Incontinence or loss of bladder or bowel control, is a symptom - not a disease in itself. A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirthThe Urinary System.

Incontinence is a problem of the urinary system, which is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. A circular muscle, called the sphincter, controls the activity of the urethra. It is not a part of the urinary system but can play a role in incontinence. Normally, the bladder stores the urine that is continually produced by the kidneys until it is convenient to urinate, but when any part of the urinary system malfunctions, incontinence can result.

According to the Clinical Practice Guidelines on Urinary Incontinence in Adults published in 1996 by the Agency for Health Care Policy and Research, 13 million Americans are incontinent – 85% of them are women. More recent consumer research reveals that one in four women over the age of 18 experience episodes of leaking urine involuntarily. One in five adults over age 40 are affected by overactive bladder or recurrent symptoms of urgency and frequency, a portion of whom don't reach the toilet before losing urine. At least half of all nursing home residents are incontinent of urine and many of them experience loss of bowel control as well. In sum, the problem is widespread and affects people of all ages including children and young adults.

Incontinence sufferers may experience emotional as well as physical discomfort. Many people affected by loss of bladder or bowel control isolate themselves for fear of ridicule and lose self-esteem. Adults may find employment impossible or compromised.
Treatment Options for Incontinence

Approximately 80% of those affected by urinary incontinence can be cured or improved. It is imperative to first obtain a diagnosis because there are different types of incontinence with different treatment options. Diagnosis includes a medical history and a thorough physical examination. Tests such as X-rays, cystoscopic examinations, blood chemistries, urine analysis, and special tests to determine bladder capacity, sphincter condition, urethral pressure, and the amount of urine left in the bladder after voiding may be required.

Because incontinence is a symptom and not a disease, the method of treatment depends on diagnostic results. Sometimes simple changes in diet or the elimination of medications such as diuretics can cure incontinence. More frequently, incontinence treatment involves a combination of medicine, behavioral modification, pelvic muscle re-education, collection devices, and absorbent products. Despite the high success rates in treating incontinence, only one out of every twelve people affected seeks help. Many types of treatment are available for incontinent people. After considering your specific case, a qualified specialist can recommend the treatment that is appropriate for you.

The three major categories of incontinence treatment are: behavioral, pharmacological, and surgical.

Behavioral techniques sometimes include the following:

   1. Scheduled Toileting - The care giver prompts the incontinent patient to go to the bathroom every 2-4 hours. This puts the patient on a regular voiding schedule. The goal is simply to keep the patient dry and is a frequently recommended therapy for frail elderly, bedridden or Alzheimer's patients.
   2. Bladder Retraining - Bladder retraining involves scheduled toileting but the length of time between bathroom trips is gradually increased. This therapy trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge and mixed incontinence.
   3. Pelvic Muscle Rehabilitation - This technique involves pelvic muscle exercises (PMEs), also known as Kegel exercises. PME may be used alone or in conjunction with biofeedback therapy, vaginal weight training, pelvic floor stimulation, and magnetic therapy. Read Nancy Muller's Keeping the Vital Pelvic Floor Healthy published in the Journal on Active Aging - International Council on Active Aging. View Entire Article

Pharmacological therapy (medications or drugs) is another common treatment for incontinence. Physicians can prescribe medications to help control incontinence, and sometimes they will take a person off a drug that is causing or contributing to incontinence. Of course, only your healthcare professional should tell you to stop using a drug he/she has prescribed.

Surgical treatment should be performed only after receiving a thorough diagnosis from a healthcare professional. All appropriate nonsurgical treatments should be tried before deciding on surgery. There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of your incontinence. Some of the more common procedures performed to treat urinary incontinence include, bladder neck suspension or sling procedures, periurethral bulking injections (collagen injections around the urethra), or implantation of an artificial urinary sphincter or sacral nerve stimulator. Your healthcare professional will thoroughly discuss any procedure you might need.

For those people whose incontinence cannot be cured or for those who are awaiting treatment, there are other devices or products to help manage incontinence. These include catheters, pelvic organ support devices, urethral inserts (plugs), external collection systems, penile compression devices, and absorbent products.



EMOTIONAL TOLL OF FEMALE INCONTINENCE


The family dinner was going well -- until a condition known as female incontinence got in the way. The middle-aged woman has urge incontinence, sometimes called overactive bladder (OAB). As the name suggests, when the urge to go to the bathroom comes on, it often can't be controlled. She leaked urine through her clothes and onto her son and daughter-in-law's upholstered dining room chair, an embarrassment that didn't go unnoticed. After the cleanup, even with her daughter-in-law and other family members assuring her that everything was fine, the woman was so humiliated she now has trouble accepting invitations.


Urinary incontinence is primarily a physical problem, affecting an estimated 12 million U.S. adults. But incontinence can also take an emotional toll on a person. When you have female incontinence, you may avoid social situations and even sexual intimacy, and that in turn can lead to withdrawal and depression. "Incontinence is embarrassing," says Jennifer Anger, MD, MPH, an assistant professor of urology at the University of California Los Angeles David Geffen School of Medicine and an attending physician at Santa Monica -- UCLA Medical Center in Santa Monica, Calif. But if you get a medical evaluation when you first notice symptoms of female incontinence, your doctor can suggest a host of treatments that will improve or eliminate the condition. "Older women think it's a normal part of aging," Anger says, clarifying that it is not. While the condition does affect older women more than younger, it doesn't have to be a side effect of aging.

Depression is more common in women with female incontinence, according to several studies. In one study, published in a 2005 issue of Obstetrics & Gynecology, researchers found that nearly three times as many women with female incontinence had depression compared to those without the condition.They surveyed nearly 6,000 women, ages 30 to 90, with more than 40% of them reporting some degree of female incontinence. Another study, published in Social Science Medicine in 2005, found that urinary incontinence is associated with depression in both women and men. And if a woman is incontinent, her husband is also more likely to be depressed, the researchers found.

Not surprisingly, the more severe the urinary incontinence, the greater the impact on quality of life, report French researchers who evaluated 556 women with female incontinence and compared them to more than 2,000 women without the condition. These women had lower self-esteem, impaired well-being, and reduced sexuality compared to the women without female incontinence.


Urinary incontinence in severe forms should be considered a disability, the French researchers conclude in their report, published in a 2006 issue of Neurourology and Urodynamics. While all types of female incontinence can cause emotional distress, urge incontinence is far more distressing, says Halina Zyczynski, MD, associate professor of obstetrics and gynecology at the University of Pittsburgh School of Medicine and a specialist in female incontinence at the Magee-Womens Hospital.

It's the unpredictable nature of urge incontinence that makes it so distressing, she says. Urge incontinence isn't totally understood, but experts think the bladder muscle may give the wrong messages to the brain, with the bladder feeling fuller than it really is. As a result, a person with urge incontinence feels the urgent need to go to the bathroom, even if they have just done so. Stress incontinence, which causes urine to leak when lifting objects, laughing, coughing, or sneezing because of weakened pelvic floor muscles, is less emotionally draining, Zyczynski says. "Women can learn which positions or situations predispose them to stress incontinence [and avoid them]. If you know, for instance, that doing the Stairmaster makes you leak [urine], you can avoid it," she says. "If you know that sneezing [makes you leak urine], as your sneeze comes on, you can cross your legs or squeeze your pelvic floor muscles." But, unlike stress incontinence, urge incontinence occurs without warning and is especially upsetting. "Before a woman has a chance to respond to that urge to go [to the bathroom], urine is already running down her leg," says Zyczynski.

Whatever form of female incontinence you have (and some women have both urge incontinence and stress incontinence - called mixed incontinence), it is crucial to seek help before the condition leads to social isolation, Zyczynski tells WebMD. Once women stop socializing, she says, it's easy to see how the withdrawal can lead to depression. If you notice symptoms of incontinence, such as leaking urine, tell your doctor. He or she may recommend you see a specialist, such as a urogynecologist -- an obstetrician-gynecologist who specializes in the treatment of women with pelvic floor problems, which includes female incontinence - or a urologist with experience treating female incontinence.

Some medications may aggravate female incontinence, such as high blood pressure drugs and antihistamines. If you have female incontinence and are taking these medications, your doctor may switch you to a different drug in hopes of alleviating the problem. Simple remedies, such as the use of protective garments like pads or adult-size protective panties, may lessen the problem, says Zyczynski. Strengthening the muscles that control the bladder by doing Kegel exercises may also help, she says.

If urinary incontinence is not helped by these remedies and is significantly interfering with your life and activities, your doctor may suggest medications or surgery. In one surgical procedure, surgical threads are used to help lift the bladder up to a normal position. This allows the muscles that help hold urine in to work better. Another procedure, called a "sling," uses strips of material, either natural or synthetic tissue, to support the bladder neck and prevent urinary incontinence.


HOW COMMON IS INCONTINENCE?


If you've recently had a problem with bladder control, you're far from alone.
Surveys show that urinary incontinence -- a problem with bladder control -- is quite common. Both surveys were reported at an annual meeting of the American Urological Association.

   Of the 23.5 million women surveyed, 38% said they'd suffered at least one episode of urinary incontinence in the last year. Among these women:

    * 13.7% of women with bladder control problems said they suffered incontinence every day.
    * 10% of women with bladder control problems said they suffered incontinence every week.
    * Bladder control problems were more common in non-Hispanic whites (41%) than in non-Hispanic blacks (20%) or Mexican-Americans (36%).
    * As women get older, daily incontinence is more common. Among women aged 60-64, 12% report daily incontinence. This increases to 21% of women aged 85 and older.

Here are results from a Michigan clinic on data from a national sample of 21,590 men.
It found that 9% of men reported a bladder control problem in the last 30 days. Among these men:

    * 29% of men with a bladder control problem reported stress urinary incontinence. That means they had trouble controlling their bladder when coughing, sneezing, laughing, or exercising.
    * 41% of men with a bladder control problem reported urge urinary incontinence. That means a strong, sudden urge to urinate followed by an involuntary bladder contraction and loss of urine.
    * 16% of men with a bladder control problem had mixed stress and urge incontinence.
    * 27% of men with a prostate condition had urinary incontinence.

There are lifestyle changes, exercises, and medications that can help improve bladder control:

    * Avoid drinking excess amounts of diuretics.
    * A popular set of exercises called Kegel exercises strengthens the muscles that are squeezed when trying to stop urinating midstream.
    * For those who smoke, stop smoking. Nicotine irritates the bladder.
    * Wearing protective devices such as absorbent products, underwear, and adult diapers or using bed pads can also help manage urinary incontinence.


SOME SIMPLE TIPS

When pregnancy, birth or just old age bring on issues with your water works, it's time to take action. Wet pants and poor bladder control are not solely the province of toddlers struggling with toilet training. Many adults suffer difficulties with urinary continence too, with women more commonly affected than men.

Urinary incontinence affects 10 to 25 per cent of women aged younger than 65, 15 to 30 per cent of non-nursing home resident women over 60, and more than 50 per cent of women who live in nursing homes. Of the women surveyed three months after giving birth, 15 per cent had urinary leakage. Aging, the hormonal changes associated with menopause, and of course stretching and damage to the pelvic floor and associated nerves as a result of pregnancy and childbirth, can all increase the risk of urinary problems. Being overweight or very unfit can also be risk factors, as is having a hysterectomy.

When your pelvic floor muscles are not very strong, they may be less able to withstand pressure or stress pushing on the bladder from above. As a result, a cough, sneeze, snort of laughter or bit of a strain to lift something heavy could lead to a squirt of urine leaking out beyond your control. It affects so many women, young and old, especially during and after pregnancy and menopause, that it could almost be considered a rite of passage.

Fortunately, there is a fairly simple remedy that works wonders in most cases: pelvic floor muscle exercises, also known as Kegel exercises. These exercises strengthen the muscles around the openings of the urethra (where urine comes out), vagina and rectum, and can easily be taught to you by your GP, a physiotherapist or urogynaecological health specialist. You need to do them regularly and well in order for them to be effective. They are particularly beneficial for stress incontinence, as well as being helpful for other types of incontinence.

The idea is to squeeze your muscles in such a way that it would stop the urinary flow if you were in the middle of voiding, but you do it when you are just sitting or standing around. You could be peeling potatoes, brushing your teeth, waiting for the lights to change, reading this paper, or watching TV while chatting to a friend on the phone and breastfeeding your newborn twins... and no-one would know that you were squeezing away down below.

As well as these simple exercises, there are also little cone-shaped weights that your doctor can prescribe to place into the vagina to further enhance the muscle-conditioning effect of pelvic floor muscle exercises. You can carry the weights for increasing periods of time and then increase the weight gradually as you get stronger. “Weight-bearing exercise” indeed.

The other common type of incontinence is known as: urge incontinence. In this form of incontinence, the bladder is overactive and overly sensitive to stretching and nerve signals so that you feel the sudden, urgent, uncontrollable urge to void even when your bladder is far from full, causing you to unintentionally leak urine just at the thought of urinating. You may find yourself wetting your pants just as you put the key in the door on arriving home, desperate for the loo, or even as you arrive in the bathroom.

Urge incontinence is largely managed by a process known as: bladder retraining. You basically need to prolong the intervals in between toilet visits by delaying urination after you get the urge to go. Start by holding off for five to 10 minutes when you feel the urge to urinate. Gradually increase to 20 minutes. The goal is to be going to the toilet no more than once every two to four hours.

If simple measures such as pelvic floor exercises and bladder retraining don’t do the trick, your doctor or gynaecologist will have a range of other possible treatments to offer, from medication to surgery, depending on your situation.