Incontinence (Urinary Incontinence)

Incontinence, the inability to control the flow of urine, affects about 10 million Americans. Between 10 and 30 percent of people over the age of 65 who are living independently are incontinent, as are more than 50 percent of those who live in nursing homes and other long-term care institutions. The problem, which is more common in women, may be transient or chronic, depending upon its cause.

Urge incontinence is characterized by a sudden, overwhelming desire to urinate and an inability to hold the urine long enough to get to a toilet. This may be due to a disorder or obstruction of the bladder or a urological problem, such as stroke, multiple sclerosis, or Parkinson's disease. In many cases, however, a cause cannot be identified. Then the condition is referred to as idiopathic incontinence.

Stress incontinence is an involuntary loss of a small amount of urine as a result of coughing, sneezing, laughing, straining, or any other motion that increases pressure in the abdominal cavity. Especially common in older women, it is due to a weakening of the muscles that support the bladder and control the urine flow. These muscles can lose tone as a result of repeated pregnancies, obesity, or hormonal changes during menopause. In men, stress incontinence is most common after prostate surgery.

Diagnostic Studies and Procedures

The type of incontinence is usually apparent from the patient's description of the symptoms. In addition, a urine analysis will be ordered to rule out a urinary tract infection, which can cause transient incontinence.

Other tests depend on the possible cause. If a stroke or other neurological problem is suspected, an electroencephalogram and a brain scan may be ordered. Sometimes the bladder is filled artificially and a catheter placed in it so that pressures can be observed and function monitored by a computer.

Medical Treatments

Treatment can cure or significantly improve about two-thirds of all cases. Antibiotics will be prescribed when a urinary infection has been identified. For stress incontinence, a pessary - a donut shaped device - may be inserted into the vagina to support the uterus and bladder. Urge incontinence may be treated with medications that prevent the bladder from contracting.

In cases where no underlying problem can be identified, alpha-adrenergic drugs may be given to help close the neck of the bladder (many older patients cannot take these medications, however, because they tend to elevate blood pressure). Surgery may be performed to restore the neck of the bladder to its normal position.

Estrogen cream is often prescribed to help restore muscle tone in menopausal and postmenopausal women, even if they are taking oral estrogen.

Alternative Therapies

Biofeedback Training. Behavior modification using biofeedback to train the bladder to wait a certain length of time before emptying is sometimes helpful. The goal is to gradually lengthen the intervals between urinating until a normal pattern is established.

Herbal Medicine. Herbalists may recommend extracts of horsetail or sweet sumac, or huang chi, a Chinese herb available in capsule and tincture forms. Chinese herbalists also suggest the Rehmannia Eight formula and cervus with powdered deer antler added as treatments for incontinence. If a urinary tract infection is responsible, drinking diluted marsh mallow root extract may help. Saw palmetto tea or capsules are also recommended.

Homeopathy. For nocturnal incontinence, practitioners recommend belladonna, to be taken every four to six hours. Causticum is advocated for stress incontinence, and gelsemium is used when the prostate is enlarged or a bladder stone is obstructing the flow of urine. For constant dribbling of urine, verbascum thapsus may be prescribed.

Naturopathy. Eliminating coffee, tea, and other sources of caffeine from the diet is helpful in controlling urge incontinence. Drinking cranberry juice is said to deodorize the urine, minimizing the odor problems.

Self-Treatment

Women often find Kegel exercises helpful for strengthening the muscles of the pelvic floor to allow greater control over urination. The exercises involve the pubococcygeus muscle, which controls the bladder sphincter. To practice, imagine that you are stopping the flow of urine in midstream. Start by tightening this muscle, then squeeze your vagina, and finally, tighten the anus as if you are holding back a bowel movement. Hold each contraction for a slow count of three. Repeat the exercise 10 to 20 times, three or more times a day. You can do it while standing, siting, or lying down.

Rather than waiting for the urge to urinate, go to the bathroom every two or three hours. Use sanitary napkins or disposable adult diapers to catch small amounts of leaking urine, various types of adult diapers are available, including non-bulky ones that fit under clothing.

When caring for a person who is incontinent, provide a portable urinal or commode. Either can be purchased or rented from a medical supply company or through a pharmacy. Make sure that the patients clothing is easy to remove and keep the skin clean and dry to prevent sores and rashes.

Other Causes of Incontinence

Diuretic medications increase urine output and can cause incontinence. Emotional stress can also cause incontinence, especially in children.