INCONTINENCE

General Information

DEFINITION--

An involuntary loss of bladder control. There are several types:

• Stress: An involuntary loss of urine that accompanies any action that suddenly increases pressure in the abdomen.
• Urge: Inability to control the bladder once the urge to urinate occurs. It may occur alone or sometimes with stress incontinence.
• Functional: Incontinence that occurs infrequently (transient) or there is failure to comprehend the need to urinate (functional).

BODY PARTS INVOLVED--Kidneys and urinary system.

SEX OR AGE MOST AFFECTED--Older adults of both sexes.

SIGNS & SYMPTOMS

• Unintentional loss of urine with lifting, sneezing, singing, coughing, laughing, crying or straining to have a bowel movement.
• Involuntary loss of urine almost immediately after feeling a slight urge to urinate. The volume of lost urine may range from a few drops to complete bladder emptying.
• Forgetting to urinate.
• Urinating at inappropriate times or places.
• Occasional problems in getting from bed to toilet in time.

> Females--

shortening of the urethra and loss of the normal muscular support for the bladder and floor of the pelvis. These changes occur during pregnancy and after childbirth, particularly repeated childbirth. They may also occur as a natural consequence of aging.

• Males--damage to the sphincter mechanism.
• Overactive muscles that cause bladder to contract and empty.
• Stone, cancer, or obstruction in urinary tract.
• Dementia; depression; mobility disorders.

RISK INCREASES WITH

• Repeated childbirth.
• Adults over 60; obesity; diabetes.
• Chronic lung disease with a cough.
• Surgery, cancer or radiation damage to the sphincter mechanism in males.
• Central nervous system disorders (stroke, Parkinson's); spinal cord injury.
• Surgery that may traumatize the urethra.
• Injury of the urethra; urinary tract infection.
• Menopause.
• General debilitated condition.
  PREVENTIVE MEASURES
• Maintain good nutrition; exercise regularly.
• Regular physical exams .
• Don't hold urine. Go when you feel the need.

What To Expect

DIAGNOSTIC MEASURES----Medical history and exam by a doctor. Medical tests to determine underlying causes.

APPROPRIATE HEALTH CARE

• Self-care; doctor's treatment.
• Treatment for any infections or tumors.
• Biofeedback, electrical stimulation or special weights for pelvic muscle strengthening.
• A pessary (support device) made of rubber or other material to fit inside the vagina to support the uterus and lower bladder muscles.
• Surgery to tighten relaxed or damaged muscles that support the bladder.
• External catheters for some impaired men.

POSSIBLE COMPLICATIONS

• Urinary-tract infections; kidney failure.
• Social isolation due to embarrassment.
• Loss of urinary control. This requires surgery.

PROBABLE OUTCOME--Most people with incontinence can be helped and even chronic cases can often be cured.

How To Treat

GENERAL MEASURES--

• Practice good genital hygiene.
• May require caregiver assistance.
• Absorbent pads or diapers may be worn. For mild incontinence, sanitary pads or panty liners may be sufficient.
• Get a portable urinal or bedside commode.
• Plan a schedule for emptying the bladder.
• Keep a daily diary of fluid intake and urination.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Antibiotics for any urinary-tract infection.
• Sympathomimetic (alpha-adrenergic) drug therapy, which helps urethral muscles.
• Anticholinergic drugs.
• Estrogen therapy.

ACTIVITY--No restrictions.

DIET--

• Lose weight if you are overweight (see Weight-Loss Diet in Appendix).
• Decrease amount of caffeine and alcohol.
• Avoid high volume of fluid intake in situations where access to bathroom facilities is limited.

Call Your Doctor If

Any sign of infection develops, such as fever, pain on urination, frequent urination or a general ill feeling.