Incontinence

Incontinence occurs when a person cannot control evacuating wastes from the body.

If the condition disappears in time or after treatment, it is called transient incontinence. This occurs most often in older persons. When it happens with younger people, it is important to find the underlying cause.

If leakage continues after transient causes of incontinence have been addressed, the condition is called established incontinence.

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Symptoms

The signs of incontinence are:

  • Leakage of urine or stools that cannot be controlled
  • Extreme urgency about the need to void or move the bowels
  • A sudden urge to void the bladder
  • A need to go to the bathroom at night or the inability to control the bladder at night
  • An inability to completely empty the bladder
  • Leakage when coughing, laughing, bending or lifting
  • Leakage when there is no stress or contraction of the bladder

Causes and Risk Factors

Several factors may contribute to transient incontinence, including:

  • Alcohol and drug use in older persons
  • Diseases such as heart failure, venous insufficiency in the hands and feet or swelling of the hands and feet caused by drugs.
  • Impacted stool, especially in elderly patients. This may affect the way the bladder or urethra works.
  • Difficulty getting to a toilet. These might include physical problems, difficulty getting out of bed, foot lesions, poorly fitted shoes, poor eyesight or a fear of falling. Having a urinal or bedside commode may help.
  • Inflammation of the urethra or the vagina after menopause. This sometimes causes symptoms in the urinary tract such as the urgent need to go to the bathroom. Other signs may be difficult or painful urination.
  • Too much urine because of a high intake of fluids, the use of diuretics (including caffeine and alcohol) or metabolism problems. This might include diabetes or having too much calcium in the blood.
  • Sexually transmitted diseases such as Chlamydia trachomatis.
  • Urinary tract infections, especially in young women. In older persons, these kinds of infections that don't cause symptoms rarely cause incontinence.

Factors that lead to established incontinence include:

  • A hernia in the bladder (in women) where urine pools
  • A pouch or diverticulum in the bladder
  • Detrusor underactivity. This causes urine to be retained and leads to overflow. It can happen as a result of nerve damage, spinal disc compression, diabetic neuropathy, pernicious anemia, Parkinson's disease, alcoholism or for no identifiable reason.
  • Involuntary contractions of the bladder (detrusor overactivity). This is the leading cause of established incontinence in older persons. It is also common in younger ones.
  • Involuntary, but weak contractions of the bladder. This is called detrusor hyperactivity with impaired contractility (DHIC).
  • Neurological disorders that affect the spinal cord or nerve roots that lead from the spinal cord
  • Obstructions of the bladder or urethra. These include scarring after surgery, a hernia in the bladder or a tumor.
  • Outlet incompetence
  • Prostate problems, including prostatic hyperplasia, prostate cancer and narrowing of the urethra
  • Weak muscle tone from injury due to surgery
  • Weakening of the urethra with age
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Diagnosis

A doctor will take the patient's medical history and do a physical examination.

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Treatments

Treatment will depend on the cause of the condition.