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Incontinence |
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Urinary control relies on the finely coordinated activities of
the smooth muscle tissue of the urethra and bladder, skeletal
muscle, voluntary inhibition, and the autonomic nervous
system.
Urinary
incontinence can result from anatomic, physiologic, or
pathologic (disease) factors. Congenital and acquired
disorders of muscle innervation (e.g., ALS, spina bifida,
multiple sclerosis) eventually cause inadequate urinary
storage or control.
Acute and temporary incontinence are commonly caused by
the following:
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Childbirth
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Limited
mobility
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Medication
side effect
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Urinary tract
infection
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Chronic
incontinence is commonly caused by these factors:
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Birth defects
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Bladder
muscle weakness
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Blocked
urethra (due to benign prostate hyperplasia, tumor, etc.)
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Brain or
spinal cord injury
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Nerve
disorders
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Pelvic floor
muscle weakness
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Types
Of the several types of urinary incontinence, stress, urge,
and mixed incontinence account for more than 90% of cases.
Overflow incontinence is more common in people with disorders
that affect the nerve supply originating in the upper portion
of the spinal cord and older men with benign prostate
hyperplasia (BPH). The primary characteristics of these types
are as follows:
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Stress—urine
loss during physical activity that increases abdominal
pressure (e.g., coughing, sneezing, laughing)
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Urge—urine
loss with urgent need to void and involuntary bladder
contraction (also called detrusor instability)
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Mixed—both
stress and urge incontinence
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Overflow—constant dribbling of urine; bladder never
completely empties
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Incidence and
Prevalence
The U.S. Department of Health and Human Services reported in
1996 that approximately 13 million people in the United States
suffer from urinary incontinence. The condition is far more
prevalent in women than men. In the general population aged 15
to 64 years old, 10-30% of women versus 1.5-5% of men are
affected. At least 50% of nursing home residents are affected.
Of that number, 70% are women.
Treatment Options
Treatment options for urinary incontinence depend
on the type of incontinence as outlined below.
Stress incontinence is urine loss during physical
activity that increases abdominal pressure (e.g., coughing,
sneezing, laughing). Treatment options include:
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Injectables
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Nonsurgical
treatments
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Medications
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Surgical
treatments
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Urge incontinence is urine loss with
urgent need to void and involuntary bladder contraction (also
called detrusor instability). Treatment options include:
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Nonsurgical
treatments
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Medications
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Surgical
treatments
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Overflow incontinence is constant
dribbling of urine; bladder never completely empties.
Treatment options include:
There are several things patients can do to
help improve continence.
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Avoid
over consumption of diuretics, antidepressants,
antihistamines, and cough-cold preparations.
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Perform Kegel
exercises daily.
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Practice
double voiding (urinate, wait a few seconds, urinate
again).
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Eat fruits,
vegetables, and whole grains daily to prevent
constipation.
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Retrain the
bladder (urinate only every 3 to 6 hours).
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Stop smoking
(nicotine irritates the bladder).
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A number of protective devices are available
to help manage accidental urination, including the following:
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Bed pads
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Combination
pad-pant systems
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Disposable or
reusable adult diapers
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Full-length
absorbent undergarments
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Male
incontinence drip collectors
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Underwear
liners (pads, guards, shields, inserts)
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Early reliance on absorbent pads may cause
the wearer to accept incontinence rather than seek diagnosis
and treatment. These products should be applied correctly and
changed often to prevent skin irritation and urinary tract
infection.
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