Incontinence

Alternative names:

loss of bladder control; uncontrollable urination; urination, uncontrollable

Home care:

There are many things you can do to manage incontinence, but they should not be done at the exclusion of a visit to your health care provider. Treatment usually focuses on identifying the cause and type of the incontinence, treating or managing the incontinence appropriately, and preventing complications (skin breakdown, injury, social embarrassment).

The various treatment options may be appropriate for several types of incontinence. Treatment options may involve use of various medications to enhance bladder function, bladder training to enhance continence, and various surgical treatments based on eliminating the cause of the incontinence.

Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.

Treatment usually includes performing Kegel exercises, bladder retraining, biofeedback and electrical stimulation.

Surgery may be required in specific instances of urinary incontinence, such as to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women. Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters which are synthetic cuffs that are surgically placed around the urethra to help retain urine.

People with overflow incontinence and those who cannot empty their bladder completely may use catheters to manage the incontinence (either long term indwelling catheters or intermittent short term catheterization), but this procedure exposes the person to potential infection.

Most incontinent people are able to manage minor incontinent episodes through the use of various urinary incontinence products (undergarments and pads).

Additional preventative measures include avoiding bladder or urethral irritants such as:

• too much alcohol or coffee
• cigarettes (if they make you cough)
• diuretics (water pills)
• beta-blockers
• various anti-spasmodic medications
• antidepressants
• antihistamines
• cough/cold medications
• Ventolin (albuterol) or other beta agonists

Call your health care provider if:

Notify your health care provider if there has been repeated incontinence of even small amounts of urine.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting incontinence may include:

• CHARACTERISTICS:
  • Describe your problem.
  • When does this occur?
  • How long has incontinence been a problem?
  • How much of a problem has this condition become?
  • How many times does this happen each day?
  • Are you aware of the need to urinate before you leak?
  • Are you immediately aware that you have passed urine?
  • Are you wet most of the day?
  • Do you wear diapers in case of accidents? Occasionally? All the time?
  • Do you avoid social situations in case of accidents?

• AGGRAVATING FACTORS:
  • Do you have a urinary tract infection now? In the past?
  • Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
  • Is it more difficult to control your urine when running, jumping or walking?
  • Is the incontinence worse when sitting up or standing?
  • Do you suffer from constipation?

• RELIEVING FACTORS:
  • Is there anything you can do to reduce or prevent accidents?
  • Have you ever been treated for this condition before? Did it help?
  • Have you tried pelvic floor exercises (Kegel)? Did it help?

• ASSOCIATED FACTORS:
  • What surgeries have you had?
  • What injuries have you had?
  • What medications do you take?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?

• OTHER:
  • Are there any other symptoms present?

The physical exam will include abdominal examination, genital examination of the male, pelvic exam in the female, rectal exam, and neurological exam.

Diagnostic tests that may be performed include:

• urinalysis
• urine culture to check for infection if indicated
• cystoscopy (inspection of the inside of the bladder)
• urodynamic studies (tests to measure pressure and urine flow)
• uroflow (to measure pattern of urine flow)
• post void residual (PVR) to measure amount of urine left after urination

Other tests may be performed to rule out pelvic weakness as the cause of the incontinence. One such test is called the Q-tip test. This test involves measurement of the change in the angle of the urethra when it is at rest and when it is straining. An angle change of greater than 30 degrees often indicates significant weakness of the muscles and tendons that support the bladder.

After seeing your health care provider:
You may want to add a diagnosis related to urinary incontinence to your personal medical record.