What Is Incontinence?
By Noah Lam

Urinary incontinence is the inability to stop urine leakage. Incontinence can be embarrassing in that it interferes with living a normal, full life. But there are several ways to control it. This article explains the different types of incontinence along with management and treatment options.

Incontinence is Common
If you have trouble controlling your bladder, you are not alone. Loss of bladder control is a common problem, shared by millions of Americans. Incontinence can rob you of sleep and leave you exhausted. It can make travel awkward and keep you from enjoying physical activity. Despite these frustrations, fewer than half the people with incontinence seek help. Many feel too embarrassed, while others don’t realize that help is available.

Incontinence is Treatable
The successful treatment of incontinence begins with an accurate diagnosis. Then you and your doctor can discuss your treatment options. These may include certain medications, exercises and other therapy to help strengthen muscles, procedures to help stop leakage, or surgery. Incontinence can be controlled and, in many cases, even cured.

Types of Incontinence
There are different types of incontinence: urge (also known as overactive bladder), stress, and overflow. You may have only one type. Or you may have urge incontinence along with one of the other types (mixed incontinence). All people with incontinence have bladder control problems. But each type of incontinence has its own pattern of signs and symptoms. You can identify your type by comparing these typical patterns.

People with URGE INCONTINENCE or OVERACTIVE BLADDER may:
• Wet themselves if they don’t get to a bathroom immediately
• Get up frequently during the night to urinate
• Go to the bathroom at least every two hours
• Feel they have a weak bladder. Each drink of coffee, cola, or alcohol seems to cause urination out of proportion to the amount they actually drink
• Wet the bed at night

People with STRESS INCONTINENCE may:
• Leak urine when they cough, sneeze, or laugh
• Go to the bathroom more frequently in order to avoid accidents
• Avoid exercise because they are afraid it will cause leaks
• Sleep through the night, but leak upon getting up from bed in the morning
• Sometimes leak urine when they get up from a chair

People with OVERFLOW INCONTINENCE may:
• Get up frequently during the night to urinate
• Take a long time to urinate and have a weak, dribbling stream with no force
• Urinate small amounts and not feel completely empty afterward
• Dribble urine throughout the day
• Feel the urge to urinate, but sometimes can’t
*People with mixed incontinence have a combination of the above signs and symptoms

When You’re Continent
Continence means you have control over your bladder. You can hold urine in or let it out when you choose. For example, you may be in a situation where it is not convenient to get to the bathroom. Even if your brain gets the message that your bladder is getting full and you feel the desire to urinate, you can consciously tell your system to wait to expel the urine until it is convenient.

HOLDING URINE IN
1. Brain gets signal that bladder is full, and you feel the urge to urinate
2. Spinal Cord sends message from brain telling external sphincter to contract
3. External Sphincter contracts and stays closed
4. This signals bladder to relax and bladder neck to stay closed. Urge to urinate subsides LETTING URINE OUT
1. Brain get signal that bladder is full, and you feel the urge to urinate
2. Spinal Cord sends message from brain telling external sphincter to relax
3. External sphincter relaxes and opens
4. This signals bladder to contract and expel urine, and bladder neck to open, allowing urine into the urethra

When You’re Incontinent
Incontinence means loss of bladder control. It occurs when any part of the urinary system fails to function. Both men and women may develop overactive bladder, stress incontinence, overflow incontinence, or mixed incontinence. Women are more likely to develop incontinence than men because their internal organ structure is different to allow for childbirth. Pregnancy, childbirth, and decreased levels of the female hormone estrogen can weaken pelvic floor muscles, allowing organs such as the bladder, urethra, and uterus to shift out of place (prolapse). This may cause incontinence and a feeling of pressure or that something is slipping. Men have fewer incontinence problems because the shape of the male urinary tract and longer urethra offer more support.

Urge Incontinence and Overactive Bladder
MEDICAL HISTORY Your medical history may show that you have been experiencing persistent and extreme urgency, even after urinating. You may have wet the bed as a child, because overactive bladder can occur temporarily in childhood, then reappear in adulthood. Overactive bladder often reappears after menopause, because hormonal changes can weaken the external sphincter. Your history may include prior pelvic surgery, back problem, nerve problems, or infections.

Stress Incontinence
Stress incontinence occurs when pelvic floor muscles have become weak and pelvic organs slip down (prolapse). As a result, the bladder neck is not in the correct position. When activity such as lifting heavy objects, coughing, laughing, sneezing, or getting up from a chair increases pressure on the abdominal cavity and the bladder, the bladder neck opens. If the external sphincter is also weak, urine leakage occurs. In people with mixed incontinence, overactive bladder is also present.
MEDICAL HISTORY Women who have had one or more pregnancies and deliveries often develop stress incontinence. That’s because pregnancy and delivery may stretch, relax, and weaken the pelvic floor muscles. Lowered estrogen levels during menopause also weaken and thin these muscles and surrounding tissues. Prior pelvic surgery can affect the position and tone of the organs and muscles. Men may experience temporary stress incontinence after prostate surgery. You may also notice your symptoms are worse if you suffer from a cold, bronchitis, or allergies.

Overflow Incontinence
Overflow may result when scar tissue or prolapsed organs make the urethra narrow, blocking urine from flowing when you try to urinate. In women, it may arise temporarily due to swelling after pelvic surgery or childbirth. In men, it may be cause by an enlarged prostate. Or it may occur if the bladder stops contracting because of medications, injured nerves, or overstretching of the bladder tissue. As a result, the bladder stays full, and constant pressure on the bladder neck results in urine leakage. Some people with overflow incontinence also have overactive bladder (mixed incontinence).
MEDICAL HISTORY Your medical history may indicate that your urine stream is getting weaker, and that it takes you a long time to urinate. You may be experiencing a dull ache in the lower abdomen, low back pain, or have accidents during the night. Women may have a feeling or fullness in the vagina. Causes include childbirth, previous pelvic surgery, prostate problems, and diabetes, medications that hinder bladder contractions, constipation, nerve or muscle problems, and a history of sexually transmitted disease.

Absorbent Products
Products that absorb urine are available in both disposable and reusable forms. They may be used temporarily until your treatment has a chance to work, if the treatment yields less than perfect results, or if you undergo no treatment. By reducing wetness and odor, they help keep you mobile, functioning, and comfortable.
Absorbent Pads Pads come in varying degrees of absorbency. They’re attached to underwear and can be worn under normal clothing.

Adult Briefs These are bulkier than pads but are more absorbent. They’re fastened with self-adhesive tape.
Bed Pads Bed pads protect the bed linens and mattress at night. They are available in different sizes and absorbencies.

Skin Care
Prolonged contact with urine is very irritating to the skin. Keeping yourself clean and dry will reduce skin rash and odor. Wash with mild non-deodorant soap and avoid harsh detergents. Special cleansers and protective creams and powders are available. Specially formulated deodorant tablets, taken daily, may further help control odor.
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