Urinary incontinence occurs when someone loses control of their bladder. Although it can affect people of all ages, it is most common in older adults.
While occasional urine leakage can happen when laughing or sneezing, those with urinary incontinence often experience symptoms without a clear cause.
Types and Symptoms of Urinary Incontinence
Symptoms vary among individuals, and there are different types of urinary incontinence:
Stress Incontinence: Caused by weak or stretched pelvic muscles, leading to urine leakage during physical activities. Symptoms can be triggered by pressure from laughing, coughing, or sneezing. Management includes Kegel exercises, lifestyle changes, devices, or surgery
Urge Incontinence: Involves faulty nerve signals or overactive bladder muscles, causing frequent urges to urinate. It is common in men with prostate issues and post-menopausal women, and symptoms can include a sudden, intense urge to urinate, often due to infections, diabetes, or neurological disorders. Treatment includes lifestyle changes, medication, or surgery.
Overflow Incontinence: Occurs when the bladder cannot fully empty, leading to constant dribbling. It is often seen in men with prostate problems and is characterized by constant dribbling of urine due to an incompletely emptied bladder.
Functional Incontinence: Caused by physical or mental impairments that hinder reaching the toilet in time.
Mixed Incontinence: This is often a combination of symptoms of stress incontinence and overactive bladder.
Urinary incontinence is a symptom, not a disease, and can result from various underlying factors. Even certain foods and beverages, such as carbonated drinks, chocolate, excessive vitamin C, chili peppers, caffeine, and alcohol, can contribute to incontinence. To determine the type of urinary incontinence, a physician will typically perform a urinalysis.
Diagnosing and Evaluating Urinary Incontinence
For elderly male patients with urinary incontinence, a thorough genitourinary exam is conducted. This includes a digital rectal exam (DRE) to assess prostate size, detect abnormalities, evaluate stool burden, and check sphincter tone. A focused neurological assessment is also performed.
Urinalysis is used to screen for urinary tract infections, hematuria, and glucose presence. Additional tests like postvoid residual (PVR) and a comprehensive multichannel urodynamics (UDS) study may be conducted to evaluate bladder outlet obstruction, detrusor underactivity, and bladder compliance.
For elderly female patients, discussing their medical history and any conditions affecting continence is essential. Obstetric and gynecologic history, including prolonged labor, multiparity pregnancy, or forceps-assisted delivery, is reviewed, as these factors may increase the risk of pelvic floor disorders such as stress urinary incontinence (SUI) or pelvic organ prolapse (POP).
A pelvic examination is performed to check for atrophic changes, POP, or SUI. Urinalysis is also conducted, and UDS may be necessary for cases involving neurogenic voiding dysfunction (VD), diabetes, or previous surgeries for POP or urinary incontinence (UI).
Treatment for Urinary Incontinence
Treatment options for patients with UI and VD include behavioral, physiotherapeutic, pharmacologic, and surgical methods.
Behavioral modification involves reducing fluid intake, adjusting diet, and changing voiding habits, which is effective for those in good cognitive health.
Physiotherapy may include exercises, biofeedback, and electrical stimulation, with patients continuing exercises at home after guided sessions.
Medications like alpha-blockers, 5-alpha reductase inhibitors, and PDE5-inhibitors can address some underlying causes of UI in men. Both men and women might benefit from bladder-directed therapies.