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Alternative Names Return to topLoss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary
Definition Return to top
Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine.
The three main types of urinary incontinence are:
Bowel incontinence, a separate topic, is the inability to control the passage of stool.
Considerations Return to top
Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.
Infants and children are not considered incontinent, but merely untrained, up to the time of toilet training. Occasional accidents are not unusual in children up to age 6 years. Young (and sometimes teenage) girls may have slight leakage of urine when laughing.
Nighttime urination in children is normal until the age of 5 or 6.
The ability to hold urine is dependent on having normal anatomy and a normally functioning urinary tract and nervous system. You must also possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.
The process of urination involves two phases:
Normally, during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine.
The first sensation of the urge to urinate occurs when approximately 200 ml (just under 1 cup) of urine is stored. A healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.
The average person can hold approximately 350 to 550 ml (over 2 cups) of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable, expandable bladder wall muscle (detrusor).
The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. At the same time, your body must be able to relax the sphincter to allow the urine to pass out of the body.
Causes Return to top
Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:
Causes that may be more long-term:
Home Care Return to top
See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.
The following methods are used to strengthen the muscles of your pelvic floor:
To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. Do NOT contract your abdominal, thigh, or buttocks muscles. And Do NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.
Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 - 4 days.
Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.
Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.
For leakage, wear absorbent pads or undergarments. There are many well designed products that go completely unnoticed by anyone but you.
Other measures include:
Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.
Surgery may be required to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women. Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters. These are synthetic cuffs that are surgically placed around the urethra to help retain urine.
If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.
Performing Kegel exercises while you are pregnant and soon after delivery may help prevent incontinence related to childbirth.
When to Contact a Medical Professional Return to top
Discuss incontinence with your doctor. Gynecologists and urologists are the specialists most familiar with this condition. They can evaluate the causes and recommend treatment approaches.
Call your local emergency number (such as 911) or go to an emergency room if any of the following accompany a sudden loss of urine control:
Call your doctor if:
What to Expect at Your Office Visit Return to top
Your doctor will take your medical history and perform a physical examination, with a focus on your abdomen, genitals, pelvis, rectum, and neurologic system.
Medical history questions may include:
Diagnostic tests that may be performed include:
References Return to top
American College of Obstetricians and Gynecologists. Urinary incontinence in women. Obstet Gynecol. 2005;105(6):1533-1545.
Madersbacher H, Madersbacher S. Men's bladder health: urinary incontinence in the elderly (Part I). J Mens Health Gend. 2005;2(1):31-37.
Kielb SJ. Stress incontinence: alternatives to surgery. Int J Fertil Womens Med. 2005; 50(1):24-29.
Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.
Rogers RG. Clinical practice: urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.
Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008;148:459-473.Update Date: 5/22/2008 Updated by: Scott M. Gilbert, MD, Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.