Other attributes
Urinary incontinence (UI) is a common health problem defined as involuntary loss of urine, also called involuntary urination. This condition is prevalent among people aged sixty years and over, especially women. The common types of UI in older people are stress incontinence and urge incontinence. Stress incontinence is the involuntary leaking of urine during physical exertion, or while sneezing or coughing. Urge incontinence is also known as overactive bladder syndrome, and its symptoms include frequency, urgency, and leakage preceded directly by urgency.
According to the World Health Organization's Integrated Care for Older People (ICOPE), the prevalence of UI ranges from 9.9% to 36.1% among the population of people over sixty, and is twice as common in older women as in older men. UI has a considerable negative impact on the quality of life and the mental health of the affected, which leads to an increased need for care. Depending on the exact definition of UI referred to, as of 2011, the prevalence ranged from 5% to 50% of the adult US population, according to the Food and Drug Administration (FDA). Moreover, the prevalence of UI increases with age, suggesting that the impact of this condition on national health care systems is likely to increase as growing populations age. Moreover, UI is associated with poor self-rated health and quality of life, social isolation, and depressive symptoms.
The risk of developing urinary incontinence in older people is greater in the presence of several chronic conditions and environmental factors. Chronic diseases that can contribute to UI include diabetes, mellitus, Parkinson's disease, dementia, stroke, prostatic cancer, chronic obstructive pulmonary disease (COPD), and arthritis. Environmental factors such as inaccessible or unsafe toilet facilities and the lack of assistance whilst using them also play a role. Nonpharmacological interventions are generally opted for in mild UI cases, in which the primary aim is to reduce the frequency of urine leakage. Nonpharmacological interventions include pelvic floor muscle training (PFMT), bladder training and habit retraining, and timed or induced voiding.
Stress urinary incontinence (SUI) is the most common type of urinary incontinence in women; it is the leakage of urine in instances of physical activity involving heightened abdominal pressure—such as while exercising, laughing, sneezing, or coughing. SUI is particularly common among older multiparous women, but rarely reported in active, young girls. SUI can occur when pelvic tissues and muscles become weak and cause the bladder neck (a group of muscles that connect the bladder to the urethra) to descend during intervals of intensified physical activity.
A descended bladder neck can prevent the urethra from properly controlling the flow of urine. SUI can also occur when the sphincter muscle that controls the urethra is weakened. In such cases, the affected sphincter muscle is not able to prevent the flow of urine under normal circumstances and when there is an increase in abdominal pressure. Weakness may be the result of pregnancy, childbirth, aging, or pelvic surgery. Other risk factors for SUI include chronic coughing or straining, obesity, and smoking.
The etiologies of urge incontinence often involve the detrusor muscle of the urinary bladder, which is the muscle that forms a layer of the wall of the bladder. The detrusor muscle (or detrusor urinae muscle) is the smooth muscle component of the urinary bladder and facilitates contraction of the bladder wall during micturition. Detrusor muscle overactivity, inadequate compliance of the detrusor, and bladder hypersensitivity are all potential causes of urge incontinence. Detrusor overactivity is believed to consist of uninhibited (involuntary) contractions of the smooth muscle during bladder filling.
Significant possible causes of this overactivity include neurologic disorders such as spinal cord injury, abnormalities in the urinary bladder, and alteration in the bladder microbiome. In some cases, detrusor overactivity can also be idiopathic. Inadequate detrusor compliance results in the failure of the bladder to stretch and thereby increase in intravesicular pressure. It also involves discomfort during filling and limited capacity. Pelvic radiotherapy or prolonged periods of catheterization can often be responsible for this.
There is some evidence to suggest that bladder hypersensitivity and the sensory role of the urothelium are connected. Because the urothelium acts as a central mediator of bladder function, the role of urothelial inflammation and infection can lead to overactivity of the bladder with or without urgency. The balance of urinary microbiota can alter bladder function, sensation, and lead to urgency incontinence as a result.
External urethral occlusive device
The external urethral occluder is a urological clamp for women intended to prevent or decrease episodes of urine leakage in women with stress incontinence. The device is applied to the urinary meatus by suction or tape, which creates a barrier for urine leakage. The occluding device can come in the form of a cap, suction cup, or foam pad, and may include adhesive gel or ointment.
Male sling for urinary incontinence
The surgical mesh is a device for treating stress urinary incontinence and repair of pelvic organ prolapse (POP) in men and women. It can use a biologic (e.g. collagen) and/or synthetic (e.g. metallic or polymeric) woven fabric of varying design and material properties. It is applied via a permanently implantable sling placed under the urethra and activates in instances of increased abdominal pressure (e.g. coughing, laughing, sneezing, etc.), applying pressure to the urethra to prevent urine leakage.
According to data from the National Association for Continence, over 25 million adults in the US experience issues of urinary incontinence, either chronic or temporary. While urinary incontinence can occur at any age and afflicts any gender, it is most common among women over the age of 50. In women, urinary continence is most likely to develop during pregnancy and after giving birth, or after going through menopause. Women typically suffer from either stress or urge incontinence, or both.
Incontinence among noninstitutionalized persons aged 65 and over, by age and sex.
A 2014 report from the Center for Disease Control and Prevention (CDC), Prevalence of Incontinence Among Older Americans, found that urinary incontinence affects twice as many women as it does men in the US. Additionally, the same report found that more than 4 in 10 women above the age of sixty-five have problems with urinary incontinence. The report also stated that non-Hispanic white women were 1.8 times more likely to experience urinary leakage and incontinence issues than non-Hispanic black women.
Treatment for urinary incontinence depends on several factors, including the type of incontinence, its severity, and the underlying cause. Doctors sometimes employ a combination of different methods in order to address incontinence, and typically start with less invasive methods. If urinary incontinence is a symptom of another underlying condition, doctors typically treat the underlying condition first. Basic behavioral techniques are traditionally the first step to addressing incontinence. These can include the following treatments:
- Bladder training—trying to delay urination after first getting the urge
- Double voiding—waiting a few minutes after using the restroom and trying to urinate again, in an effort to empty the bladder more completely
- Scheduled toilet trips—scheduling bathroom trips every two to four hours instead of waiting for the urge to go
- Fluid or diet management—drinking less fluids, as well as limiting the intake of or avoiding alcohol, caffeine, or fatty foods has been shown to ease the problem of incontinence; weight loss and increase in exercise may also be beneficial
Doctors may also recommend doing pelvic floor exercises to ease the problem of incontinence. These exercises, also known as Kegel exercises, are especially fruitful when addressing incontinence caused by stress. Pelvic floor exercises involve contracting the muscles one uses to urinate, holding for around ten seconds, and then releasing. It is typically recommended that these exercises be done three times a day, with ten repetitions each time.
A doctor may also recommend taking medication in order to address urinary incontinence. If dealing with urge incontinence, a doctor may recommend an anticholinergic medication, used to calm an overactive bladder. Examples of anticholinergics include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare), and trospium chloride. Another medication used to treat urge incontinence is Mirabegron, sold under the brand name Myrbetriq. This medication relaxes the bladder muscle and can increase the amount of urine one’s bladder is able to hold. Additionally, Mirabegron can possibly increase the amount one is able to urinate when they use the bathroom, allowing the bladder to be emptied more completely.
For men with urinary incontinence, alpha blockers may be used. These medications are typically used to address incontinence caused by urge to go or overflow of the bladder. Alpha blockers relax the bladder neck muscles and muscles in the prostate in order to make emptying the bladder easier. Examples of alpha blockers include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura). For women with urinary incontinence, a doctor may recommend using topical estrogen. Topical estrogen comes in several forms, including a vaginal cream, ring, or patch. Topical estrogen may help tone and rejuvenate muscle tissue in the urethra and vaginal areas.
If medication or behavioral techniques do not ease urinary incontinence, a doctor may need to use methods that are more interventional to solve the problem. These include electrical stimulation (wherein an electrode is inserted into the vagina or rectum to stimulate pelvic floor muscles), a urethral insert or pessary, injections, nerve stimulators, or surgery. Absorbent pads, protective garments and catheters may also be used to ease the discomfort and inconvenience of leaking urine if medical treatments prove ineffective.
A 2021 study presented at the American Urological Association’s annual meeting found that regularly engaging in moderate physical activity and exercise reduces urinary incontinence in women. The study included 30,213 women, with 16,541 (54.74%) having urinary incontinence of any type. Women in the study who participated in moderate physical activity, either at work or for leisure, were found to have a lower likelihood of having stress incontinence or urge incontinence.
- American Urological Association (AUA)—The AUA was founded in 1902 and is headquartered near Baltimore, Maryland. The association had more than 23,000 members worldwide as of 2021.
- Urology Times—Urology Times is an online news source and journal for urologists and allied health professionals owned by MJH Life Sciences, a privately held, independent, full service medical media company.
- Depend Community Forum—Depend Community Forum is an online forum hosted by Depend, a company making absorbent and disposable underwear and undergarments for adults with urinary or fecal incontinence. The forum is open to people who have incontinence issues or are caring for someone with incontinence issues.
