Incontinence is simply inability to prevent the discharge of any of the excretions, especially of urine or feces. Urinary incontinence thus is an involuntary leakage or passage of urine. It is a common problem in elderly people, but can occur at any age.
Symptoms of urinary incontinence depend upon the type of incontinence which could include stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, functional incontinence, and total incontinence. Bed-wetting is also a type of urinary incontinence.
1. Stress incontinence
It is leakage of urine when abdominal pressure is increased in conditions such as laughing, sneezing, coughing, or lifting weight. Stress incontinence occurs when the sphincter (a ring-like muscle at the orifice of a tube) of the bladder is weakened.
2. Urge incontinence
This is sudden and intense desire to urinate, and the urination occurs before the patient could reach the toilet. In this condition, the patient may need to urinate frequently, often throughout the night. Urge incontinence may be associated with urinary tract infections. If the cause is not known, the condition may be called overactive bladder.
3. Mixed incontinence
A combination of both, the stress incontinence and the urge incontinence, thus symptoms of both are seen.
4. Overflow incontinence
In this condition, there is dribbling of urine, frequently or constantly, and an inability to completely empty the bladder. When trying to urinate, only a weak stream of urine comes out. Overflow incontinence may occur in people with blocked urinary passage or nerve damage. In men, it can be associated with prostate problems.
5. Functional incontinence
In this condition, urinary system may work well, but physical or mental disabilities or other circumstances prevent normal, timely toilet usage.
6. Total incontinence
This term is sometimes used to describe continuous leakage of urine, day and night, or the periodic involuntary passage of large volumes of urine.
It is the most common condition in childhood. The passage of urine occurs in sleep.
Causes may be temporary or persistent.
Conditions Associated with Temporary Urinary Incontinence
- Alcohol, carbonated drinks, tea, coffee, etc. act as a bladder stimulant and diuretic, thus cause an urgent need to urinate.
- Drinking a lot of fluids especially in a short period of time increases the amount of urine the bladder has to deal with and may result in urine incontinence.
- Certain medications such as antihypertensives, sedatives, muscle relaxants, and others may contribute to loss of bladder control and produce incontinence of urine.
- Urinary tract infection causes bladder irritation and a strong urge to urinate and may result in incontinence.
- Constipation. The same set of nerves supply both the rectum and the bladder. Hard, compacted stools in the rectum cause these nerves to be overactive and increase urinary frequency. In addition, sometimes due to constipation there is interference with emptying of bladder resulting in overflow incontinence.
Conditions Associated with Persistent Urinary Incontinence
1. Pregnancy and childbirth
Because of hormonal changes and the increased weight of an enlarging uterus, stress incontinence may result. In addition, vaginal delivery weakens the muscles and nerves of pelvic floor. Thus bladder control is affected and incontinence results.
In old age, bladder capacity decreases and there is overactivity of bladder. The condition can be worse if associated with conditions such as diseases of blood vessels, smoking, high blood pressure, or weight gain.
After menopause, production of estrogen (a hormone that helps keep the lining of the bladder and urethra healthy) decreases. Thus with decreased estrogen levels, these tissues deteriorate and cause bladder irritability and urine incontinence.
Hysterectomy (removal of uterus) causes damage to the supporting pelvic floor muscles and ligaments and lead to incontinence.
5. Interstitial cystitis or painful bladder syndrome
This condition is associated with painful and frequent urination, and sometimes incontinence of urine.
Loss of bladder control and urinary incontinence may be associated with prostatitis (inflammation of prostate gland, a walnut-sized organ located just below the male bladder).
7. Benign prostatic hyperplasia (BPH) or enlarged prostate
In old age, incontinence sometimes occurs due to enlargement of the prostate gland.
8. Prostate cancer
In this condition, the incontinence can either be due to prostate cancer directly or as a side effect of its treatment.
9. Neurological disorders
Such as multiple sclerosis, Parkinson’s disease, stroke, brain tumor, or a spinal cord injury can affect bladder control through defect in nerve conduction. Thus urinary incontinence results.
Obstruction can be anywhere in the urinary tract, in the kidneys, bladder, or uterus. It can be due to a tumor or a stone and may cause blockage in the normal flow of urine resulting in incontinence, usually overflow incontinence.