URINARY INCONTINENCE

Loss of urine control, or urinary incontinence (in-CON-ti-nents), occurs in people of all ages, but is particularly common in older people. At least 1 in 10 persons age 65 or older suffer from incontinence. This condition can range from the discomfort of slight losses of urine to the disability and shame of severe, frequent wetting.

Many people with incontinence withdraw from social life and try to hide the problem from their families, friends, and even their doctor. Family members who care for an older person with incontinence often do not know about treatment choices and may believe that nursing home care is the only option.

These reactions are unfortunate because in most cases incontinence can be treated and controlled, if not cured. Incontinence is not an inevitable result of aging. It is caused by specific changes in body function that often result from diseases or use of medications.

Persons who have problems controlling urination should see their doctor. Even when incontinence cannot be completely cured, modern products and ways of managing the condition can ease the discomfort and inconvenience it causes.

Incontinence may be brought on by any illness accompanied by fatigue, confusion, or hospital admission. Incontinence is sometimes the first and only symptom of an urinary tract infection. Curing the illness usually will relieve or clear up the incontinence.

Types Of Incontinence

The most common forms of urinary incontinence are listed below:

Stress incontinence is the leakage of urine 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 is the inability to hold urine long enough to reach a toilet. It is often found in people ho have conditions such as diabetes, stroke, dementia, Parkinson's disease, and multiple sclerosis. It can also be a warning sign of early bladder cancer. In men, it is often a sign of an enlarged prostrate. It can, however, occur in otherwise healthy older persons.

Overflow incontinence is the leakage of small amounts of urine from a bladder that is always full. In older men, this can occur when the flow of urine from the bladder is blocked. Another cause is loss of normal bladder contractions in some people with diabetes.

Functional incontinence occurs in many older people who have normal urine control but who have difficulty reaching a 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 examination. This generally involves giving a detailed history of health and related problems, as well as undergoing a physical examination that focuses on the urinary and nervous systems and reproductive organs. The doctor will probably also want to check urine samples. In many cases, patients will then be referred to a urologist, a doctor who specializes in diseases of the urinary tract.

Treatment

Treatment of urinary incontinence should be tailored to each patient's needs. As a general rule, the least dangerous procedures should be tried first. The many options include:

Certain behavioral techniques - including pelvic muscle exercises, biofeedback, and bladder training are helpful in controlling urination. These techniques can help a person sense bladder filling and delay voiding until he or she can reach a toilet.

A number of medications can be used to treat incontinence. However, these drugs may cause side effects such as a dry mouth eye problems, and buildup of urine; therefore, they must be used carefully under a doctor's supervision.

Several types of surgery can improve or even cure incontinence that is related to a structural problem such as an abnormally positioned bladder or blockage due to an enlarge prostate. Devices that replace or aid the muscles controlling urine flow have been tried in persons with incontinence. Many of these devices require surgical implantation.

Management

Sometimes incontinence cannot be cured, but it can be managed in several ways.

Specifically designed absorbent underclothing is available and many of these garments are no more bulky than normal underwear and can be worn easily under everyday clothing.

Incontinence may be managed by inserting a flexible tube known as a catheter into the urethra and collecting the urine into a container. However, long-term catheterization - although sometimes necessary - creates many problems, including urinary infections. In men, an alternative to the indwelling catheter is an external collecting device. This fitted over the penis and connected to a drainage bag.

It is important to remember that under a doctor's care, incontinence can be treated and often cured. Even incurable problems can be managed to reduce complications, anxiety, and stress. When treatment is not completely successful, management plans can help many persons with incontinence.