Incontinence and Bladder Control

Incontinence is the inability to control urinary and bowel functions. It is a condition that can virtually paralyze your life because the effort to maintain secrecy becomes more important than enjoying a fulfilling life. Independence, dignity and self-esteem are diminished.

Ten million Americans suffer from incontinence, and the majority are women. Many people associate incontinence with aging, but the reality is that incontinence is not a problem which afflicts only the elderly. One in four women age 30-59 have experienced an episode of urinary incontinence.

Types of Incontinence

Stress incontinence

Stress incontinence occurs when the patient sneezes, jumps up and down, runs or does any activity that causes stress to the bladder. Physical changes resulting from pregnancy, childbirth and menopause often cause stress incontinence. Childbirth can injure the scaffolding that helps support the bladder. Pelvic floor muscles, the vagina, and ligaments support the bladder. When these structures are weakened, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. When this happens it prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should, resulting in a urine leak.

Urge incontinence 

Urge incontinence occurs when the patient constantly has the urge to urinate because the bladder is not supporting as much of the urine as it should. A common cause of urge incontinence is inappropriate bladder contractions. Abnormal nerve signals might be the cause of these bladder spasms.

Some other types of incontinence are: 

• Combination incontinence occurs when the patient experiences both stress and urge incontinence at the same time.
• Overflow Incontinence, or the leakage of urine from an always full bladder. In older men, this also results from blocked urine flow from the bladder.
• Functional Incontinence, which occurs in people who have urine control, but have difficulty reaching a toilet in time because of arthritis or other physical limitations.
• Bowel Incontinence, or the inability to completely control bowel functions.

Though you might be a little embarrassed at first, you should talk to your doctor if you are experiencing incontinence due to urge or stress or a combination of both. If you have urine leakage because you can’t walk or have other mobility problems, you have functional incontinence.

If you have to urinate eight or more times a day, you may have an overactive bladder. Getting up to urinate two or more times each night is another sign of overactive bladder. With an overactive bladder, you feel strong, sudden urges to urinate, and you also may have urge incontinence.

Incontinence Causes

Most incontinence results from weakened pelvic floor muscles and the accumulation of stress on these weakened muscles. Examples include pregnancy, childbirth, lifting and chronic constipation. Certain medications, caffeine and alcohol consumption may magnify lack of control.

Incontinence Risk Assessment

1. Do you ever leak urine when you don't want to?
2. Do you urinate more than seven times per day?
3. Do you urinate fewer than five times per day?
4. Do you ever feel the strong need to urinate with little or no warning?
5. Do you ever experience burning, pain, discomfort or pressure in your bladder?
6. Do you ever feel you do not fully empty your bladder after urinating and need to return to the bathroom shortly after?

Incontinence Treatment

Treatment for incontinence and bladder control concerns includes surgical and non-surgical options.

Biofeedback

Biofeedback uses computer assisted devices to retrain your pelvic floor muscles. This helps the patient gain control over these muscles which reduce or eliminates incontinence.

Your doctor may recommend the following:

Kegel Exercises

Kegel exercises are used to strengthen the muscles that surround the openings of the rectum, vagina, and urethra. Developing these muscles can increase continence. The doctor will ask you to squeeze your sphincter muscles as if you were stopping a bowel movement. In the same way that doing sit-ups can help flatten the abdomen, these exercises only work when the right muscles are used, indicating that the "squeeze" is held long enough, and enough repetitions are done.

Pessary

A pessary is a stiff ring that is inserted into the vagina used to treat incontinence cased by weak pelvic muscles holding the bladder in place and holding urine inside. The pessary presses against the wall of the vagina and nearby urethra and leads to less stress leakage.