The kidneys filter waste from the body. Combined with water, this waste becomes urine, which is carried from the kidneys through tubes called the ureters to the bladder. The bladder is a balloon-like muscular organ that can store up to 400 cc. urine, and is about the size of a fist when empty. The ureters enter the bladder at an angle, so they are squeezed when the bladder begins to fill. This prevents the urine from flowing back into the kidneys.

The bladder is located in the lower abdomen. In men, the anal canal is right behind the bladder and the prostate is right under it. In women, the uterus and vagina are between the bladder and the anal canal. From the bladder, the urine is carried out of the body through a tube called the urethra. In men, the urethra carries urine out of the penis. In women, the urethra is very short - only about two inches long.

During urination, the bladder muscles contract while muscles around the urethra relax. This pushes the urine out of the body. Incontinence occurs when the bladder suddenly contracts, or if there is a problem with the muscles that hold the urine in.

Urinary incontinence is defined as an involuntary loss or leakage of urine that causes a social or hygienic problem. More than ten million people in the United States suffer from urinary incontinence. Both sexes experience incontinence, although twice as many women than men are affected.

All age groups are affected, although incontinence is more common in the elderly. Up to half of all nursing home residents are affected, and 15-30% of all women over age 65 have some degree of incontinence. Though age related changes or illnesses may predispose some to the problem, incontinence is not an inevitable consequence of aging. Urinary incontinence is treatable and often curable at any age.

 

Types of Incontinence

Stress Incontinence	is leakage of urine during physical movement, such as coughing, sneezing, bending, or exercising. This is the most common form of incontinence in women and can occur at any age. Usually not much urine is lost, and this type of incontinence may result from weakened pelvic floor muscles resulting from pregnancy and childbirth. Hormonal changes of menopause and in the week before the menstrual period may be a factor in stress incontinence. Stress incontinence is treatable.
Urge Incontinence	occurs when there is a strong urge to urinate, but the urine cannot be held back. Urge incontinence may be triggered by coughing, the sound of running water, or after drinking small amounts of water. Urine loss may occur during sleep. This type of incontinence is usually caused by strong, inappropriate bladder contractions. A variation of urge incontinence is reflex incontinence, when urine the bladder contracts and empties of urine without the sense of urgency. Overactive nerves controlling the bladder may be at fault.
Overflow incontinence	occurs when the nerve supply to the bladder is impaired. The bladder is overfilled and leaks urine. This can be caused by delaying the need to urinate, by diabetes, spinal injuries, weak bladder muscles, or other diseases or disorders.
Continuous incontinence	is rare. Urine leaks more or less constantly with no urge to urinate. This may be caused by congenital abnormalities, pelvic surgery or advanced cancer within the pelvis.
Mixed incontinence	usually refers to the occurrence of stress and urge incontinence together. Other combinations are also called mixed incontinence, but this combination is the most common.
Functional Incontinence	occurs when the urinary tract is functioning normally, but a person has a disability that prevents him from reaching the toilet in time. This can be a physical obstacle such as a wheelchair, or a disorder with thinking and planning ahead, such as Alzheimer's.
Transient incontinence	refers to temporary incontinence. Medications, urinary tract infections, and even constipation can cause transient incontinence.

 

In some cases, the doctor will need to do further tests to determine the cause of your incontinence. He may measure your bladder capacity and residual urine to test your bladder muscles. This involves drinking fluids and then urinating into a pan. The doctor may measure the urine left in your bladder. You may be asked to keep a record of your urination habits over a period of time.

Other tests may include:

Stress test	As you cough, the doctor checks for urine loss.
Urinalysis	A urine sample is tested for infections or urinary stones.
Blood tests	Blood samples are examined for substances related to incontinence.
Ultrasound	Sound waves are used to detect problems within the kidneys, ureters, bladder, and urethra.
Cystoscopy	Your doctor inserts a tube into the urethra. This tube contains a camera so that he can detect problems in the bladder.
Urodynamics	Pressure in the bladder urethral sphincter activity and urine flow are measured.

 

[Treatments for Incontinence]