General Information
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 two main types of urinary incontinence are:
- Stress incontinence occurs during certain activities like coughing, sneezing, laughing, or exercise.
- Urge incontinence involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don’t have enough time between when you recognize the need to urinate and when you actually do urinate.
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.
Diagnostic Tests
- Urinalysis
- Urine culture to check for infection if indicated
- Cystoscopy (inspection of the inside of the bladder)
- Urodynamic studies (tests to measure pressure and urine flow)
- Uroflow (to measure pattern of urine flow)
- Post void residual (PVR) to measure amount of urine left after urination
Other tests may be performed to rule out pelvic weakness as the cause of the incontinence. One such test is called the Q-tip test. This test involves measurement of the change in the angle of the urethra when it is at rest and when it is straining. An angle change of greater than 30 degrees often indicates significant weakness of the muscles and tendons that support the bladder.
What is Normal Urination?
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:
- The filling and storage phase
- The emptying phase
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.
Temporary vs. Long-Term Incontinence
Causes of sudden or temporary incontinence:
- Urinary tract infection or inflammation
- Prostate infection or inflammation
- Stool impaction from severe constipation, causing pressure on the bladder
- Side effects of medications (such as diuretics, tranquilizers, some cough and cold remedies, certain antihistamines for allergies, and antidepressants)
- Increased urine amounts, like with poorly controlled diabetes
- Pregnancy
- Weight gain
- Short-term bedrest — for example, when recovering from surgery
- Mental confusion
Causes of long-term urinary incontinence:
- Spinal injuries
- Urinary tract anatomical abnormalities
- Neurological conditions like multiple sclerosis or stroke
- Weakness of the sphincter, the circular muscles of the bladder responsible for opening and closing it; this can happen following prostate surgery in men, or vaginal surgery in women
- Pelvic prolapse in women — falling or sliding of the bladder, urethra, or rectum into the vaginal space, often related to having had multiple pregnancies and deliveries
- Large prostate in men
- Depression or Alzheimer’s disease
- Nerve or muscle damage after pelvic radiation
- Bladder cancer
- Bladder spasms