Bladder control problems, "incontinence," affects over ten million Americans and the number is increasing as our population ages. We define incontinence as the involuntary leakage of urine. Despite its high incidence in our society, many people do not seek medical help for this problem due to shame and embarrassment.

Incontinence can affect a person's self-image and self-respect. Many people affected will retreat from social interactions for fear of embarrassment. Most people with bladder control difficulties can be helped or even cured with modern treatment. Anyone with a significant bladder control problem is urged to seek proper medical help.

What Are The Different Types Of Incontinence?

STRESS INCONTINENCE results from a weakening or relaxation of the pelvic floor muscles that support the urinary bladder. Urinary leakage will occur with sneezing, coughing, laughing or exercising. The bladder control muscles cannot overcome the increased abdominal and bladder pressure or "stress" that accompanies these activities and urinary leakage results.

URGE INCONTINENCE is the sudden need to urinate that is so strong it cannot be prevented. It is usually associated with a spasm or involuntary contraction of the bladder muscle. This is the type of urinary leakage that is common in patients after a stroke.

MIXED INCONTINENCE describes the condition where both urge incontinence and stress incontinence occur together. This is usually found in the elderly.

OVERFLOW INCONTINENCE occurs when the bladder is unable to empty due to obstruction or unusual bladder muscle weakness. Any additional bladder filling results in leakage. This is most commonly found in men with enlarged prostates causing a blockage, but is also found in association with various neurological diseases, medications or as a consequence of various surgeries.

FUNCTIONAL INCONTINENCE describes the condition where the various bladder control organs can work normally, but limited mobility or sensation prevents the patient from getting to the bathroom and urinary leakage occurs.

What Causes Loss Of Bladder Control And Incontinence?

Multiple pregnancies and childbirths may result in stretching and weakening of the pelvic floor muscles surrounding the bladder neck. These muscles help prevent urinary leakage and if they are weakened or damaged leakage will result.

Irritation of the bladder from infections, stones or injury will cause leakage. Obstruction from an enlarged prostate or scarring from pelvic surgery or radiation will also interfere with normal bladder control. Various medical conditions such as diabetes will tend to make some patients lose control and develop leakage.

Neurologic disease such as multiple sclerosis, stroke, Parkinson's or spinal cord injury will affect the nerves that control the bladder and result in leakage. In many cases, medications given for other reasons will affect the bladder's nerves or muscles and cause incontinence.

How Is Incontinence Diagnosed?

The first step in evaluating a patient with incontinence is a thorough history and physical examination. The patient can help by preparing a voiding diary. This involves preparing a list of the times and amounts of involuntary urinary leakage during a period of at least several days up to a week. From this, the physician can begin to get an understanding of the degree and nature of the patient's particular incontinence problem. All medications should be listed as well as any medical treatments or surgeries that might have an influence on bladder control or function. The urine can be examined to determine the presence of any infection.

The next step will depend on the specific nature of the patient's incontinence problem. A careful evaluation of the bladder muscles, called "urodynamics," is often used. This is a type of bladder muscle testing that involves the placement of a soft rubber tube into the bladder and then filling the bladder with water while monitoring the pressure. An examination of the bladder with a special telescope, called "cystoscopy," is another diagnostic test that is frequently recommended. X-rays of the kidneys and bladder may also be helpful.

What Treatments Are Available?

The management of incontinence is different for each patient, but in general we try the simplest remedies first and resort to surgery only in selected cases resistant to other methods. The following is a listing of some of the treatment options available.

Environmental factors that contribute to leakage can be eliminated. Making a toilet available to a patient on a regular basis can help some people. Medications that aggravate the leakage problem can be stopped or changed.

Many people find various foods and beverages affect their bladder control. These foods include coffee, tea, caffeine, carbonated beverages, citrus fruits and juices, tomatoes, spicy foods, sugar, honey, milk, milk products, chocolate and nutrasweet.

Various medications can help improve bladder control. Antibiotics will eliminate infections. There is a nasal spray that will reduce urine production overnight for patients with nighttime problems. Estrogen vaginal cream allows many women to improve their bladder control.

Biofeedback techniques and behavioral modification exercises help many patients with their urinary leakage. Special exercises and pelvic floor stimulation with a small electrical device strengthen weakened pelvic muscles and reduce incontinence.

Intermittent catheterization can be used to decrease bladder residuals in some patients. Permanent catheters are discouraged whenever possible.

Selection of appropriate medical grade absorbent undergarments and bed pads can be very effective in managing bladder control problems not adequately handled by other means.

When these treatments fail, surgery can sometimes be helpful, including the new injectable therapy involving liquefied cartilage which can be injected into the bladder neck area and urethra to help increase control in selected patients. Endoscopic urethropexy, where the bladder neck is surgically stabilized using only two small incisions in the lower abdomen, is another new surgical technique now available to patients.

Almost every patient with significant bladder control problems can be helped through modern treatment. There is no longer any need to suffer from this embarrassing but correctable problem. Most people will not need surgery to improve their bladder control and resume their full normal activities.