Urinary incontinence is the involuntary leaking of urine. It affects approximately 13 million American men and women of all ages. Many people suffer in silence with this disorder. Yet, incontinence can be easily managed or treated.
Normal Urine Flow
To better understand incontinence, it may help to understand a bit more about the parts of the urinary tract that store and release urine (Figures).
Urine flows from the kidneys through a pair of tubes called the ureters to the bladder, where it is stored. Urine leaves the bladder through another tube called the urethra. Urination is controlled by the sphincter muscles and the muscle of the bladder wall. The sphincter muscles are responsible for allowing urine to pass through the bladder neck into the urethra. The muscles of the bladder wall are responsible for forcing urine out of the bladder. Incontinence occurs if closure of the sphincter muscles is inadequate or if the bladder muscle is overactive and contracts involuntarily.
Types of Incontinence
•Stress urinary incontinence—due to poor bladder support by weak pelvic and bladder sphincter muscles. It affects more women than men. It can occur as a result of multiple childbirths or estrogen deficiency. This condition allows urine to leak when anything puts a strain on the abdomen, such as coughing, sneezing, laughing, or lifting heavy packages.
•Urge incontinence—also called overactive bladder. This incontinence happens when the bladder muscle contracts when you do not want it to. Urge incontinence affects both men and women. This incontinence can be due to a bladder infection or a condition (such as stroke, Alzheimer's disease, or Parkinson's disease) that may affect the nerves that control the bladder. This condition causes a sudden strong urge to urinate and an inability to get to the bathroom fast enough. It also can cause urine leakage with no warning.
•Overflow incontinence—occurs when the bladder becomes so full of urine that it overflows. The bladder can overflow due to bladder muscle weakness or blockage that prevents it from emptying properly. Bladder weakness can develop in both men and women. It can be caused by conditions that decrease nerve function, by diabetes, or by heavy alcohol use. An enlarged prostate can cause blockage. Thus overflow incontinence is more common in men than in women. These conditions result in involuntary leaking of urine, trouble getting the urine stream started, and dribbling of urine.
•Mixed incontinence—a combination of stress and urge incontinence. When an individual has 2 or more types of incontinence, the causes of each must be identified so that the conditions can be treated properly.
Treatments for Incontinence
Many types of treatments for incontinence are available, including lifestyle and medication options. A qualified specialist can recommend the treatments that are best for your condition.
Lifestyle changes that can improve incontinence include stopping smoking; losing weight, if you are overweight; avoiding bladder irritants; and not drinking large amounts of fluid, especially at bedtime. Special exercises and training programs are effective in improving bladder control. The American Urological Association makes the following recommendations:
•Avoiding dietary bladder irritants: Some of the most common bladder irritants are alcohol, carbonated beverages (with and without caffeine), coffee or tea (with and without caffeine), chocolate, citrus fruits, tomatoes, and acidic fruit juices.
•Bladder training: A diary is kept of fluid intake, urination times, and when urinary accidents occur. The diary is used to set time intervals for urination before an accident occurs. By achieving regular bladder emptying, you should have fewer incontinent episodes.
•Bladder retraining: The goal of retraining is to increase the amount of urine that you can hold within your bladder. A diary is used to determine how often you urinate. Individuals are then instructed to gradually increase the interval between urination by 15 to 30 minutes per week.
•Pelvic floor exercises: These exercises also are known as Kegel exercises. They help strengthen the sphincter and pelvic muscles. Individuals who are able to contract and relax the pelvic floor muscles can improve their strength by doing the exercises regularly.
Medications can be prescribed to relax the bladder or tighten the sphincter muscles. The medications used depend on the type of incontinence that you have.
•Stress incontinence may be treated with drugs that cause the sphincter muscles to contract and tighten the bladder neck. Two of these medications are Sudafed (pseudoephedrine) and Tofranil (imipramine). Postmenopausal women may benefit from hormone treatment. With loss of estrogen, the tissues in the bladder neck and urethra become weakened and are unable to close properly. Hormone replacement improves the health of these tissues.
•Urge incontinence is treated with drugs that have anticholinergic properties (blocking the passage of impulses through the nerves). Anticholinergics allow for relaxation of the bladder wall muscle. Commonly used anticholinergic agents for the treatment of incontinence include Ditropan (oxybutynin chloride) and Detrol (tolterodine tartrate).
•Overflow incontinence due to an enlarged prostate is treated with drugs that can shrink the size of the prostate, such as Proscar (finasteride) or Avodart (dutasteride). Other medications can help relieve some of the pressure on the urethra due to the enlarged prostate. These medications include Hytrin (terazosin), Cardura (doxazosin), Flomax (tamsulosin), and Uroxatral (alfuzosin). If overflow incontinence is due to problems with bladder muscle contraction, it can be treated with Urecholine (bethanechol).
Certain medications for other conditions can affect bladder control. Remember to talk to your pharmacist or your doctor about medications that can worsen or treat incontinence. If you would like more information about urinary incontinence, please contact one of the following resources:
•American Foundation for Urologic Disease: www.afud.org or www.incontinence.org
•American Urological Association: www.urologyhealth.org
•National Association for Continence: www.nafc.org
Dr. Singla is an assistant professor of pharmacy practice at Midwestern University College of Pharmacy—Glendale, Glendale, Ariz.