Incontinence

Alternative names:

loss of bladder control; uncontrollable urination; urination, uncontrollable

Definition:

The inability to control urination (passage of urine). See also bowel incontinence. Urinary incontinence can range from an occasional leakage of urine to a complete inability to hold any urine.

Considerations:

Incontinence is fairly rare in children. Infants and children up to the time of toilet training are not considered incontinent but merely untrained. Occasional accidents in children up to age 6 years, especially with urine, are not unusual. Nighttime incontinence is usually referred to as bedwetting or enuresis in children. In young girls, and occasionally adolescent females, slight leakage of urine may be associated with laughing.

Incontinence in children may be associated with severe urinary tract infections, spinal injuries and neurological abnormalities that result in abnormal bladder control.

Incontinence is seen more frequently among the elderly. Almost 20% of older people living at home, one-third of those in hospitals and one-half of all nursing home residents suffer from urinary incontinence. Women are more likely than men to be affected by urinary incontinence.

Incontinence is not a hopeless situation. Although incontinence is usually not an emergency, problems with incontinence should be reported to the doctor. The gynecologist and the urologist are the specialists who are most familiar with incontinence and can evaluate the causes of incontinence and recommend several treatment approaches.

NORMAL URINATION:
The ability to hold urine and maintain continence is dependent on normal anatomy and function of the lower urinary tract and the nervous system. Additionally, the person must possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.

The process of urination involves two phases: 1) the filling and storage phase, and 2)the emptying phase. Normally during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine. The first sensation of the urge to urinate occurs when approximately 200 ml of urine is stored. The healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate while also allowing the bladder to continue to fill. The average person can hold approximately 350 to 450 ml of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable bladder wall muscle (detrusor).

The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. Additionally, the body must also be able to simultaneously relax the sphincter to allow the urine to pass out of the body.

TYPES OF INCONTINENCE:
Incontinence can be classified as acute (sudden onset) or persistent. Acute incontinence is usually caused by sudden changes in the urinary tract (such as infection, increased urine amounts) or changes in the ability to urinate. Persistent incontinence is usually caused by chronic (long-term) conditions and can be further classified based on the type of symptoms the person exhibits. The common types of incontinence are:

• Stress incontinence
• Urge incontinence
• Overflow incontinence
• Functional incontinence

Proper treatment can help the majority of people, and often the problems can be eliminated altogether. Sometimes surgery is required. However, incontinence can often be greatly improved and sometimes even cured without surgery.

Common causes:

ACUTE INCONTINENCE:

• mental confusion (delirium)
• restricted mobility
• urinary tract infection
• prostate infection
• inflammation of the urinary tract
• stool impaction
• side effects of medications (such as diuretics, tranquilizers, anticholinergics, and antidepressants)
• polyuria (increased urine amounts)
• psychological factors

PERSISTENT INCONTINENCE:

• sphincter weakness (following prostate surgery in men, or vaginal surgery in women)
• pelvic prolapse (in women)
• nervous system impairment (Multiple sclerosis, Parkinson's disease, strokes, spinal cord injury)
• mental or psychological changes (Alzheimer's disease, acute confusion, depression)
• bladder cancer
• pelvic muscle weakness, especially in women who have had multiple pregnancies
• enlarged prostate in middle-aged or older men
• nerve or muscle damage after pelvic radiation
• developmental problems of the bladder
• pelvic, prostate, or rectal surgery
• bladder spasms

Note: There may be other causes of urinary incontinence. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as time course, aggravating factors, relieving factors, and associated complaints.