Family Health Magazine - FAMILY MEDICINE
Treatment for an embarrassing problem
Does the thought of sneezing in public or being far from a bathroom make you nervous? Urinary incontinence is the unwanted release of urine at the wrong time. More simply put, it is wetting your pants. It may be a relief to learn that you are not alone. In fact, urinary incontinence is surprisingly common. Although embarrassing, it can be treated effectively.
Estimates suggest that many people experience incontinence:
- 10 per cent of six-year-olds
- about 15 per cent of all men aged 60 or more
- and up to half of middle-aged and older women.
This condition is most common in women over the age of 50. Younger people can also be affected, especially women who have just given birth. All told, over 3.3 million Canadians experience incontinence.
Urinary incontinence is a broad definition of a problem that can present itself in different ways. Understanding the cause helps decide whether further investigation and particular treatments might be needed.
The bladder is a muscle, similar in shape to a small balloon. It holds urine made by the kidneys, expanding to fill and contracting to empty. The bladder works together with the sphincter muscle, which helps hold urine in the bladder.
When urine is stored, the bladder relaxes and the sphincter contracts to keep urine inside the bladder. Your spinal cord and brain control this system. Once the bladder is full, the brain receives a message of discomfort. In turn, the brain signals the bladder to pass urine, when you have an appropriate chance.
To pass (or void) urine, the sphincter relaxes while the bladder muscle contracts. Urine passes from the bladder through the urethra and out of the body. It may leak out if any part of the system, including the bladder, spinal cord, and brain, does not work properly.
Types of incontinence
Stress incontinence is the leakage of urine when a person coughs, sneezes, laughs, lifts a heavy object, jogs, or does anything that makes abdominal pressure stronger than the bladder’s closure mechanism. Pregnancy also increases pressure in the abdomen.
Urge incontinence is the strong desire to pass urine, along with an inability to wait long enough to get to a toilet. Here, a large amount of urine can be lost at one time.
Overflow incontinence is the frequent leakage of urine without feeling the urge to void. This might also happen when someone is not able to void a normal amount. When the bladder's capacity is exceeded, a little urine leaks out but the bladder remains full.
Total incontinence is the complete absence of control. This causes either continuous leakage or periodic uncontrolled emptying of the bladder.
Enuresis refers to bedwetting in children who are old enough to be potty-trained. This term also applies to adults who lose bladder control during the night.
Don’t believe the myths
Two major myths exist about this condition.
Myth #1: Incontinence is a disease.
Fact: Incontinence is a symptom of something else going on in the body. It should always be assessed and diagnosed by a health care provider who is interested and experienced in incontinence.
Incontinence can have many causes.
- A urinary tract infection, commonly of the bladder or a build-up of stool in the bowels (constipation) can cause incontinence.
- Pelvic floor muscles can weaken. This often happens after childbirth or with the start of menopause.
- Certain medications, including anti-depressants, sedatives, diuretics, or muscle relaxants, can cause it as a side effect.
- A person can be born with a defect of the urinary system.
- Physical changes that occur as part of menopause, the natural aging process in women, can affect control of urine. A reduction in the hormone estrogen can thin and dry skin in the vagina (birth canal) and the urethra (the tiny tube through which urine passes from the bladder to the outside of the body).
- Being confused or unsure of where you are can contribute to incontinence.
- In men, the prostate gland can partially block the exit from the bladder because it has become too big. Prostate surgery can also sometimes weaken control of urination.
- Conditions that affect the nervous system can interfere with communication between the brain and the bladder or bowel control mechanism (the sphincter). For instance, stroke, multiple sclerosis, Parkinson's disease, nerve problems due to diabetes, or spinal cord injury might bring on incontinence.
Myth #2: Those who experience incontinence just have to learn to live with it.
Fact: Incontinence can almost always be cured, treated, or successfully managed. Many options are available to help, depending on the nature and cause of the incontinence.
The following strategies may help.
- Schedule times to go to the toilet and pass urine.
- Try changing diet and fluid intake.
- Pelvic floor exercises, sometimes with biofeedback or electrical stimulation equipment, may help.
- For some, medications can help. The drugs increase the bladder's ability to empty, or relax the bladder and reduce urgency (the feeling of needing to void right now). Some medications work to tighten the sphincter, preventing urine from leaking out of the bladder. Topical hormone therapy, a medication placed on the skin, can reverse the skin thinning of the vagina and urethra associated with menopause.
- Other options include surgery (bladder repair in women, prostate surgery in men) or procedures to help the sphincter open and close.
- For women, fitting a special appliance (called a pessary) into the vagina may be quite helpful.
- Restoring or improving continence is also possible for those who are physically or cognitively (mentally) challenged. Options include help using the toilet, or using devices that assist with mobility or communication.
- Incontinence products (pads, adult diapers or catheter devices) are another possibility. A catheter is a thin tube that goes into the urethra to the bladder to drain urine. Choosing the most appropriate product to conduct or contain urine can make a world of difference in quality of life.
Talk to your doctor
- Your health care professional can help determine the type and cause of your incontinence.
- Before your visit, make a list of all prescription and non-prescription medications you are taking, or bring them with you.
- Briefly describe your medical history, including information on any surgeries you may have had.
- If you have been pregnant, discuss how many times and any problems you experienced during pregnancy.
- Your health care professional will ask questions about how much fluid you drink, and how and when you lose urine.
Once a complete history has been taken, you may need special tests (urodynamic studies) to diagnose the reason for the incontinence. One test uses ultrasound to assess the amount of urine left in your bladder after you have voided. Another test measures the pressure in the bladder and urethra. The bladder and kidneys may be examined in detail. Urinalysis or a urine culture may be needed. The type and cause of the incontinence determine what needs to be investigated.
If incontinence is a problem for you, it can be reassuring to learn that management and treatment options are available. Understanding the possible causes is a good place to start. Schedule a visit with your family doctor to discuss your options. Your doctor can start the investigation and provide you with further help, perhaps referring you to a specialist.
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2018, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1 [FM_FHab18]