Incontinence: A Fairly Common Problem



Types of incontinence

Bladder and bowel control are complex processes that involve the brain, spinal cord, and muscles of the bladder, bowel, and pelvis. Loss of bladder or bowel control can be caused by problems with any of these components. Incontinence, or loss of the ability to control urination or defecation, is a symptom, not a disease. Some of the causes include normal changes in muscles because of aging, birth defects, pelvic surgery, injuries to the pelvic region or the spinal cord, neurological diseases, multiple sclerosis, infection, degenerative changes associated with aging, and pregnancy and childbirth.

There are four basic types of urinary incontinence:


  • Urge incontinence is the urgent need to pass urine and the inability to get to a toilet in time. It also is called hyperactive or irritable bladder. It occurs when nerve passages along the pathway from the bladder to the brain give the wrong signal to the brain or the brain is unable to inhibit the bladder muscle from contracting.



Diagnosis and treatment

Because incontinence is a symptom, not a disease, treatment depends on the results of diagnostic tests by your doctor, which may include X-rays, blood work, and urine analysis, and examination of bladder capacity, the amount of urine left in the bladder after urination, urethral pressure, and sphincter condition.

Three major categories of treatment are behavior change, medications, and surgery.

These are common behavioral approaches:


  • Bladder or bowel retraining. Bladder retraining involves scheduled toileting, but the length of time between bathroom trips is gradually increased. This therapy trains the bladder to wait for larger time intervals and has been proven effective in treating urge and mixed incontinence. In bowel retraining, elimination is stimulated by suppositories, at the same time each day. The muscles are trained to defecate on a regular schedule.

  • Pelvic muscle rehabilitation. This technique involves pelvic muscle exercises, such as Kegel, which may be used alone or in conjunction with biofeedback therapy, vaginal weight training, and pelvic floor stimulation to stimulate pelvic nerves.

Drinking less water is not a good way to avoid problems with urinary incontinence because this may cause dehydration. Concentrated urine caused by dehydration can cause the lining of the bladder and urethra to become irritated and actually make incontinence worse. Drinking two to three quarts, preferably water, a day may help. Some fluids, like alcohol and caffeinated drinks, may make incontinence worse. Stop drinking any fluids two to three hours before bedtime.

A high-fiber diet that prevents constipation helps with fecal and urinary incontinence. Constipation makes urinary incontinence worse.

Medications may be prescribed to help control incontinence. Medications relax the bladder and reduce spasms or instability. These drugs help prevent the bladder contracting spontaneously.

Sometimes a health care provider will take a person off a medication that is causing or contributing to incontinence. Of course, only your health care provider should tell you to stop using a drug that he or she has prescribed.

Topical estrogen applied to the vaginal area can help if the cause of urinary incontinence is related to menopause or an estrogen deficiency.

Surgery should be performed only after being thoroughly evaluated by a health care provider. All appropriate nonsurgical treatments should be tried before deciding on surgery.

Many different surgical procedures may be used to treat urinary 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 "suspending" internal organs with your own tissue or a mesh, injecting collagen around the urethra to ensure closure, and implanting an artificial urinary sphincter or sacral nerve stimulator.

Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: Sohrabi, Farrokh, MD
Last Review Date: 1/7/2013
