What is incontinence?
Incontinence (in-CONT-ti-nunce), or loss of bladder or bowel control, is a symptom - not a disease in itself. A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirth.
Incontinence is a problem of the urinary system, which is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. A circular muscle, called the sphincter, controls the activity of the urethra. It is not a part of the urinary system but can play a role in incontinence. Normally, the bladder stores the urine that is continually produced by the kidneys until it is convenient to urinate, but when any part of the urinary system malfunctions, incontinence can result.
According to the Clinical Practice Guidelines on Urinary Incontinence in Adults published in 1996 by the Agency for Health Care Policy and Research, 13 million Americans are incontinent – 85% of them are women. More recent consumer research reveals that one in four women over the age of 18 experience episodes of leaking urine involuntarily. One in five adults over age 40 are affected by overactive bladder or recurrent symptoms of urgency and frequency, a portion of whom don't reach the toilet before losing urine. At least half of all nursing home residents are incontinent of urine and many of them experience loss of bowel control as well. In sum, the problem is widespread and affects people of all ages including children and young adults. NAFC estimates on the basis of multiple studies and expert opinion that 25 million adult Americans experience transient or chronic urinary incontinence.
—Resnick, NM, Improving treatment of urinary incontinence (commentary letter). JAMA. 1998;280 (23):2034-2035.
Incontinence sufferers may experience emotional as well as physical discomfort. Many people affected by loss of bladder or bowel control isolate themselves for fear of ridicule and lose self-esteem. Adults may find employment impossible or compromised.
Treatment Options for Incontinence
Approximately 80% of those affected by urinary incontinence can be cured or improved. It is imperative to first obtain a diagnosis because there are different types of incontinence with different treatment options. Diagnosis includes a medical history and a thorough physical examination. Tests such as X-rays, cystoscopic examinations, blood chemistries, urine analysis, and special tests to determine bladder capacity, sphincter condition, urethral pressure, and the amount of urine left in the bladder after voiding may be required.
Because incontinence is a symptom and not a disease, the method of treatment depends on diagnostic results. Sometimes simple changes in diet or the elimination of medications such as diuretics can cure incontinence. More frequently, incontinence treatment involves a combination of medicine, behavioral modification, pelvic muscle re-education, collection devices, and absorbent products. Despite the high success rates in treating incontinence, only one out of every twelve people affected seeks help. Many types of treatment are available for incontinent people. After considering your specific case, a qualified specialist can recommend the treatment that is appropriate for you.
The three major categories of incontinence treatment are: behavioral, pharmacological, and surgical.
Behavioral techniques sometimes include the following:
- Scheduled Toileting - The care giver prompts the incontinent patient to go to the bathroom every 2-4 hours. This puts the patient on a regular voiding schedule. The goal is simply to keep the patient dry and is a frequently recommended therapy for frail elderly, bedridden or Alzheimer's patients.
- Bladder Retraining - Bladder retraining involves scheduled toileting but the length of time between bathroom trips is gradually increased. This therapy trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge and mixed incontinence.
- Pelvic Muscle Rehabilitation - This technique involves pelvic muscle exercises (PMEs), also known as Kegel exercises. PME may be used alone or in conjunction with biofeedback therapy, vaginal weight training, pelvic floor stimulation, and magnetic therapy. Read Nancy Muller's Keeping the Vital Pelvic Floor Healthy published in the Journal on Active Aging - International Council on Active Aging. View Entire Article
Pharmacological therapy (medications or drugs) is another common treatment for incontinence. Physicians can prescribe medications to help control incontinence, and sometimes they will take a person off a drug that is causing or contributing to incontinence. Of course, only your healthcare professional should tell you to stop using a drug he/she has prescribed.
Surgical treatment should be performed only after receiving a thorough diagnosis from a healthcare professional. All appropriate nonsurgical treatments should be tried before deciding on surgery. There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of your incontinence. Some of the more common procedures performed to treat urinary incontinence include, bladder neck suspension or sling procedures, periurethral bulking injections (collagen injections around the urethra), or implantation of an artificial urinary sphincter or sacral nerve stimulator. Your healthcare professional will thoroughly discuss any procedure you might need.
For those people whose incontinence cannot be cured or for those who are awaiting treatment, there are other devices or products to help manage incontinence. These include catheters, pelvic organ support devices, urethral inserts (plugs), external collection systems, penile compression devices, and absorbent products.