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Urinary incontinence is the loss of bladder control or the leakage of urine. It can happen to anyone, but is very common in older people. At least 1 out of 10 people age 65 or older suffers from incontinence. It is a condition that rages from mild leakage to uncontrollable and embarrassing wetting.

Many people with incontinence pull away from their family and friends. They try to hide the problem from everyone, even their doctors. The good news is that in most cases urinary incontinence can be treated and controlled, if not cured. The bad news is that caregivers may not know that treatment is a choice. They may think that nursing home care is the only answer for an older person with incontinence.

Incontinence does not happen because of aging. It may be caused by changes in your body due to disease. For example, incontinence may be the first and only symptom of a urinary tract infection. Curing the infection may relieve or cure the problem. Some drugs may cause incontinence or make it worse.

If you are having trouble with incontinence, see your doctor. Even if it can't be completely cured, modern products and ways of managing incontinence can ease its discomfort and inconvenience.

Types of Incontinence

The most common types of urinary incontinence are:

Stress incontinence happens when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It is the most common type of incontinence and can almost always be cured.

Urge incontinence happens if you can't hold your urine long enough to reach a toilet. Although healthy people can have urge incontinence, it is often found in people who have diabetes, stroke, dementia, Parkinson's disease, or multiple sclerosis. It can also be a warning sign of early bladder cancer. In men, it is often a sign of an enlarged prostate.

Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. In older men, this can occur when the flow of urine from the bladder is blocked. Some people with diabetes also have this problem.

Functional incontinence happens in many older people who have relatively normal urine control but who have a hard time getting to the toilet in time because of arthritis or other crippling disorders.

Diagnosis

The first and most important step in treating incontinence is to see a doctor for a complete medical exam. The doctor will ask for a detailed history of your health and give you a physical exam. The doctor may want to check urine samples. You may be referred to a urologist, a doctor who specializes in diseases of the urinary tract, or to a gynecologist, a specialist in the female reproductive system.

Treatment

Treatment of urinary incontinence should be designed to meet your needs. As a general rule, the least dangerous procedures should be tried first. The many options include:

Behavioral techniques such as pelvic muscle exercises, biofeedback, and bladder training can help control urination. These techniques can help you sense your bladder filling and help delay voiding until you can reach a toilet.

A doctor can prescribe medicines to treat incontinence. However, these drugs may cause side effects such as dry mouth, eye problems, or urine buildup.

Sometimes surgery can improve or cure incontinence if it is caused by a structural problem such as an abnormally positioned bladder or blockage due to an enlarged prostate. Implanting devices that replace or aid the muscles controlling urine flow has been tried in people with incontinence.

Management

If your incontinence cannot be cured, it can be managed in several ways.

You can get special absorbent underclothing that is no more bulky than normal underwear and can be worn easily under everyday clothing.

A flexible tube (indwelling catheter) can be put into the urethra (the canal that carries the urine from the bladder) to collect urine in a container. Long-term catheterization--although sometimes necessary--creates many problems, including urinary infections. Men have the choice of an external collecting device. This is fitted over the penis and connected to a drainage bag.

Remember, under a doctor's care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help.

Resources

For more information about incontinence, contact:

National Association for Continence
P.O. Box 8306
Spartanburg, SC 29305-8306
1-800-BLADDER (1-800-252-3337)

Simon Foundation for Continence
P.O. 835
Wilmette, IL 60091
1-800-237-4666

National Kidney and Urologic Diseases
Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580

For a list of free publications on health and aging from the National Institute on Aging (NIA), contact:

NIA Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
(1-800-222-4225 TTY)
E-mail: niainfo@access.digex.net

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