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Urinary Incontinence

What is Urinary Incontinence?

Urinary control relies on the finely coordinated activities of the smooth muscle tissue of the urethra and bladder, skeletal muscle, voluntary inhibition, and the autonomic nervous system.

Urinary incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innervation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause urinary incontinence.
Acute and temporary urinary incontinence are commonly caused by the following:

  • Childbirth
  • Limited mobility
  • Medication side effect
  • Urinary tract infection

Chronic urinary incontinence is commonly caused by these factors:

  • Birth defects
  • Bladder muscle weakness
  • Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)
  • Brain or spinal cord injury
  • Nerve disorders
  • Pelvic floor muscle weakness
  • Vaginal Prolapse

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Types of Urinary Incontinence

Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of urinary incontinence cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with benign prostate hyperplasia (BPH). The primary characteristics of these types of urinary incontinence include:

  • Stress — urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing)
  • Urge — urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability)
  • Mixed — both stress and urge incontinence
  • Overflow — constant dribbling of urine; bladder never completely empties

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Incidence and Prevalence of Urinary Incontinence

The U.S. Department of Health and Human Services reported in 1996 that approximately 13 million people in the United States suffer from urinary incontinence. Urinary incontinence is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected by urinary incontinence. At least 50% of nursing home residents are affected. Of that number, 70% are women.

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Treatment Options

Treatment options and incontinence supplies for urinary incontinence depend on the type of incontinence as outlined below.

Stress urinary incontinence is urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing). Treatment options include:

  • Injectables via catheters
  • Nonsurgical treatments
  • Medications
  • Surgical treatments

Urge urinary incontinence is urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability). Treatment options include:

  • Nonsurgical treatments
  • Medications
  • Surgical treatments

Overflow urinary incontinence is constant dribbling of urine; bladder never completely empties. Treatment options include:

  • Medications
  • Intermittent use of catheter products (typically self-catheterization)

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Management of Urinary Incontinence

There are several things patients can do to help reduce urinary incontinence.

  • Avoid overconsumption of diuretics, antidepressants, antihistamines, and cough-cold preparations.
  • Perform Kegel exercises daily.
  • Practice double voiding (urinate, wait a few seconds, urinate again).
  • Eat fruits, vegetables, and whole grains daily to prevent constipation.
  • Retrain the bladder (urinate only every 3 to 6 hours).
  • Stop smoking (nicotine irritates the bladder).

A number of protective devices and incontinence supplies are available to help manage urinary incontinence, including the following:

  • Bed pads
  • Combination pad-pant systems
  • Disposable or reusable adult diapers
  • Full-length absorbent undergarments
  • Male incontinence drip collectors
  • Male and female catheter products
  • Underwear liners (pads, guards, shields, inserts)

Early reliance on absorbent pads may cause the wearer to accept urinary incontinence rather than seek diagnosis and treatment. These urinary incontinence supplies should be applied correctly and changed often (especially if you rely on catheters) to prevent skin irritation and urinary tract infection.

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