Incontinence

Incontinence and Overactive Bladder&nbsp&nbsp Definition of Incontinence

Urinary Incontinence
Urinary Incontinence is the inability to control urinary functions effectively; the result is that a person is unable to make it to the toilet in time. Incontinence is often temporary, and it almost always results from an underlying medical condition. It is a condition that ranges from mild leakage to uncontrollable wetting.

Stress Incontinence
Stress Incontinence happens when urine leaks during exercise, coughing, sneezing, laughing, \lifting heavy objects, or other body movements that put pressure on the bladder. It is the most common type of incontinence and can almost always be cured.

Urge Incontinence
Urge Incontinence occurs when an overactive bladder contracts without your wanting it to do so. Although healthy people can have urge incontinence, it is often found in people who have diabetes, stroke, dementia, Parkinson's disease, or multiple sclerosis. It can also be a warning sign of early bladder cancer. In men, it is often a sign of an enlarged prostate.

Overflow Incontinence
Overflow Incontinence happens when small amounts of urine leak from a bladder that is always full. In older men, this can occur when the flow of urine from the bladder is blocked, usually by an enlarged prostate. It can sometimes be prevented by medication when early symptoms of prostate enlargement, such as frequent urination, appear. Some people with diabetes also have overflow incontinence.

Functional Incontinence
Functional Incontinence happens in many older people who have relatively normal urine control but who have a hard time getting to the toilet in time because of arthritis or other crippling disorders.

Incontinence and Overactive Bladder&nbsp&nbsp Diagnosing

Overview
The first and most important step in treating incontinence is to see a doctor for a complete medical exam. The doctor may check urine samples and ask questions about your history and specific situation. The RealAge Incontinence and Overactive Bladder Health Assessment ( Free Incontinence Assessment )can provide a list of your symptoms to take with you to discuss with your doctor. You may be referred to a urologist, a doctor who specializes in diseases of the urinary tract, or to a gynecologist, a specialist in the female reproductive system.

Symptoms
The symptoms of an overactive bladder or incontinence are different for everyone, but rarely do they go away on their own. If you are experiencing any of the following symptoms, talk to your doctor.

1. Having the urge to urinate more than 8 times per day
2. Getting up 2 or more times during the night to urinate
3. Leaking urine unexpectedly
4. Wetting the bed or clothing

1. Obesity
2. Smoking
3. Pregnant or have carried to full term
4. Postmenopausal
5. Have bladder infections
6. Aged 60 years or older
7. Have an enlarged prostate or a family history of prostate trouble
8. Have had pelvic surgery or injury
9. Have had a disease that might cause nerve or muscle damage
10. Have had a stroke

1. Take the RealAge Incontinence and Overactive Bladder Health Assessment and print your symptoms.
2. Write down any medications you may be taking in the space provided on your RealAge Overactive Bladder Symptoms sheet.
3. Keep a record of your incontinence for a week. For each 3-hour period, note the type and quantity of fluid intake, the amount voided, the amount of leakage (small, medium, large), what you were doing when the leakage occurred, and whether you had the urge to urinate beforehand.
4. Take the information you’ve gathered from 1-3 above to your doctor. This information will help your doctor determine what kind of tests you should have and what treatment is best for your situation. You may be referred to a urologist or a urogynecologist, doctors who specialize in the urinary tract.

Incontinence and Overactive Bladder&nbsp&nbsp Self-Treatment

Overview
To find the cause of incontinence and treat your condition, talk to your doctor. Only you and your doctor can determine the right treatment for your condition. You can, however, help avoid and minimize symptoms. Avoiding or Minimizing Symptoms
If you have already visited your doctor to determine the cause of your incontinence, or if you want to be proactive against incontinence, there are several things you can do to help keep your bladder healthy:

1. Don’t smoke.
2. Go to the bathroom when you need to. Every 2-3 hours when you’re awake is about right for the average, healthy adult.
3. Avoid caffeine, acidic foods, and alcohol.
4. Before you sneeze, cough, laugh, jump, or lift something heavy, squeeze and hold your pelvic muscles tightly.
5. Lose weight if you are overweight.
6. Do Kegel exercises. These help strengthen weak sphincter and pelvic floor muscles in both men and women. To do them, clench the muscles that you use to stop urine flow. Hold tightly for 5 seconds, then rest for 10 seconds. Repeat for 10 to 20 sets, three times a day.
7. Drink plenty of water each day.

To learn which muscles you need to strengthen, try to stop the flow of urine the next time you go to the bathroom. One of the ways to do Kegel exercises is to tighten these muscles for a count of five and then relax them. Repeat this tightening 10 to 20 times. Do this exercise several times each day.

Incontinence and Overactive Bladder&nbsp&nbsp What to Expect at the Doctor

Overview
After going over your history, your doctor may suggest testing to determine the cause of your incontinence and to determine which treatment is right for you. Your doctor may recommend one or more of the following tests to determine the cause of your incontinence. All of these tests can be done in a doctor’s office and do not require surgery.

Tests
Urinalysis
At the doctor’s office restroom, you will collect a sample of your urine in a sterile cup. This sample will be analyzed at the lab for the presence of bacteria, blood, or other abnormalities. Some analyses can be done right away, such as testing for bacteria, and some will take a couple of days.

Post-void residual measurement
If you have the urge to urinate frequently, but you don’t void much fluid, your doctor might recommend a post-void residual measurement test to see if you are emptying your bladder completely. Your doctor might insert a small, soft tube, called a catheter, into the bladder through the urethra to drain any remaining urine. Alternatively, your doctor might measure by using ultrasound. Ultrasound is when sound waves are directed at the bladder and images are shown on a monitor. These images show the size and shape of your bladder and can show how much urine remains in the bladder.

Ultrasound
Your doctor may use ultrasound, or sound waves, to view and measure the size and shape of the kidneys, bladder, and prostate, and to check for abnormal growths or fluid.

Cystoscopy
Depending on your condition, your doctor might need to see the inside of the bladder. Your doctor would use a thin telescope-like instrument, called a cystoscope, which would be inserted into the bladder through the urethra.

Stress Test
This could be a series of tests that analyze the function of your bladder and sphincter muscles. These tests will tell your doctor whether you have normal bladder sensations and capacity and whether your bladder fills and empties in a healthy manner. For example, you might be X-rayed while voiding, coughing, or straining to measure how much the position of the bladder changes during these activities.

Treatment Options
Your doctor most likely will recommend a combination of one of the following treatments: behavioral techniques, medication, surgery, using a pessary, using a catheter, or electrical stimulation.

Behavioral Techniques
Behavioral techniques such as pelvic muscle exercises, biofeedback, and bladder training can help control urination. These techniques can help you sense that your bladder is filling and help delay voiding until you can reach a toilet.

• Kegel exercises: To do these pelvic muscle exercises, clench the muscles that you use to stop urine flow. Hold tightly for 5 seconds, then rest for 10 seconds. Repeat for 10 to 20 sets, three times a day.
• Biofeedback: Biofeedback uses a measuring system to help you become aware of your body's functioning. Electronic devices and diaries are two ways to track when your bladder and urethral muscles contract. With this information, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
• Bladder training: Biofeedback and muscle conditioning -- known as bladder training -- can alter the bladder's schedule for storing and emptying urine, which can be effective for urge and overflow incontinence. Chart the timing of your voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Use the toilet 20 to 30 minutes after each meal, at least twice between meals, and before you go to bed. You can set a timer to remind you. Adjust the schedule as you learn the frequency that best meets your needs.

Pessary
Stress incontinence can be eased by using a pessary, which is similar to the outer ring of a diaphragm. The pessary is inserted around a woman's cervix, where it gives support to the pelvic muscles. Your doctor may advise a pessary if lax pelvic muscles are contributing to the incontinence.

Catheter
Catheters are often used to help with overflow incontinence. A catheter is a soft tube that you can learn to insert through the urethra into the bladder to drain urine. A catheter may be used only when you need it or constantly, in which case the tube connects to a bag that you can attach to your leg. If you experience any pain or burning while using a catheter, talk to your doctor. You could be experiencing symptoms of a urinary tract infection.

Electrical Stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a similar way that exercising the muscles does. Electrical stimulation can help stabilize overactive muscles and exercise urethral muscles.

Surgery
Doctors don’t usually suggest surgery to alleviate incontinence until all other treatments have been tried. Sometimes surgery can improve or cure incontinence if it is caused by a structural problem. For example, most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position.

Additional Information
Incontinence Resource Center