Incontinence

The National Association for Continence (NAFC) calls urinary incontinence a symptom, not a disease and says that's important to remember because symptoms can be treated, if people will talk about them. (Note: This story focuses on urinary incontinence. To read about fecal incontinence see "Fecal Incontinence.") It's estimated that some 12 million people suffer from incontinence or uncontrollable loss of urine in the United States. The American Academy of Family Physicians (AAFP) says that it's most common in women over the age of 50 and women who have just given birth, but it also affects younger people, and it is also common in young children. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in boys as in girls.

Types of bladder problems

Incontinence can occur when there are problems with the urinary system and with bladder control. (Read about "The Urinary System") There are different types of bladder control problems. Each of them happens for a different reason and each is treated differently. They can also be signs of other problems that need treatment. NIA, NAFC and AAFP say the different types include:

• Overactive bladder (OAB) - Overactive bladder is a condition in which the bladder squeezes too often or squeezes without warning. Symptoms include leaking urine (urinary incontinence), feeling the sudden and urgent need to urinate, and frequent urination. The Food and Drug Administration (FDA) says overactive bladder affects an estimated 33 million Americans, the majority of whom are older women. According to NIDDK, voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.
• Stress incontinence - This happens with a sudden pressure on the bladder. It can be caused by exercise, coughing, sneezing, laughing, lifting heavy objects or other pressure on the lower abdomen. Stress incontinence happens to people with weakened pelvic muscles. (Read about "Pelvic Floor Disorders") It is common in women who have just given birth.
• Urge incontinence - This is when you have to go and you can't make it to the toilet in time. This can happen to otherwise healthy people, but is most common in people with diseases such as diabetes (Read about "Diabetes"), stroke (Read about "Stroke"), dementia (Read about "Alzheimer's" "Dementia"), Parkinson's (Read about "Parkinson's"), or multiple sclerosis (Read about "MS"). It can also be the sign of a kidney or bladder infection (Read about "Urinary Tract Infection" "Kidney Disease") and an early warning sign of bladder cancer. In men it can be a sign of an enlarged prostate (Read about "Prostate Problems").
• Overflow incontinence - This is when small amounts of urine constantly leak. It is caused by an overfilled bladder that isn't emptied every time. This is common in older men and is often caused by an enlarged prostate or something else blocking the flow of urine.
• Functional incontinence - This afflicts people who have normal bladder control but are unable to get to the bathroom in time because of other physical ailments such as arthritis (Read about "Arthritis and Rheumatic Diseases").
• Nocturia - This is defined as the need to urinate at least twice during the night. It becomes more common with age. Nocturia can sometimes be caused by an overproduction of urine at night. It can also result from taking certain medications or from drinking too much water at night. Nocturia can also indicate other problems such as prostate enlargement, diabetes, high blood pressure or congestive heart failure. (Read about "The Prostate" "Diabetes" "Hypertension: High Blood Pressure" "Congestive Heart Failure")
• Bedwetting or enuresis - This is fairly common in children. About 5 million to 7 million children wet the bed. Bedwetting may also run in families. And it may be caused by an infection or a nerve disease. Children with nerve disease often also have daytime wetting as well.

Treatment options for children

NIDDK says parents or guardians of children who experience bedwetting at night or accidents during the day should treat this problem with understanding and patience. It's important to remember that the child isn't doing this to annoy you, and he or she shouldn't be punished for it.

Most cases of bedwetting probably result from a mix of factors including slower physical development, small bladder capacity, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep and sometimes, anxiety.

Daytime incontinence in children can be associated with urinary infections. (Read about "Urinary Tract Infections") Other possible causes include an overactive bladder or abnormal elimination habits, such as infrequent voiding and constipation. (Read about "Constipation")

One issue parents should be aware of is that nighttime incontinence may be one sign of another condition called obstructive sleep apnea (Read about sleep apnea in "Sleep"), in which the child's breathing is interrupted during sleep, often because of inflamed or enlarged tonsils or adenoids. (Read about "Tonsils & Adenoids") In addition, a small number of cases of incontinence are caused by physical problems in the urinary system in children. Rarely, a blocked bladder or urethra may cause the bladder to overfill and leak.

The good news for parents is that many children overcome incontinence naturally - without treatment - as they grow older. NIDDK says the number of cases of incontinence goes down by 15 percent for each year after the age of 5.

If the incontinence persists, talk with your doctor about ways to help your child. For example, bladder training can help your child hold urine longer. In bladder training, you figure out how long your child waits between trips to the bathroom, and gradually try to extend that amount of time. A moisture alarm may help at night, by alerting the child to wake up when he starts to urinate. There are also medications available. Medication can help slow down how fast your body makes urine. Another type of medication can help the bladder relax so it can hold more urine.

Treatment options for adults

Many adults with incontinence are embarrassed. They try to hide the fact from everyone, including their doctors, but they are not alone. According to the National Institute on Aging (NIA) one in ten people over the age of 65 is incontinent. That's over ten million people according to NAFC. The group also says that 80 percent of incontinent people can be cured or have major improvement.

That's why it's important to talk with your physician or healthcare provider. He or she needs to check and see if there are other medical reasons for your incontinence before you can start treating it. Many times incontinence will disappear when the underlying medical problem is addressed. Then you can move ahead with treatments specifically for the incontinence.

The treatments fall into four areas - behavioral, drugs, surgical and non-surgical.

• There are several different types of behavioral treatments.
  • Stress incontinence is often treated with pelvic tightening and strengthening exercises called Kegel exercises. They can be used by both men and women, be done anywhere and can result in improvement in 3 to 6 months according to AAFP.
  • Scheduled toileting is where you go to the bathroom every couple of hours even if you don't have the urge. It helps patients with urge, overflow and functional incontinence.
  • Bladder training can help with urge incontinence and functional incontinence. In bladder training, you schedule your toileting but slowly increase the time between trips to the bathroom.
• Nerve stimulation may be an option for some people. A weak electrical current is applied through electrodes to strengthen pelvic floor muscles. This can be combined with a program involving Kegel exercises.
• For women who continue to experience incontinence, there are devices can help block or catch the flow of urine. A pessary is a device that is inserted daily to support the bladder and prevent leakage. Urethral inserts are used only during specific activities.
• There are also some drugs that help with incontinence, but once again, you will need to discuss this with your doctor. There are different classes of such medications. Some increase sphincter or pelvic muscle strength so you can hold more urine. Others relax the bladder, thus reducing the urinary frequency and the urge to urinate. Other types of medication can reduce the amount of urine produced by the body. Keep in mind that sometimes, drugs you may be taking can actually cause incontinence. If that happens, you need to talk with your doctor about changing the drug. Do not stop taking a prescribed medication without discussing it with your physician. (Read about "Medicine Safety")
• There are many different surgical procedures that can treat incontinence, depending on the type and cause of the condition. NAFC says surgery should be considered only if other options have not worked. Some of the more common procedures include bladder neck suspension or sling procedures, periurethral bulking injections (a procedure in which collagen or other material is injected around the urethra), or implantation of an artificial urinary sphincter or sacral nerve stimulator. You need to discuss the benefits and drawbacks of each procedure with your doctor.
• A non-surgical option for stress urinary incontinence involves heat waves, delivered through a urethral probe. The heat waves are designed to impact collagen in the affected tissue, making it more resistant to involuntary leakage.
• Botox injections can also be used. Botox injections in the bladder muscle help prevent contractions, which will reduce the urge to urinate.

In cases where incontinence can't be cured, there are devices to help you manage it. NAFC says catheters, pelvic organ support devices, urethral inserts or patches, external collection systems, and absorbent products can be helpful. Again, talk to your doctor, which is always the first step in solving an incontinence problem. Doctors can't help you if they don't know, and since incontinence often is a sign of a more serious problem, it is important you bring it up.

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