Freelance Writing Jobs | Today's Articles | sign in

Urinary Incontinence in Adults

Involuntary Loss of Bladder Control is Probably Underreported

Apr 3, 2009 Stephen Allen Christensen

Urinary incontinence is more common than believed. Those who suffer from this condition--and those who care for them--are often embarrassed, isolated, and exhausted.

Urinary incontinence (UI) is the involuntary leakage of urine from the bladder. This condition causes embarrassment, social isolation, and depression for those individuals who are affected.

In 2006, approximately 13 million Americans were thought to suffer from UI, but this estimate is undoubtedly low. A 2008 study revealed that up to 55% of older women and 12 to 42% of younger and middle-aged women suffer from UI. (Holroyd-Leduc JM, et al. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446-1456)

At least 15% of elderly men suffer from UI.

Many elderly people are institutionalized because families or caregivers cannot deal with their incontinence. For the bedridden individual, UI leads to skin irritation and eventually contributes to the formation of decubitus ulcers (bedsores).

Elderly persons who experience urinary urgency are at higher risk for falls and fractures as they attempt to get to a bathroom.

Several types of UI have been described; they are characterized by the patient’s symptoms and the factors that initiate or worsen the incontinence. While it is useful to identify the type of UI in a given individual, treatment modalities often overlap.

Types of Urinary Incontinence

Urge incontinence: the most common type of UI in the elderly, but can affect younger people. Characterized by a sudden, uncontrollable need to empty the bladder, followed by the leakage of moderate to large volumes of urine. Bedwetting and nocturnal incontinence are common.
Stress incontinence: leakage of urine that is due to sudden increases in intra-abdominal pressure (sneezing, coughing, lifting, laughing, etc.). Usually involves low to moderate volumes of urine. Common in younger women due to weakening of the pelvic floor during childbirth; more severe in obese individuals.
Overflow incontinence: dribbling of urine from a bladder that is overfull. The second most common form of UI in men. Leaked volumes are usually low, but leaking may be persistent or constant.
Functional incontinence: inappropriate loss of urine secondary to cognitive or physical disabilities (e.g., dementia, stroke, pulmonary or cardiac disease, orthopedic impairment) that prevent an individual from getting to a bathroom in time to empty the bladder.
Mixed incontinence: combinations of any of the above types. Urge incontinence, for example, is often accompanied by functional incontinence.

Conditions that Contribute to Urinary Incontinence

A variety of medical conditions can aggravate UI or interfere with treatment:

Constipation and fecal impaction
Atrophic vaginitis
Urinary tract infections
Kidney stones
Psychiatric conditions (e.g. psychosis, delirium, dementia, depression)
Drugs (alcohol, decongestants, antihistamines, diuretics, blood pressure medications, pain killers, medications for prostate enlargement, etc.)
Orthopedic or neurologic problems (e.g., hip fracture, use of walkers, stroke, spinal cord injury)

Treatment for Urinary Incontinence

Once a person’s UI has been characterized—and this may require evaluation by a urologist—treatment can be more effectively targeted.

Most people benefit from bladder training. This might include timed or prompted voiding, changes in fluid intake (i.e., ensuring sufficient intake of fluids at appropriate times of the day), avoidance of substances that irritate the bladder (e.g., caffeine), and Kegel exercises.
Portable commodes, padded undergarments or absorbent pads, and even intermittent self-catheterization can supplement other therapies; these modalities should not be used as substitutes for comprehensive evaluation and treatment.
Drugs are used to supplement bladder training techniques: alpha-agonists, alpha-antagonists, anticholinergics, antimuscarinics, or estrogens can be useful, depending on the predominant cause of the UI.
Surgery is the treatment of last resort.

(From The Merck Manual, 18th Edition, 2006:1950-60)

Urinary incontinence is a significant health issue in the United States. It is underreported because of the stigma associated with this condition. Treatment is multifaceted; its success depends upon the patient’s underlying condition and motivation.

The copyright of the article Urinary Incontinence in Adults in General Medicine is owned by Stephen Allen Christensen. Permission to republish Urinary Incontinence in Adults in print or online must be granted by the author in writing.