Question

Why am I voiding on myself and what can be done to prevent it?

Answer

The most important fact about urinary incontinence that must be emphasized is that incontinence is never a normal part of aging. Incontinence is, however, associated with many diseases and conditions which older adults are likely to experience. And to make matters more complicated, some treatments including surgeries and medications used to treat some of these disorders can themselves cause incontinence.

The first step in identifying the cause of urinary incontinence and selecting an appropriate treatment is to determine the type of incontinence the individual is experiencing. Physical examination is an essential part of determining the cause of incontinence. The information provided here is not a substitute for a medical examination. The individual's history of incontinence, however, can provide important indicators as to which type of incontinence is being encountered.

Types of incontinence and other abnormal patterns of voiding are described here.

- Urge Incontinence is the sudden loss of urine that occurs with or immediately following a sudden urge or desire to void. Urge incontinence may be associated with hyperactive or weakened muscles in the pelvic floor. These may be caused by strokes, spinal cord lesions, multiple sclerosis, and other neurologic disorders.

- Stress Incontinence is the uncontrolled loss of urine with physical exertion such as lifting, sneezing, coughing, laughing, or sitting up. The urine loss may be only a dribble or may be full volume. Stress incontinence is caused by a weakness or unusual pressures on the muscles that control urine flow.

- Overflow incontinence is a constant or frequent leakage of small amounts of urine when bladder is full, or it may present as either urge or stress incontinence. It may be due to altered sensation of the full bladder due to neurologic changes as seen in diabetes, spinal cord injuries, or following major pelvic surgeries. Individuals with overflow incontinence sometimes report the sense that after voiding they still feel the need to void but are unable to do so.

- Frequency is the sensation of needing to void more than usual. Individuals with frequency are often obliged to interrupt their activities for voiding and may even limit activities outside of the home to insure frequent access to a toilet.

- Nocturia is the need to void during the night so that sleep is disturbed.

- Retention is the inability to empty the bladder completely. This occurs when the urine's path is blocked by disease, pressure on the urethra, or the narrowing of the path due to some neurologic diseases. Older men with enlarged prostate glands often have this difficulty. Both men and women with chronic or frequent constipation may also experience urinary retention.

- Hesitancy is the inability to void promptly with the urge. When an individual experiencing hesitancy attempts to void, there may a delay of many seconds or even minutes before the urine stream begins. Hesitancy may be a side effect of medications.

Fortunately, some episodes of incontinence are transient or temporary and may last for several days, weeks or even months. Transient incontinence may be due to delirium (confusion) from any cause, trauma (physical or emotional), childbirth, infections, drug toxicity, medication side effects, and infections. Some individuals may also experience a single episode of incontinence, most often due trauma and sudden change mental status. A single episode of incontinence may also be caused by any of the causes of transient incontinence.

There are many medications which have been implicated in incontinence. It is not just prescription medications which may contribute to incontinence. Some over-the-counter medications and even foods are also associated with these problems. Any individual experiencing incontinence should review all of the medications being used with his or her primary care provider or pharmacist. It is important that the primary care provider be informed about any and all medications being used, and any and all functional changes such as incontinence.

Some times the cause of incontinence will be identified quickly by the primary care provider based on history and office examination. Other times a more extensive diagnostic work up must be done. Not every patient needs every test. The diagnostic methods which may be used to determine the cause of urinary incontinence include the following:

- Cystoscopy is an examination of the bladder and urethra (the tube through which urine passes from the bladder to the outside) done by passing a very small tube into the opening to permit visual examination by the doctor.

- Post-Void Residual (PVR) measures the amount of urine that remains in the bladder after the individual has voided.

- Stress test is done by asking the patient to cough, stand, or lift and then examining for any leaked urine.

- Urinanalysis is a laboratory examination of collected urine, looking specifically for indication of infection, blood in the urine, or other abnormalities.

Another important type of incontinence is referred to as Functional Incontinence. For these individuals, the incontinence is due to diseases or conditions which disable the person from responding to the need to void fully. Such conditions include advanced dementia (for example, Alzheimer's disease), stiffness or pain (slowing the ability to get to a toilet quickly enough), or impaired mobility (preventing independent movement).

Urinary incontinence is never normal. It may be caused by many diseases, condition and even medications. There are treatment options for incontinence which include behavioral patterning, education, medication adjustment, introduction of new medications, and surgery. All treatment plans must be based on appropriate medical examination.

Links

• Can one prevent incontinence ?
• Behavioral treatment for incontinence
• Incontinence Help Services