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Incontinence Explained

Urinary incontinence is the inability to control urination. The term may be used interchangeably with Over-active Bladder (OAB) which also includes the same frequency in urination and urinary urge.

People who suffer from overactive bladder, or urinary incontinence, can't hold their urine -- they wet themselves. (Leaking urine is normal only in infants; it is not a normal result of aging). If you have this problem, you may be too embarrassed or upset to ask for help. Don't be.

It is estimated that over 12 million Americans have urinary incontinence. Incontinence affects all ages, both sexes, and people of every social and economic level. It is also estimated that 15 to 30 percent of people over the age of 60 who live at home have incontinence. Women are twice as likely as men to have this condition. In addition, at least half of the 1.5 million Americans who reside in nursing homes are incontinent. The exact number of people with incontinence is not known, but the total number of people affected may be far greater than current estimates.

Incontinence is classified by the symptoms of or circumstances occurring at the time of urine leakage.

Stress Urinary incontinence may be due to poor bladder support by the pelvic muscles or to a weak or damaged sphincter. This condition allows urine to leak when you do anything that strains or stresses the abdomen, such as coughing, sneezing, laughing, or even walking.

Urge incontinence results when an overactive bladder contracts without your wanting it to do so. You may feel as if you can't wait to reach a toilet. At times, you may leak urine without any warning at all. A bladder can become overactive because of infection that irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. In other cases, the cause may be unclear.

Mixed incontinence is often a combination of both conditions above -- stress urinary incontinence and urge incontinence. Overflow urinary incontinence occurs when the bladder does not empty properly and it becomes so full that it simply overflows. This happens when bladder weakness or a blocked urethra prevents normal emptying. An enlarged prostate can result in such blockage. For this reason, overflow incontinence is more common in men that in women. Bladder weakness can develop in both men and women, but it happens most often in people with diabetes, heavy alcohol users, and others with decreased nerve function.

Environmental incontinence (sometimes called functional incontinence) occurs when people cannot get to the toilet or get a bedpan when they need it. The urinary system may work well, but physical or mental disabilities or other circumstances prevent normal toilet usage.

Nocturnal enuresis is incontinence that occurs during sleep.

When individuals have two or more types of incontinence, the causes of each must be found and considered in planning appropriate treatment.

Some Possible Causes of Incontinence:

Other causes can be longer lasting, even permanent. These include such conditions as an overactive bladder muscle, weakness of the muscles holding the bladder in place, weakness of the sphincter muscles surrounding the urethra, birth defects, an enlarged prostate, spinal cord injuries, surgery, or diseases involving the nerves and/or muscles (multiple sclerosis, muscular dystrophy, polio, and stroke). In some cases, more than one factor causes incontinence in a single individual.

For millions of Americans, incontinence is not just a medical problem. It is a problem that also affects their emotional, psychological, and social well being. Many people are afraid to participate in normal daily activities that might take them too far from a toilet. So it is particularly important to note that the great majority of incontinence causes can be treated successfully.

How Does the Body Normally Control Urine Flow?

To better understand incontinence, it helps to know a bit about the urinary tract (also called the urinary system), particularly the parts that store and release urine. Urine is waste and water removed from the blood by the kidneys. Urine flows from the kidneys downward through a pair of tubes (the urethras) to the bladder. The bladder is a balloon-like container that stores urine. Urine leaves the body through another tube (the urethra) at the bottom of the bladder.

Urination is controlled by muscles, called sphincters, located at the base of the bladder and in the wall of the urethra. These normally stop the flow of urine. Usually, the sphincters close off the neck of the bladder and the urethra -- like a tie around the bottom of a balloon -- urine will not leak. When the sphincters relax, they open the passage for urine. At the same time, the muscle of the bladder wall contracts (squeezes) and forces the urine out of the bladder. When urination is finished, the sphincters contract, and the bladder itself stops squeezing and relaxes the muscles that control urine flow.

Urge incontinence results when an overactive bladder contracts without your wanting it to. You may fell as if you can't wait to go. Sometimes you may leak urine without any warning at all. A bladder can become overactive because of an infection that irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. In other cases, the cause is not clear.

Stress incontinence may be due to a weak sphincter or an abnormal urethra. This condition allows urine to leak when you do anything that strains or stresses the abdomen, such as coughing, sneezing, laughing, or even walking.

Overflow incontinence occurs when the bladder is allowed to become so full that it simply overflows. This happens when bladder weakness or blockage prevents normal emptying. An enlarged prostate (the male gland surrounding the urethra) can result in such blockage. For this reason, overflow incontinence is more common in men than in women. Bladder weakness can develop in both men and women, but it happens most often in those with diabetes, heavy alcohol use, or any condition that can lead to decreased nerve function.