Incontinence

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:

	Childbirth
	Limited mobility
	Medication side effect
	Urinary tract infection

Chronic incontinence is commonly caused by these factors:

	Birth defects
	Bladder muscle weakness
	Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)
	Brain or spinal cord injury
	Nerve disorders
	Pelvic floor muscle weakness

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:

	Stress—urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing)
	Urge—urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability)
	Mixed—both stress and urge incontinence
	Overflow—constant dribbling of urine; bladder never completely empties

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:

	Injectables
	Nonsurgical treatments
	Medications
	Surgical treatments

Urge incontinence is urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability). Treatment options include:

	Nonsurgical treatments
	Medications
	Surgical treatments

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.

	Avoid over consumption of diuretics, antidepressants, antihistamines, and cough-cold preparations.
	Perform Kegel exercises daily.
	Practice double voiding (urinate, wait a few seconds, urinate again).
	Eat fruits, vegetables, and whole grains daily to prevent constipation.
	Retrain the bladder (urinate only every 3 to 6 hours).
	Stop smoking (nicotine irritates the bladder).

A number of protective devices are available to help manage accidental urination, including the following:

	Bed pads
	Combination pad-pant systems
	Disposable or reusable adult diapers
	Full-length absorbent undergarments
	Male incontinence drip collectors
	Underwear liners (pads, guards, shields, inserts)

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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