Definition

Urinary incontinence is a problem with the control of urine as it flows out of the body. It may cause rare, minor leaks or more severe wetting. There are different type of urinary incontinence including:

• Stress incontinence—urine leaks out when you are active and when you cough, sneeze, or laugh
• Urge incontinence (overactive bladder)—the muscle of the bladder squeezes when it shouldn't and lets urine leak
• Overflow incontinence—bladder does not empty properly; urine builds up in the bladder and overflows
• Functional incontinence—the bladder is normal, but you are unable to reach the toilet in time

Causes

There are several different causes for incontinence. In some cases, the cause may be unclear.

Causes can also vary by the type of incontinence:

• Stress Incontinence may be caused by:
  • Weakening of the muscles that hold the bladder in place
  • Weakening of the muscles that control the flow of urine
  • Damage to the muscles that control urine flow after prostate surgery
  • Obesity
• Urge Incontinence may be caused by:
  • Urinary tract infection
  • Diabetes type 1 and type 2
  • Bladder irritation such as a kidney stone or tumor
  • Drugs, such as hypnotics or diuretics
  • Caffeine
  • Alcohol
  • Nerve damage due to:
    • Spinal cord injury
    • Stroke
    • Multiple sclerosis
    • Parkinson disease
  • Constipation
• Overflow Incontinence may be caused by:
  • Prostate enlargement
  • Bladder that is blocked, such as by a scar in the urethra (stricture)
  • Fecal impaction putting pressure on the urethra
  • Drugs, such as antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, and calcium channel blockers
  • Vitamin B12 deficiency
  • Weak bladder muscles
  • Nerve damage
• Functional Incontinence may be caused by:
  • Conditions like severe arthritis that make movement difficult
  • Drugs that cause confusion or sedation

Risk Factors

Men who are older than 65 are most affected.

Factors that may increase your risk of incontinence include:

• History of prostate surgery
• Prostate enlargement due to benign prostatic hyperplasia (BPH), infection, or prostate cancer
• Urinary tract infection
• Obesity
• Chronic lung disease
• Urethritis
• Depression
• Dementia, including Alzheimer disease
• Diabetes
• Stroke
• Multiple sclerosis
• Spinal cord injury or disease
• Use of certain substances or medications:
  • Caffeine
  • Alcohol
  • Beta-blockers
  • Alpha-agonists
  • Cholinergic agents
  • Cyclophosphamide

Symptoms

Incontinence is any loss of bladder control. Examples include:

• Leakage during laughing, sneezing, lifting heavy object, or any other activity that increases pressure on bladder (stress incontinence)
• Leakage plus strong urge to urinate (urge incontinence)
• Difficulty holding urine long enough to make it to bathroom

Diagnosis

You will be asked about your symptoms and medical history. The doctor will ask about your urine leakage and how often you empty your bladder. A physical exam will be done to look for some causes such as blockages or nerve problems.

If the cause is not clear in first exam you may be asked to to keep a diary of your urinary habits. A specialist may also be needed. Urologists are doctors who focus on urinary issues.

Tests to help find the cause of the incontinence may include:

• Stress test—you relax, and then cough as your doctor watches for loss of urine (this will confirm if you have stress incontinence)
• Urine tests
• Tests to explore problems with your prostate, such as a prostate exam or blood tests
• Blood tests to detect diabetes
• Ultrasound—can show if any urine remains in your bladder after urinating
• Cystoscopy —a thin tube with a tiny camera is passed into the bladder through the urethra (tube that carries urine out of the body); it can show any problems with the urethra or bladder
• Urodynamic tests—measures the flow of urine and the pressure in the bladder

Treatment

Treating the cause may help to stop or decrease incontinence. If the cause cannot be changed, there are steps to help deal with leakage. Options include:

Devices

Tools that may help include:

• Absorbent diapers or briefs are often used by men with mild incontinence.
• A catheter is a small tube that collects urine leaving the body and stores it into a bag. This may be used for more severe incontinence. The catheter may be:
  • External (condom)—slips over the penis like a condom
  • Internal (Foley)—tube is inserted into the urethra
• Penile clamp—puts light pressure on penis to help stop dribbling.

Condom Catheter Copyright © Nucleus Medical Media, Inc.

Prevention

To help prevent incontinence:

• Avoid food or drinks that can irritate the bladder such as caffeine, alcohol, or spicy foods.
• Maintain a healthy weight.
• Eat plenty of fruits and vegetables to decrease the risk of constipation.