Urinary Incontinence Can Usually Be Controlled

While millions live with it and television ads openly discuss it, urinary incontinence is still frequently hidden because people are too embarrassed to talk about it - even with their doctors.

"It is underreported, often because people think it is a normal part of aging. People are reluctant to talk about it," says Mary Cohan, MD, Assistant Professor of Medicine (Geriatrics and Gerontology) at the Medical College of Wisconsin. Dr. Cohan practices at both the Froedtert & The Medical College of Wisconsin Urology Clinic and Geriatrics Clinics.

Quite simply, urinary incontinence is the inability to hold urine until reaching a toilet. It can result from a nerve injury, diabetes, stroke, prostate cancer, or other physical problems. More than 13 million men and women in the United States of all ages experience incontinence. The problem is common in older people; at least 1 in 10 of those age 65 or older has it. Symptoms can range from mild leaking to uncontrollable wetting.

Women are more likely than men to have incontinence. Pregnancy, childbirth, menopause and the structure of the female urinary tract are part of the reason why. "Older women suffer from it more often than younger women, but most of the time it can be treated no matter what your age," Dr. Cohan says.

The body stores urine - water and wastes removed by the kidneys - in the bladder. The bladder connects to the urethra, the tube through which urine leaves the body. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or if the muscles surrounding the urethra are weak.

Types of Incontinence
"There are five types of incontinence: stress, urge, a combination of stress and urge, overflow, and functional," says Dr. Cohan. "Stress incontinence is a problem for many women who leak urine when they cough, laugh or sneeze, or during exercise," she adds. The pelvic floor muscles that support the bladder can weaken from childbirth or menopause, preventing them from forcing the urethra to close. As a result, urine can leak into the urethra during moments of physical stress. After menopause, lower estrogen levels also contribute to stress incontinence.

"Urge incontinence is an overactive bladder - you have a strong urge to urinate," Dr. Cohan says. The most common cause of urge incontinence is inappropriate bladder contractions. These contractions can occur because of nerve damage to the bladder or the nervous system or the muscles themselves, according to the National Institutes of Health. In some instances, women suffer from so-called "mixed incontinence." This is a combination of stress and urge incontinence.

"Men with prostate problems may experience overflow incontinence, which is caused by a blocked urethra. The bladder gets too full and causes urine to leak," Dr. Cohan explains. Nerve damage from diabetes or other diseases can also lead to weak bladder muscles.

"Functional incontinence happens when someone is not able to reach the bathroom," Dr. Cohan explains. For example, a physical disability, external obstacles, or problems in thinking or communicating can prevent a person from reaching a toilet. These conditions are often associated with age.

Diagnosing the Problem
Fortunately for the many people who experience incontinence, the first step toward treatment is a simple one: see your health care provider. He or she will ask about your symptoms and medical history, including factors that can contribute to your problem, such as discomfort, medications, recent surgeries, or medical problems.

"There is a lot we can do to help people with incontinence," Dr. Cohan says. After checking you for signs of any medical problems that could be causing incontinence, your doctor will likely perform some tests, such as a urinalysis for evidence of infection, blood tests, or ultrasound to assess the condition of the kidneys, bladder and urethra. A cystoscopy may also be done, which involves inserting a thin tube into the urethra to see the inside of the urethra and bladder.

Treatment
"There are three types of treatment for incontinence: behavioral, medical, and surgical," according to Dr. Cohan. "Behavioral treatment involves teaching people lifestyle changes that will help their problem. If people are able to follow the behavioral measures, they often show major improvement," she says.

For example, Dr. Cohan recommends Kegel Exercises, which can strengthen or retrain pelvic floor muscles and sphincter muscles to help reduce or cure stress leakage. "These exercises can help you calm bladder spasms," she says. A healthcare professional can teach you the exercises.

Biofeedback, which trains people to improve their health by using signals from their own bodies, is often used to treat chronic pain, and is also used to treat incontinence. "We use biofeedback to help patients gain control over their body's functions," Dr. Cohan says. Biofeedback can be used to teach pelvic muscle exercises.

Your doctor might also recommend something called "timed voiding." "We try to have patients go to the bathroom on a schedule," Dr. Cohan says. "They use a chart to keep track of their voiding and leaking habits and try to go to the bathroom before they begin to leak."

In addition, your doctor might encourage you to keep track of the amount of fluids you drink. "If you have trouble with nighttime voiding, limit fluids after supper. Cut back on caffeine and alcohol, which are diuretics," Dr. Cohan says. To make sure you are getting adequate fluids, "It is very important to drink enough fluids during the daytime," she adds.

If behavioral changes don't seem to be working, then Dr. Cohan considers prescribing medication. "Most of the medications available - the ones you see advertised on television - are used for urge incontinence. They help calm down bladder spasms," Dr. Cohan says.

"If behavioral measures and medications aren't helpful, there are some surgical options," The surgery can be complicated, so in older adults, we try other methods first," Dr. Cohan says.

It is important to keep in mind that urinary incontinence can be treated, no matter what your age. "It is not considered a normal part of aging and there are simple ways to treat it," Dr. Cohan says. "Don't wait to seek treatment."

JoAnn Petaschnick
HealthLink contributing writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.