is also used for stress incontinence. If atrophic urethritis or vaginitis is the cause of stress incontinence, estrogen creams often work. For people with stress incontinence, it is often helpful to urinate frequently to empty a full bladder.
For stress incontinence that is not relieved by medications or behavioral measures, surgery or devices such as Pessari may help. Vaginal Suspension Retraction creates support that helps keep the urethra from opening when coughing, sneezing, or laughing. Most often, the sling is made of synthetic mesh. Although mesh implants are effective, severe complications occur in a small number of people who have mesh implants. A doctor may also make a hook using tissue from the abdominal wall or leg. In men with stress incontinence, a mesh hook or artificial urinary sphincter implant may be placed around the urethra to prevent numbness in the urine.
Overflow incontinence
Treatment depends on whether the cause is obstruction of the bladder outlet, weak bladder wall muscles, or both. For overflow incontinence due to obstruction of the bladder outlet, certain treatments may help relieve the blockage (such as prostate surgery or drugs for prostate disease, bladder prolapse surgery, and urethral stricture dilatation or stenting).
For overflow incontinence due to weak bladder wall muscles, treatment consists of intermittently inserting a catheter into the bladder to reduce urine output, or, in rare cases, inserting a catheter and leaving it in the bladder. The goal is to reduce the size of the bladder to regain some of the bladder wall volumes so that urine does not overflow. Other measures can help empty the bladder after urination. These include urinating again after urination is complete (called double voiding), exerting effort after urination, and/or applying pressure to the lower abdomen towards the end of urination. Sometimes electrical stimulation can be used to help empty the bladder more completely.
Essential Information for Seniors: Incontinence
Incontinence is more common among older people, but incontinence is not a common factor in aging.
As the bladder capacity decreases with age and the ability to delay urination decreases, involuntary bladder contractions are more common, and bladder contractions become weaker. This makes it more difficult to delay urination and tends to leave residual urine. The pelvic muscles, ligaments, and connective tissue weaken, contributing to incontinence. In postmenopausal women, estrogen levels drop, resulting in atrophic urethritis and atrophic vaginitis, and urethral sphincter weakness. In men, the prostate enlarges, partially blocking the urethra, incomplete urination, and straining the bladder muscles. This change is normal and occurs in many older people who do not incontinence, and it promotes but does not cause incontinence.
Incontinence significantly reduces quality of life, leading to feelings of embarrassment, isolation and depression. Incontinence is often the reason older people need to be looked after in a long-term care facility. Urine irritates the skin and contributes to bedsores in people who live in beds or chairs. Older people with urge incontinence are at higher risk of falling or fractures while rushing to the bathroom.
The most effective medications for many types of incontinence have anticholinergic effects. The effects of these drugs, such as constipation, dry mouth, blurred vision, and sometimes even confusion, can be a troubling problem, especially for older people.
