Urinary Incontinence

GENERAL INFORMATION:

What is it?

• If you are unable to control when and where you urinate, this condition is called urinary (U-re-ner-ee) incontinence (in-KON-ti-nens). Urinary incontinence is a condition that has a cause, which can be treated, improved, and in some cases cured.
  
  
• The bladder is a hollow organ that holds urine. When you are ready to urinate, the urine travels from the bladder through the urethra (u-REE-thrah). The urethra is a small tube that goes from the bladder to the outside of the body.

What causes urinary incontinence? There are many different causes for urinary incontinence. The cause of your incontinence may include one or more of the following:

• Being immobile (not being able to move around).
  
  
• Blocked urethra, such as from an enlarged prostate. The prostate gland is a donut-shaped organ that circles the neck of the bladder in men.
  
  
• Caffeine.
  
  
• Certain medicines and herbs used to treat high blood pressure or swelling, or used to help a person lose weight.
  
  
• Constipation (having hard, dry stools which are difficult to pass, less often than usual).
  
  
• Diseases such as multiple sclerosis, Parkinson disease, or dementia.
  
  
• Hormone or weight changes in women, such as pregnancy or menopause.
  
  
• Kidney stones.
  
  
• Overactive bladder muscles.
  
  
• Urinary tract or vaginal infections (in-FEK-shuns).
  
  
• Weakness of the bladder, or the muscles that hold it in place.
  
  
• Weakness of the muscles that keep the urethra closed.

What may be done to treat urinary incontinence? Some people are so embarrassed about having urinary incontinence that they will not talk to caregivers about their problem. They may also think that incontinence cannot be treated. This keeps them from being helped by caregivers. If you have urinary incontinence, talk to your caregiver. Bring a list of your current medicines to your caregiver to see if they might be making your incontinence worse. You may need one or more of the following tests to find out what type of urinary incontinence you have, and help caregivers plan your treatment.

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Physical exam: Your caregiver will examine you and ask you questions about your current and past health and urinary habits.
  
  
• Post-void residual: A small soft tube is put into the bladder, or ultrasound is used to measure how much urine is left in the bladder after urinating.
  
  
• Stress test: This test checks to see if urine leaks when coughing, lifting, or exercising.
  
  
• Urine record: Caregivers may ask you to keep a record of when you urinate and when you are incontinent.
  
  
• Urine tests: Your urine is examined to look for signs of infection, blood, or other problems.
  
  
• Urodynamic (yer-oh-deye-NAM-iik) testing: This test looks at the bladder, urethra, and muscles with x-rays.
  
  
• Cystoscopy (sis-TOS-ke-pee): A cystoscope is put in your urethra and into your bladder. The scope is a long tube with a magnifying glass and light on the end. The scope may be hooked to a camera and pictures may be taken of the inside of your bladder. The scope may be used to take a tissue sample for tests or to look for kidney stones. During this test, small tumors can be removed or bleeding can be stopped.

How are different types of urinary incontinence treated? There are several different types of urinary incontinence. Caregivers will do tests to find out which type you have. Signs, symptoms, and treatment of urinary incontinence differ depending on the type of urinary incontinence you have.

• Stress incontinence: Stress incontinence is more common in women. You may lose urine when you exercise or strain in a certain way. You may go to the bathroom often during the day to avoid accidents. The following things may cause you to leak urine:
  
  
  • Standing up from a chair or getting out of bed.
    
    
  • Sneezing, coughing, or laughing.
    
    
  • Walking or doing other exercise.
  
  
• Treatment options for stress incontinence: You may have some of the following treatments alone or together:
  
  
  • You may be taught pelvic muscle exercises. These exercises are called Kegel exercises. They make the weak muscles around the bladder stronger. Caregivers may use a biofeedback machine to see how well you are doing these exercises.
    
    
  • You may be given special tools to help you hold your urine. These tools might be weights or pessaries (PES-ah-reez).
    
    
  • Stopping smoking and losing weight may also help your symptoms.
    
    
  • Alpha-adrenergic agonist (AL-fah ad-ren-ER-jik AG-oh-hist): These medicines tighten a part of your bladder to keep the urethra closed. This helps to stop urine leaking when you exercise or get up quickly.
    
    
  • Surgery may be needed to correct badly weakened pelvic muscles. Surgery can also return the neck of the bladder to its correct position.
  
  
• Urge incontinence: This condition is also called "overactive bladder". If you have urge incontinence, you start losing urine as soon as you realize you need to go to the bathroom. You may need to go the bathroom very often, such as every two hours, even during the night. You may even wet the bed. The following things may also make you leak urine:
  
  
  • Drinking even a small amount of liquids.
    
    
  • Not getting to the bathroom quickly enough.
  
  
• Treatment options for urge incontinence: You may have some of the following treatments alone or together:
  
  
  • "Distraction", which is thinking about other things to control the urge to urinate.
    
    
  • "Prompted voiding", which is learning to urinate at exact times each day.
    
    
  • Pelvic muscle, or Kegel exercises.
    
    
  • Biofeedback. This is a machine used that may help you to control your urges.
    
    
  • Limiting your intake of spicy foods, certain fruits, and drinks with caffeine. Caffeine may be found in coffee, tea, soda, and sports foods and drinks.
    
    
  • Anticholinergics/Antispasmodics (an-teye-ko-lin-ER-jik/an-teye-spaz-MOD-ik): This type of medicine stops the muscles of your bladder from contracting too much. You will not feel the urge to go to the bathroom as often. This medicine may cause you to be drowsy or have a dry mouth.
  
  
• Functional incontinence: If you have functional incontinence, you may have a disease or condition that limits your ability to move around. You may have Parkinson disease or a type of dementia (de-MEN-shah). You may also have an injury to your spinal cord or be recovering from surgery and be immobile. You could be in chronic pain. Often you may find that you have accidents on the way to the bathroom, or you may wet the bed.
  
  
• Treatment options for functional incontinence: You may have some of the following treatments alone or together:
  
  
  • Physical or occupational (ok-u-PAY-shun-al) therapy to help strengthen the muscles in your legs. This may make it easier to get to the bathroom in time. You may also be taught gait training, which is learning to walk safely.
    
    
  • Caregivers may teach you "prompted voiding", which is learning to urinate at exact times each day. This is especially helpful for people in nursing homes.
    
    
  • You may be provided with urinals or bedside commodes to help you more easily get to a toilet if you are in bed. You may also be fitted with a catheter.
    
    
  • Caregivers may have you stop taking certain medicines. These medicines may be causing you to have difficulties with walking or to be drowsy. Some medicines make you need to urinate more often. Talk to your caregiver if you have concerns about your medicines.
  
  
• Overflow incontinence: If you have overflow incontinence, you may feel that you never completely empty your bladder. Overflow incontinence is more common in men. You may have the following problems.
  
  
  • Lose small amounts of urine often during the day and night.
    
    
  • Often feel as if you have to empty your bladder but cannot.
    
    
  • Pain in your lower abdomen (stomach).
    
    
  • Pass only a small amount of urine but feel as though your bladder is still partly full.
    
    
  • Spend a long time at the toilet, but only make a weak, dribbling stream of urine.
  
  
• Treatment options for overflow incontinence: You may have some of the following treatments alone or together:
  
  
  • A catheter (KATH-e-ter) is a tube that can be placed in your urethra to help empty your bladder. Men may use a catheter placed outside the body to collect urine at night. This is called condom catheter.
    
    
  • Caregivers may teach you ways to empty your bladder more completely.
    
    
  • Cholinomimetic (koh-lin-oh-mi-MET-ik): This medicine causes your bladder to contract. It allows your bladder to empty all the way. It may cause you to feel sick to your stomach or dizzy.
    
    
  • Surgery may be needed to remove tissue or a kidney stone that is causing blockage.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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