Not surprisingly, few people are willing to openly discuss their bladder and urine problems despite the increasingly frequent advertisements for disposable underwear and pharmaceuticals that claim to prevent embarrassing breakdowns. Specifically, urinary incontinence is another term for an overactive bladder or the inability to retain urine. This happens due to voluntary loss of control over the urinary sphincters, which are two small, but very important muscles used to control the flow of urine from the body.

It is estimated that about 30% of older women and 15% of older 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 a much more common problem than many people think, as a high percentage of people with incontinence do not openly discuss their condition, not even with their doctors.

Types of urinary incontinence

Ultimately, urinary incontinence affects tens of millions of adults . In addition to older adults, it also affects the obese, men with prostate or bladder problems, and women who have recently given birth. With this in mind, let’s take a closer look at urinary incontinence to help you determine if you are being affected by this condition and, if so, what steps you should take. The main types of urinary incontinence are listed below, based on symptoms experienced:

Urge incontinence

This refers to involuntary urination that occurs right after you feel the urge. This is more common among the elderly, especially those who take diuretic medications. The volume of urine can be medium or heavy, and it is common for this to happen at night while sleeping (known as nighttime incontinence).

Stress incontinence

Stress incontinence is involuntary urination that occurs suddenly due to increased pressure (“stress”) placed on the intra-abdominal muscles. This can happen due to coughing, sneezing, laughing, bending over, exercising, or lifting. Women who recently gave birth, obese adults, and those who recently had prostate surgery are more likely to be affected.

Overflow incontinence

This refers to light involuntary urination that occurs slowly due to having an overly full bladder. This is more common among men.

Functional incontinence

Functional incontinence is involuntary urination that occurs due to a physical or mental impairment that makes it difficult to feel the need to urinate or get to a bathroom on time. People who are most likely to be affected are those who have recently had a stroke, who have dementia or another neurological disorder, or who have physical disabilities that interfere with their mobility and muscle control.

Mixed incontinence

Mixed incontinence refers to any combination of the types of incontinence described above.

Causes of urinary incontinence

Ultimately, the underlying cause of urinary incontinence is dysfunction of the bladder or urethra , but there are many specific reasons why the muscles that control the bladder and urethra may stop working properly.

Causes of urinary incontinence 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 reach a bathroom on time.

Causes of urinary incontinence in women can include pregnancy, childbirth, menstruation, and menopause, which cause hormonal changes in women that can alter the need to urinate. After giving birth, the pelvic floor may weaken, reducing control over the urinary and bladder muscles. In postmenopausal women, decreased estrogen levels make the vagina and urethritis smaller, leading to increased urethral resistance.

Causes in men can include an enlarged prostate, which partially obstructs the urethra and can lead to incomplete emptying of the bladder. Bladder cancer, which is more common in men, can also contribute to incontinence. It’s also important to note that smoking, alcoholism, and a family history of urinary incontinence increase risk for both women and men.

Causes in teens / younger people may include drug, cigarette, alcohol, or caffeine use; gastrointestinal disorders; pelvic floor dysfunction, obesity; urinary tract infections; injury or trauma to the pelvic region; use of certain medications; and neuropsychiatric disorders.

In general, the most common causes of urinary incontinence are:

  • Overactive bladder in children / adolescents.
  • Pelvic muscle weakness in women in labor.
  • Bladder outlet obstruction in middle-aged men.
  • Functional disorders such as dementia and stroke in older people, along with weakened muscles and decreased sensitivity to the urge to urinate.

Certain prescription medications can also cause urinary incontinence, including diuretics used to decrease fluid retention, alpha-adrenergic antagonists, calcium channel blockers, hormonal therapy, opioids, antihistamines, antipsychotics / psychoactive drugs, benzotropine and tricyclic antidepressants.

Signs of urinary incontinence

The following are some of the most common symptoms of urinary incontinence:

1. Small or large volumes of urine “leaks” that occur unintentionally. This can occur under many different circumstances, including during sleep or while exercising, walking, doing housework, laughing, having sex, or even relaxing.

2. A sudden and intense urge to urinate.

3. Skin irritation, rashes and ulcer formation if urine comes in contact with the skin too often.

4. Increased risk of urinary tract infections (UTI).

5. Emotional struggles including shame, stigmatization, isolation, and depression related to urination or bladder problems.

6. Blood in the urine, pain or burning when urinating, pelvic or abdominal pain, changes in bowel movements, general muscle weakness or fatigue, if the incontinence is caused by a separate medical condition.

Ways to Control Urinary Incontinence Symptoms

Treatment for urinary incontinence depends on the specific type of incontinence and, as a result, can vary widely. In general, these are tips that can help prevent urinary incontinence or help alleviate any symptoms you may be experiencing:

Keep hydrated

Try to drink approximately 1.5-2 liters of water a day. 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 the bladder. However, you don’t want to over-hydrate yourself either, as it will obviously send you to the bathroom more often. Take stock by paying attention to your thirst and examining the color of your urine; It should be light to medium yellow, but not light, amber, or gold.

Limit fluids before bed

To avoid having to urinate multiple times during the night, reduce the amount of fluids as you get closer to bedtime. Try not to drink anything more than a few sips of water (no coffee or alcohol) about 3-4 hours before going to sleep.

Limit or avoid alcohol and caffeine consumption

Both have a diuretic effect that increases your desire to urinate. Avoid caffeine after noon if possible, and limit alcohol consumption to just 1-2 drinks per day maximum. You can also find some relief by cutting back on chocolate, spicy foods, tomato and citrus-based foods, which also have diuretic effects and can also be irritating to the digestive and urinary tracts.

Practice bladder training / Kegel exercises

Practicing the pelvic floor or Kegel exercises can help you have better control over your bladder and urethral muscles. The goal is to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. Training your bladder and pelvic floor involves practicing urge suppression techniques and relaxation exercises so that you can stay longer without urinating. You can take shorter intervals at first and gradually lengthen them in 15-30 minute increments until it is possible to stay comfortable for three to four hours without using the bathroom.

Maintain a healthy weight and 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 to quit.

Talk to your doctor about prescription options

If other treatment approaches aren’t effective enough to improve your symptoms and quality of life, talk to your doctor about using anticholinergic medications.

When to see a doctor for urinary incontinence

While urinary incontinence is not always a serious condition and can sometimes be easy to treat, sometimes it is important to visit a doctor. In certain situations, incontinence can even signal a more serious underlying health problem , such as cancer, recurring infections, diabetes, or kidney disease.

If you experience any of the above symptoms on an ongoing basis, discuss it with your doctor. Seek emergency care if you also experience unexplained blood in your urine for more than 1 to 2 days, burning, severe pain, or signs of infection or fever.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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