Not surprisingly, few people are willing to openly discuss their bladder and urine problems—despite more and more frequent commercials for disposable underwear and pharmaceuticals that aim to prevent embarrassing “leaks.”
Specifically, urinary incontinence is another term for an overactive bladder, or the inability to hold in urine. This happens due to loss of voluntary control over the urinary sphincters, which are two small, but very important, muscles used to control the exit of urine from the body.
It’s estimated that about 30% of elderly women and 15% of elderly men struggle with urinary incontinence, and the risk is even higher for those who smoke, are overweight, abuse alcohol, or have diabetes. But the condition is actually much more common problem than many people realize, as a high percentage of people with incontinence don’t openly discuss their condition, even with their doctors. (1)
As it turns out, urinary incontinence affects tens of millions of adults living in the U.S. Aside from elderly adults, it also impacts the obese, men with prostate or bladder problems, and women who have recently given birth.
With that in mind, let’s take a closer look at urinary incontinence to help you determine whether you are being affected by this condition and, if so, what steps you should take next.
Types of Urinary Incontinence
Below are the main types of urinary incontinence, based on symptoms that are experienced: (2)
This refers to involuntary urination that happens just after the urge is felt. This is most common among the elderly, especially those taking diuretic medications. The volume of urine can either be medium or heavy, and it’s common for this to happen overnight while sleeping (called nocturnal incontinence).
Stress incontinence is the involuntary urination that happens suddenly due to increased pressure (“stress”) placed on the intra-abdominal muscles. This can happen due to coughing, sneezing, laughing, bending, exercising, or lifting. Women who have recently given birth, obese adults, and those who recently had prostate surgery are most likely to be affected.
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This refers to light involuntary urination that happens slowly due to having an overly-full bladder. This is more common among men.
Functional incontinence is involuntary urination that happens due to a physical or mental impairment that makes it hard to sense the need to urinate, or to get to a bathroom on time. People who are most likely to be affected are those who recently had a stroke, who have dementia or another neurological disorder, or who have physical disabilities that that interfere with their muscular control and mobility.
Mixed incontinence refers to any combination of the types of incontinence described above.
What Causes Urinary Incontinence?
Ultimately, the underlying cause of urinary incontinence is either bladder or urethral dysfunction, but there are many specific reasons why the muscles that control the bladder and urethra can stop working properly. (3)
Causes in the elderly include decreased bladder capacity, weakened muscle control, weakened or damaged connective tissue near the bladder, increased urine volume due to certain medications, and decreased mobility to get to a bathroom on time.
Causes in women can include pregnancy, childbirth, menstruation, and menopause, which all cause hormonal changes in women that can alter the need to urinate. After giving birth the pelvis floor can become weaker, which decreases control over the urinary and bladder muscles. In postmenopausal women, decreasing estrogen levels cause the vagina and urethritis to get smaller, therefore leading to increased urethral resistance.
Causes in men can include an enlarged prostate, which partially obstructs the urethra and can lead to incomplete bladder emptying. Bladder cancer, which is more common in men, can also contribute to incontinence. It’s also important to note that smoking, alcoholism, and having a family history of urinary incontinence raises the risk for both women and men.
Causes in adolescents/younger people can include use of drugs, cigarettes, alcohol, or caffeine; gastrointestinal disorders; pelvic floor dysfunction, obesity; urinary tract infections; injury or trauma to the pelvic region; use of certain medications; and neuropsychiatric disorders.
Overall, the most common causes of urinary incontinence are:
- Overactive bladder in children/adolescents.
- Pelvic muscle weakness in women from childbirth.
- Bladder outlet obstruction in middle aged men.
- Functional disorders such as dementia and stroke in seniors, along with weakened muscles and decreased sensitivity to the urge to urinate.
Certain prescription drugs can also cause urinary incontinence, including diuretics used to decrease fluid retention, alpha-adrenergic antagonists, calcium channel blockers, hormone therapy, opioids, antihistamines, antipsychotics/psychoactive drugs, benztropine, and tricyclic antidepressants.
Signs You Might Have Urinary Incontinence
Follow are some of the most common symptoms of urinary incontinence:
- Small or large volumes of urine “leaks” that happen involuntarily. This can happen under many different circumstances, including during sleep or while exercising, walking, doing chores, laughing, having sex, or even relaxing.
- A sudden, intense urge to urinate.
- Irritated skin, rashes and ulcer formation if urine comes into contact with your skin too often.
- Increased risk for urinary tract infections (UTIs).
- Emotional struggles including embarrassment, stigmatization, isolation, and depression related to urine or bladder issues.
- Blood in urine, pain or burning when urinating, pelvic or abdominal pain, changes in bowel movements, general muscle weakness or fatigue—if incontinence is caused by a separate medical condition
Prevention, Treatment Options, and Ways to Manage Urinary Incontinence Symptoms
Treatment for urinary incontinence depends on the specific type of incontinence and, as a result, can vary widely.
Generally speaking, these are tips that can help prevent urinary incontinence or help relieve any symptoms you may already be experiencing:
- Stay hydrated—Aim to drink about 1.5-2 liters of water daily. You can also have hydrating drinks like herbal tea, fresh vegetable juice, sparkling water, or bone broth. Hydration is important because concentrated urine can irritate your bladder. However, you don’t want to over-hydrate either, since this will obviously send you running to the bathroom more often. Strike a balance by paying attention to your thirst and examining the color of your urine; it should be light or medium yellow, but not clear, amber, or gold.
- Limit fluids before bed—To avoid having to urinate several times during the night, cut back on liquids as you near your bedtime. Try not to drink anything beyond a few sips of water (especially not coffee or alcohol!) about 3-4 hours before going to sleep.
- Limit or avoid alcohol and caffeine—These both have a diuretic effect which increases your urge to urinate. Avoid caffeine after noon if possible, and limit alcohol to just 1-2 drinks per day at most. You might also find some relief by cutting back on chocolate, spicy foods, tomato-based foods, and citrus, which also diuretic effects and may also be irritating to your digestive and urinary tracts.
- Practice Bladder Training/Kegel Exercises—Practicing pelvic floor or Kegel exercises can help you gain better control over your bladder and urethra muscles. The goal is to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. (4) Training your bladder and pelvic floor involves practicing urge suppression techniques and relaxation exercises so you can go longer without needing to pee. You can perform shorter intervals at first and gradually lengthen them by 15- to 30-minute increments until it is possible to remain comfortable for three or four hours without using the bathroom.
- Maintain A Healthy Weight & Quit Smoking—Eat a healthy diet that includes enough fiber and antioxidants, avoid processed foods as much as possible, and if you smoke, get help for quitting.
- Talk to Your Doctor About Prescription Options—If other treatment approaches are not effective enough to improve your symptoms and quality of life, talk to your doctor about using anticholinergic medications. These can include the drugs Oxybutynin (Ditropan XL, Oxytrol), Tolterodine (Detrol), Darifenacin (Enablex), and Solifenacin (Vesicare).
When Should You See a Doctor About Urinary Incontinence?
While urinary incontinence isn’t always a serious condition and can sometimes can be simple to treat, there are times when it’s important to visit a doctor. In certain situations, incontinence can even point to a more serious underlying health problem, such as cancer, reoccurring infections, diabetes, or kidney disease.
If you experience any of the symptoms above on an ongoing basis, discuss them with your doctor. Seek emergency attention if you also experience unexplained blood in your urine for more than 1-2 days, burning, strong pain, or signs of an infection or fever.
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