الأحد، 12 يونيو 2011

Urinary Incontinence

Overview, Causes, & Risk Factors

Urinary incontinence is the uncontrollable loss of urine. The six main types of urinary incontinence are:
  • urge incontinence, which is an urgent need to urinate followed by urine leakage

  • stress incontinence, which is the leakage of urine when laughing, coughing, sneezing, or lifting heavy objects

  • overflow incontinence, which occurs when small amounts of urine leak from a full bladder

  • total incontinence, or a constant dripping of urine day and night

  • psychological incontinence, which has an emotional rather than a physical cause

  • mixed incontinence, which is a mixture of the causes listed


    • What is going on in the body?
    Urinary incontinence can occur at any age. The kidneys constantly produce urine. Urine flows through two long tubes, or ureters, to the bladder, where urine is stored. A muscle at the bottom of the bladder stays contracted, or tightened, so urine remains in the bladder until it is full. When the decision is made to urinate, the muscle relaxes and urine flows out. The entire process is complex. The ability to control urination can be disrupted in different ways, resulting in urinary incontinence.
    What are the causes and risks of the condition?
    Urinary incontinence can occur at any age. Women are twice as likely as men to be affected. The cause of this condition is different among different age groups. There are many possible causes of urinary incontinence. These include:
  • urinary tract infection

  • stones in the bladder

  • emotional disturbances

  • side effects of medications

  • weakened bladder muscles

  • excessive caffeine or alcohol intake

  • nerve damage to the bladder

  • severe constipation

  • overactivity of the bladder

  • in women, lack of the main female hormone known as estrogen

  • changes in the body from childbirth or surgery

  • enlargement of the prostate or benign prostatic hyperplasia

    • Symptoms & Signs

    What are the signs and symptoms of the condition?
    The symptoms of urinary incontinence include:
  • uncontrolled leakage of urine

  • urine leakage after coughing, laughing, or sneezing

  • bedwetting

    • Diagnosis & Tests

    How is the condition diagnosed?
    People often live with incontinence without seeking help. Many cases can be cured or controlled if the treatment is started early.
    The condition is diagnosed mainly on the pattern of symptoms. Different types of urinary incontinence are diagnosed if symptoms started recently and suddenly, or if they developed over a period of time. If symptoms started suddenly, the cause is most likely a bladder problem. The most common bladder problem is infection. Usually the cause can be discovered by a healthcare professional by taking a thorough history of the problem and performing a physical exam. A test of the urine, called a urine culture, must be done to check for infection.
    Sometimes special tests during urination may be required.

    Prevention & Expectations

    What can be done to prevent the condition?
    There are ways to prevent urinary incontinence:
  • Exercising the muscles of the pelvic floor can help. To find these muscles, a person can simply stop the flow of urine while urinating. This exercise should be practiced several times a day to strengthen the muscles.

  • Drinking one or two glasses of cranberry juice each day will help prevent infection.

  • Drinking at least eight glasses of water each day will keep the urine dilute.


    • What are the long-term effects of the condition?
    Urinary incontinence is the second leading cause of institutionalizing elderly people. The problem contributes to the development of pressure sores, bladder and kidney infections, and depression. Depression is a common long-term effect. The condition disrupts the normal activities of daily living. Without correct diagnosis and treatment, the problem will worsen and will be even more difficult to treat. Urinary incontinence is also embarrassing and frustrating.

    Treatment & Monitoring

    What are the treatments for the condition?
    Treatment depends, in part, on the problem. A doctor can discuss the available treatments. The best treatment needs careful analysis of the problem in each person. Newer treatments involve electrical stimulation of the muscles that close the bladder. Treatment often involves simple steps to regain bladder control. These steps include:
  • avoiding alcohol and drinks containing caffeine such as coffee and sodas

  • drinking lots of water to keep urine dilute

  • urinating frequently to keep the bladder as empty as possible

  • refraining from taking any medications that may irritate the bladder


    • What are the side effects of the treatments?
    The side effects of treatment depend on the type of incontinence that is diagnosed and the method used to treat it. It is important to check with a doctor before stopping any medication.
    How is the condition monitored?
    Follow up is important in any treatment to make sure progress is being made.

    Attribution

    Author:Dr. Karen Wolfe, MBBS, MA
    Date Written:
    Editor:Evans, Gwen, BA
    Edit Date:03/29/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:09/04/01
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