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Bladder Control Problems

 

Bladder Control Problems Overview
People who have bladder control problems have trouble stopping the flow of urine from the bladder. They are said to have urinary incontinence. Incontinence is uncontrollable leaking of urine from the bladder. Although urinary incontinence is a common problem, it is never normal.

 

Incontinence is both a health problem and a social problem.

Most people with incontinence suffer social embarrassment. Many become depressed and limit their activities away from home, often becoming socially isolated and lonely.


Physical conditions linked to incontinence include infection, skin irritations and infections, falls, fractures, and sleep disturbances.


Many people with incontinence are too embarrassed to talk to their health care provider about it. They "cope" or "just learn to live with it." This is changing gradually as people realize that help is available.


Approximately 15-30% of elderly people who live at home are affected by urinary incontinence. Another 40% of elderly persons who live in nursing homes are affected. Incontinence is a major reason for people going into nursing homes. However, it is not an inevitable consequence of aging.


Here is a brief description of the urinary system and the process of urination (micturition):

 

The urinary system is composed of the kidneys, ureters, bladder, and urethra.

The kidneys filter water and waste from the blood. They excrete urine, which passes via the ureters to the bladder. The bladder stores urine until you urinate.

The kidneys typically excrete about 1 to 1-1/2 quarts (1000-1500 mL) of urine in 24 hours.

The bladder is a hollow, muscular organ. The bladder wall includes a smooth muscle known as the detrusor muscle. The bladder's size, shape, position, and relation to other organs vary with age and the amount of urine stored.


The urethra is a narrow tube connecting the bladder with the opening when the urine comes out of the body. Surrounding the urethra are sphincter muscles, which partly control release of urine from the bladder and from the body.

Although the bladder is able to hold about 600 mL of urine, the urge to urinate develops once the bladder contains 300 mL. As the bladder starts to stretch, nerves in the bladder and surrounding area send messages to the brain, via the spinal cord, telling it that the bladder is filling. The brain sends back the urge to urinate.

Although you normally make the choice when to urinate, once you decide to do so the nervous system takes over and the process becomes automatic. The detrusor contracts and the sphincters relax to allow urine to flow. When the bladder is empty, the sphincters contract and the detrusor relaxes.

You can stop or hold off urination by contracting (squeezing) the external sphincter, which causes relaxation of the detrusor. Urine is stored, and the urge to urinate is temporarily stopped.

As you continue to produce urine, however, the messages to and from the brain get more urgent, and the urge to urinate becomes even stronger.


Urinary incontinence is believed to affect at least 13 million people in the United States.

 

This number may even be higher, and it is expected to increase sharply with the aging of the baby boomers.

Incontinence affects both sexes and all ages but is most common in older people.

Incontinence is much more common in women than in men. Most men with incontinence are older and suffer from some type of prostate disease.
The good news about urinary incontinence is that it is treatable. A great majority of people with bladder control problems can be helped by treatments that are available now. If incontinence cannot be cured, it can at least be controlled.

 

Incontinence is a symptom with a wide variety of causes. The most common causes include the following:


Urinary tract infection:


Side effect of medication: Examples include alpha-blockers, calcium channel blockers, antidepressants, antihistamines, sedatives, sleeping pills, narcotics, caffeine-containing preparations, and water pills (diuretics). Occasionally, the medicines used to treat some forms of incontinence can also worsen the incontinence if not prescribed correctly.


Impacted stool: Stool becomes so tightly packed in the lower intestine and rectum that a bowel movement becomes very difficult or impossible.


Weakness of muscles in the bladder and surrounding area: This can have a variety of causes.


Overactive bladder


Bladder irritation


Blocked urethra, usually due to enlarged prostate (in men)


Many of the causes are temporary, such as urinary tract infection. The incontinence improves or goes away completely when the underlying condition is treated. Others are longer lasting, but the incontinence can usually be treated.


Risk factors: Underlying causes or contributors to urinary incontinence include the following:

 

Smoking: The connection with incontinence is not completely clear, but smoking is known to irritate the bladder in many people.


Obesity: Excess body fat can reduce muscle tone, including the muscles used to control urination.


Chronic constipation: Regular straining to have a bowel movement can weaken the muscles that control urination.


Diabetes: Diabetes can damage nerves and interfere with sensation.


Spinal cord injury: Signals between the bladder and the brain travel via the spinal cord. Damage to the cord can interrupt those signals, disrupting bladder function.


Disability or impaired mobility: People who have diseases such as arthritis, which make walking painful or slow, may have "accidents" before they can reach a toilet. Similarly, people who are permanently or temporarily confined to a bed or a wheelchair often have problems because of their inability to get to a toilet easily.


Neurologic disease: Conditions such as stroke, multiple sclerosis, Alzheimer disease, or Parkinson disease can cause incontinence. The problem can be a direct result of a disrupted nervous system or an indirect result of having restricted movement.

Surgery or radiation therapy to the pelvis: Incontinence can result from certain surgeries or medical therapies.


Pregnancy: One third to one half of pregnant women have problems controlling their bladder. In most of these women, incontinence stops after delivery. However, 4-8% of pregnant women experience renewed incontinence after delivery (postpartum). Risk factors for postpartum incontinence include vaginal delivery, long second stage of labor (the time after the cervix is fully dilated), and having large babies.


Menopause: Studies have not demonstrated a consistent increase in risk of incontinence following menopause. The relationship between postmenopausal hormone replacement therapy and incontinence is unclear.


Hysterectomy: Women who have had a hysterectomy may have incontinence later in life.


Enlarged prostate: In men with an enlarged prostate, the prostate can block the urethra, causing urine leakage. However, less than 1% of men treated for benign (noncancerous) enlargement of the prostate report incontinence.


Prostate surgery: Up to 87% of men whose prostate has been removed report problems with incontinence.


Bladder disease: Certain disorders of the bladder, including bladder cancer, can sometimes cause incontinence.
There are several types of urinary incontinence. Many people have more than one type. A combination of stress and urge incontinence is especially common. Stress and urge incontinence are the most common types.

 

Stress incontinence: This occurs when you do anything that strains the muscles around the bladder, such as laughing, coughing, sneezing, bending, or even walking in some people. It is caused by weakness or injury to the muscles of the pelvis or the sphincters. The underlying causes include physical changes due to pregnancy, childbirth, or menopause. It is a frequent type of incontinence in women.


Urge incontinence: This is a sudden uncontrollable desire to urinate regardless of how much urine is in the bladder. It is believed to be caused by inappropriate contractions of the bladder. The term "overactive bladder" has been adopted to describe urge incontinence, detrusor instability, and hypersensitive detrusor. Urgency, frequency, and urination at night (nocturia) are common in people with this condition. This is due to disruption of signals between the bladder and the brain. Environmental cues, such as running water or putting the key in the front door, may prompt urgency or leakage. It is a frequent type of incontinence in both men and women.


Mixed incontinence: This is a mixture of stress and urge incontinence.


Overflow incontinence: This results when you retain urine in your bladder either because your muscle tone is weak or you have some sort of blockage below your bladder. Symptoms include dribbling, urgency, hesitancy, low-force urine stream, straining, and urinating only a small amount despite a sensation of urgency. It is a frequent type of incontinence in men.


Neuropathic incontinence: This results from a problem affecting one or more nerves. Either the detrusor muscle overcontracts or the interior sphincter lacks the tension to hold urine in.


Fistula: This is an abnormal internal connection between organs or structures such as the bladder, ureters, or urethra. This can cause incontinence.


Traumatic incontinence: This is incontinence that occurs after injury to your pelvis (such as a fracture) or as a complication of surgery.


Congenital incontinence: This may occur in people born with their bladder or one or both ureters out of place.


Obstruction to urine flow: This may cause incontinence.


The following seem to have little or nothing to do with causing bladder control problems:

Problems or delays in toilet training in childhood (However, some evidence links childhood voiding dysfunction with adult voiding dysfunction, that is, incontinence.)

Having a parent with a bladder control problem