Urinary incontinence
Encyclopedia
Urinary incontinence is any involuntary leakage of urine
. It is a common and distressing problem, which may have a profound impact on quality of life
. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners. There is also a related condition for defecation
known as fecal incontinence
.
s specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth and some also treat urinary incontinence in women. Family practitioners and internists see patients for all kinds of complaints and can refer patients on to the relevant specialists.
A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.
The physical examination
will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.
A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.
Other tests include:
Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.
Bladder control problems have been found to be associated with higher incidence of many other health problems such as obesity and diabetes. Difficulty with bladder control results in higher rates of depression and limited activity levels.
Incontinence is expensive both to individuals in the form of bladder control products and to the health care system and nursing home industry. Injury related to incontinence is a leading cause of admission to assisted living and nursing care facilities. More than 50% of nursing facility admissions are related to incontinence.
Coital incontinence (CI) is urinary leakage that occurs during either penetration or orgasm
and can occur with a sexual partner or with masturbation
. It has been reported to occur in 10% to 24% of sexually active women with pelvic floor disorders.
treatments. Both women and men can become incontinent from neurologic injury, congenital defects, stroke
s, multiple sclerosis
, and physical problems associated with aging
.
While urinary incontinence affects older men more often than younger men, the onset of incontinence can happen at any age. Recent estimates by the National Institutes of Health (NIH) suggest that 17 percent of men over age 60, an estimated 600,000 men, experience urinary incontinence, with this percentage increasing with age. Incontinence is treatable and often curable at all ages.
Incontinence in men usually occurs because of problems with muscles that help to hold or release urine. The body stores urine—water and wastes removed by the kidneys—in the urinary bladder
, a balloon-like organ. The bladder connects to the urethra
, the tube through which urine leaves the body.
During urination
, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter
muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
, medications and surgery. In all cases, the least invasive treatment is started first. The success of treatment depends on the correct diagnoses in the first place.
Most treatment options are most appropriate for a specific underlying cause of the incontinence (though these can overlap if there is a mixed component to the incontinence.) However, some approaches (such as use of absorbent products) address the problem symptomatically, and can be applicable to more than one type. It is also sometimes possible to use a treatment for the pathophysiology of one type of incontinence to provide relief for an unrelated type of incontinence.
Absorbent pads and various types of urinary catheters
may help those individuals who continue to experience incontinence. Some absorbent pads are not bulky like in the old days but are close fitting underwear with liners.
Men also can use an external urine collection device that is worn around the penis. These are traditionally referred to as condom or Texas catheters. These are not appropriate for men who are uncircumcised, have large or small anatomy or those who are have retracted anatomy. Condom catheter users frequently experience complications including urinary tract infections and skin breakdown. Newer products are available for men which do not have these associated complications. These include, "Liberty" which has recently reached one million devices without any reported urinary tract infections.
Absorbent products include shields
, undergarments, protective underwear, briefs
, diapers, adult diapers and underpads
.
Hospital
s often use some type of incontinence pad
, a small but highly absorbent sheet placed beneath the patient, to deal with incontinence or other unexpected discharges of bodily fluid
. These pads are especially useful when it is not practical for the patient to wear a diaper.
The most common form of urine management in hospitals is indwelling or Foley catheters. These catheters may cause infection and other associated secondary complications.
The bladder is made of two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stay contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.
A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system develops. The child's brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.
Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.
Incontinence happens less often after age 5: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in girls as in boys.
or sleepwetting—is more common than daytime wetting in boys. Experts do not know what causes nighttime incontinence. Young people who experience nighttime wetting tend to be physically and emotionally normal. Most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, in some cases, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.
, or ADH. The body normally produces more ADH during sleep so that the need to urinate is lower. If the body does not produce enough ADH at night, the making of urine may not be slowed down, leading to bladder overfilling. If a child does not sense the bladder filling and awaken to urinate, then wetting will occur.
Incontinence itself is an anxiety-causing event. Strong bladder contractions leading to leakage in the daytime can cause embarrassment and anxiety that lead to wetting at night.
, a misplacement of the ureter outside the bladder, can also commonly cause incontinence. In these cases, the incontinence can appear as a constant dribbling of urine.
Sometimes overly strenuous toilet training may make the child unable to relax the sphincter and the pelvic floor to completely empty the bladder. Retaining urine (incomplete emptying) sets the stage for urinary tract infections.
Children may also be affected by giggle incontinence
, an involuntary response to laughter.
Many children overcome incontinence naturally (without treatment) as they grow older. The number of cases of incontinence goes down by 15 percent for each year after the age of 5.
, or DDAVP, which recently became available in pill form. Patients can also spray a mist containing desmopressin into their nostrils. Desmopressin is approved for use by children.
Another medication, called imipramine
, is also used to treat sleepwetting. It acts on both the brain and the urinary bladder. Unfortunately, total dryness with either of the medications available is achieved in only about 20 percent of patients.
If a young person experiences incontinence resulting from an overactive bladder, a doctor might prescribe a medicine that helps to calm the bladder muscle. This medicine controls muscle spasms and belongs to a class of medications called anticholinergic
s.
Unfortunately, none of the above has demonstrated proven success.
Techniques that may help daytime incontinence include:
can awaken a person when he or she begins to urinate. These devices include a water-sensitive pad worn in pajamas, a wire connecting to a battery-driven control, and an alarm that sounds when moisture is first detected. For the alarm to be effective, the child must awaken or be awakened as soon as the alarm goes off. This may require having another person sleep in the same room to awaken the bedwetter.
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
. It is a common and distressing problem, which may have a profound impact on quality of life
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners. There is also a related condition for defecation
Defecation
Defecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
known as fecal incontinence
Fecal incontinence
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
.
Physiology of continence
Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intraabdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence. Normal voiding is the result of changes in both of these pressure factors: urethral pressure falls and bladder pressure rises.Causes
- PolyuriaPolyuriaPolyuria is a condition usually defined as excessive or abnormally large production or passage of urine . Frequent urination is sometimes included by definition, but is nonetheless usually an accompanying symptom...
(excessive urine production) of which, in turn, the most frequent causes are: uncontrolled diabetes mellitusDiabetes mellitusDiabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, primary polydipsia (excessive fluid drinkingDrinkingDrinking is the act of consuming water or a beverage through the mouth. Water is required for many of life’s physiological processes. Both excessive and inadequate water intake are associated with health problems.-Physiology:...
), central diabetes insipidus and nephrogenic diabetes insipidusNephrogenic diabetes insipidusNephrogenic diabetes insipidus is a form of diabetes insipidus due primarily to pathology of the kidney. This is in contrast to central/neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone /Argenine Vasopressin...
. Polyuria generally causes urinary urgencyUrinary urgencyUrinary urgency is a sudden, compelling urge to urinate. It is often, though not necessarily, associated with urinary incontinence, polyuria, nocturia, and interstitial cystitis. It tends to increase with age...
and frequency, but doesn't necessarily lead to incontinence. - CaffeineCaffeineCaffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
or colaColaCola is a carbonated beverage that was typically flavored by the kola nut as well as vanilla and other flavorings, however, some colas are now flavored artificially. It became popular worldwide after druggist John Pemberton invented Coca-Cola in 1886...
beverages also stimulate the bladder. - Enlarged prostateProstateThe prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
is the most common cause of incontinence in men after the age of 40; sometimes prostate cancer may also be associated with urinary incontinence. Moreover drugs or radiation used to treat prostate cancer can also cause incontinence. - Disorders like multiple sclerosisMultiple sclerosisMultiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, spina bifidaSpina bifidaSpina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through...
, Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
, strokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
s and spinal cord injurySpinal cord injuryA spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
can all interfere with nerve function of the bladder.
Types
- Stress incontinenceStress incontinenceStress incontinence is a form of urinary incontinence.Stress urinary incontinence , also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles.-Pathophysiology:...
, also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles. - Urge incontinenceUrge incontinenceUrge incontinence is a form of urinary incontinence.Urge incontinence is involuntary loss of urine occurring for no apparent reason while feeling urinary urgency, a sudden need or urge to urinate.-Causes:...
is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. - Overflow incontinenceOverflow incontinenceOverflow incontinence is a form of urinary incontinence.Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have passed urine...
: Sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine. It is as if their bladders were constantly overflowing, hence the general name overflow incontinence. - Mixed incontinence is not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.
- Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood (for example, an ectopic ureterEctopic ureterEctopic ureter is a medical condition where the ureter, rather than terminating at the urinary bladder, terminates at a different site. In males this site is usually the urethra, in females this is usually the urethra or vagina...
). Fistulas caused by obstetric and gynecologic trauma or injury can lead to incontinence. These types of vaginal fistulas include, most commonly, vesicovaginal fistula and, more rarely, ureterovaginal fistula. These may be difficult to diagnose. The use of standard techniques along with a vaginogram or radiologically viewing the vaginal vaultVaginal vaultThe vaginal vault is the expanded region of the vaginal canal at the internal end of the vagina.The vaginal vault may prolapse after a hysterectomy , leading to a prolapse of the vaginal vault or a vaginal vault prolapse....
with instillation of contrast media. - Functional incontinence occurs when a person recognizes the need to urinate but cannot make it to the bathroom. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity, unwillingness to toilet because of depression, anxiety or anger, drunkenness, or being in a situation in which it is impossible to reach a toilet. People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer's Disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly women and men in nursing homes. Disease or biology is not necessarily the cause of functional incontinence. For example, someone on a road tripRoad tripA road trip is any journey taken on roads, regardless of stops en route. Typically, road trips are long distances traveled by automobile.-Pre-automobile road trips:...
may be between rest stops and on the highway; also, there may be problems with the restrooms in the vicinity. - BedwettingBedwettingNocturnal enuresis, commonly called bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary when a child has not yet had a prolonged period of being dry...
is episodic UI while asleep. It is normal in young children. - Transient incontinence is a temporary version of incontinence. It can be triggered by medications, adrenal insufficiency, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.
- Giggle incontinenceGiggle incontinenceGiggle incontinence, giggle enuresis or enuresis risoria is the involuntary release of urine in response to giggling or laughter. The bladder may empty completely or only partially....
is an involuntary response to laughter. It usually affects children.
Diagnosis
Patients with incontinence should be referred to a medical practitioner specializing in this field. UrologistUrology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
s specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth and some also treat urinary incontinence in women. Family practitioners and internists see patients for all kinds of complaints and can refer patients on to the relevant specialists.
A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.
The physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.
A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.
Other tests include:
- Stress testStress testStress test may refer to:*Stress Test , an episode of Brandy and Mr Whiskers*Stress testing, a form of testing that is used to determine the stability of a given system or entity*Stress testing , determines the robustness of software...
– the patient relaxes, then coughs vigorously as the doctor watches for loss of urine. - UrinalysisUrinalysisA urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
– urine is tested for evidence of infection, urinary stones, or other contributing causes. - Blood testBlood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence. - UltrasoundUltrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
– sound waves are used to visualize the kidneys, ureters, bladder, and urethra. - CystoscopyCystoscopyCystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
– a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder. - Urodynamics – various techniques measure pressure in the bladder and the flow of urine.
Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.
Urinary incontinence in women
Bladder symptoms affect women of all ages. However, bladder problems are most prevalent among older women. Up to 35% of the total population over the age of 60 years is estimated to be incontinent, with women twice as likely as men to experience incontinence. One in three women over the age of 60 years are estimated to have bladder control problems.Bladder control problems have been found to be associated with higher incidence of many other health problems such as obesity and diabetes. Difficulty with bladder control results in higher rates of depression and limited activity levels.
Incontinence is expensive both to individuals in the form of bladder control products and to the health care system and nursing home industry. Injury related to incontinence is a leading cause of admission to assisted living and nursing care facilities. More than 50% of nursing facility admissions are related to incontinence.
Coital incontinence (CI) is urinary leakage that occurs during either penetration or orgasm
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
and can occur with a sexual partner or with masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...
. It has been reported to occur in 10% to 24% of sexually active women with pelvic floor disorders.
Urinary incontinence in men
Men tend to experience incontinence less often than women, and the structure of the male urinary tract accounts for this difference. It is common with prostate cancerProstate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
treatments. Both women and men can become incontinent from neurologic injury, congenital defects, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
s, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, and physical problems associated with aging
Senescence
Senescence or biological aging is the change in the biology of an organism as it ages after its maturity. Such changes range from those affecting its cells and their function to those affecting the whole organism...
.
While urinary incontinence affects older men more often than younger men, the onset of incontinence can happen at any age. Recent estimates by the National Institutes of Health (NIH) suggest that 17 percent of men over age 60, an estimated 600,000 men, experience urinary incontinence, with this percentage increasing with age. Incontinence is treatable and often curable at all ages.
Incontinence in men usually occurs because of problems with muscles that help to hold or release urine. The body stores urine—water and wastes removed by the kidneys—in the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
, a balloon-like organ. The bladder connects to the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, the tube through which urine leaves the body.
During urination
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter
Sphincter
A sphincter is an anatomical structure, or a circular muscle, that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning...
muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
Treatment
The treatment options range from conservative treatment, behavior managementBehavior management
Behavior management is similar to behavior modification. It is a less intensive version of behavior therapy. In behavior modification the focus is on changing behavior, while in behavior management the focus is on maintaining order. Behavior management skills are of particular importance to...
, medications and surgery. In all cases, the least invasive treatment is started first. The success of treatment depends on the correct diagnoses in the first place.
Most treatment options are most appropriate for a specific underlying cause of the incontinence (though these can overlap if there is a mixed component to the incontinence.) However, some approaches (such as use of absorbent products) address the problem symptomatically, and can be applicable to more than one type. It is also sometimes possible to use a treatment for the pathophysiology of one type of incontinence to provide relief for an unrelated type of incontinence.
Absorbent pads and various types of urinary catheters
Urinary catheterization
In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...
may help those individuals who continue to experience incontinence. Some absorbent pads are not bulky like in the old days but are close fitting underwear with liners.
Men also can use an external urine collection device that is worn around the penis. These are traditionally referred to as condom or Texas catheters. These are not appropriate for men who are uncircumcised, have large or small anatomy or those who are have retracted anatomy. Condom catheter users frequently experience complications including urinary tract infections and skin breakdown. Newer products are available for men which do not have these associated complications. These include, "Liberty" which has recently reached one million devices without any reported urinary tract infections.
Absorbent products include shields
Shields
-United Kingdom:* North Shields, Tyneside, England* South Shields, Tyneside, England* Shields Road subway station, an underground station in Glasgow, Scotland-United States:* Shields, Indiana, an unincorporated community...
, undergarments, protective underwear, briefs
Briefs
Briefs are a type of short, tight underwear and swimwear, as opposed to styles where the material extends down the legs.In the case of men's underwear, briefs, unlike boxer shorts, hold the wearer's genitals in a relatively fixed position, which make briefs a popular underwear choice for men who...
, diapers, adult diapers and underpads
Pads
Pads are protective equipment used by batters in the sports of cricket and baseball, and by goaltenders in hockey, bandy and lacrosse. They serve to protect the legs from impact by a hard ball or puck at high speed which could otherwise cause injuries to the lower leg.In cricket, pads fall into...
.
Hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s often use some type of incontinence pad
Incontinence pad
An incontinence pad is a small impermeable multi-layered sheet with high absorbency that is used in the health-care industry. The term can also used to refer to what are more correctly known as Incontinence Diapers. Actual incontinence pads are usually placed on a bed or chair under a patient as a...
, a small but highly absorbent sheet placed beneath the patient, to deal with incontinence or other unexpected discharges of bodily fluid
Bodily fluid
Body fluid or bodily fluids are liquids originating from inside the bodies of living people. They include fluids that are excreted or secreted from the body as well as body water that normally is not.Body fluids include:-Body fluids and health:...
. These pads are especially useful when it is not practical for the patient to wear a diaper.
The most common form of urine management in hospitals is indwelling or Foley catheters. These catheters may cause infection and other associated secondary complications.
Urinary incontinence in children
Urination, or voiding, is a complex activity. The bladder is a balloonlike muscle that lies in the lowest part of the abdomen. The bladder stores urine, then releases it through the urethra, the canal that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, the spinal cord and the brain.The bladder is made of two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stay contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back.
A baby's bladder fills to a set point, then automatically contracts and empties. As the child gets older, the nervous system develops. The child's brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void.
Failures in this control mechanism result in incontinence. Reasons for this failure range from the simple to the complex.
Incontinence happens less often after age 5: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds experience episodes of incontinence. It is twice as common in girls as in boys.
Causes of nighttime incontinence
After age 5, wetting at night—often called bedwettingBedwetting
Nocturnal enuresis, commonly called bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Nocturnal enuresis is considered primary when a child has not yet had a prolonged period of being dry...
or sleepwetting—is more common than daytime wetting in boys. Experts do not know what causes nighttime incontinence. Young people who experience nighttime wetting tend to be physically and emotionally normal. Most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and, in some cases, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.
Slower physical development
Between the ages of 5 and 10, incontinence may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the body's alarms that signal a full or emptying bladder. This form of incontinence will fade away as the bladder grows and the natural alarms become operational.Excessive output of urine during sleep
Normally, the body produces a hormone that can slow the making of urine. This hormone is called antidiuretic hormoneVasopressin
Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a neurohypophysial hormone found in most mammals, including humans. Vasopressin is a peptide hormone that controls the reabsorption of molecules in the tubules of the kidneys by affecting the tissue's...
, or ADH. The body normally produces more ADH during sleep so that the need to urinate is lower. If the body does not produce enough ADH at night, the making of urine may not be slowed down, leading to bladder overfilling. If a child does not sense the bladder filling and awaken to urinate, then wetting will occur.
Anxiety
Experts suggest that anxiety-causing events occurring in the lives of children ages 2 to 4 might lead to incontinence before the child achieves total bladder control. Anxiety experienced after age 4 might lead to wetting after the child has been dry for a period of 6 months or more. Such events include angry parents, unfamiliar social situations, and overwhelming family events such as the birth of a brother or sister.Incontinence itself is an anxiety-causing event. Strong bladder contractions leading to leakage in the daytime can cause embarrassment and anxiety that lead to wetting at night.
Genetics
Certain inherited genes appear to contribute to incontinence. In 1995, Danish researchers announced they had found a site on human chromosome 13 that is responsible, at least in part, for nighttime wetting. If both parents were bedwetters, a child has an 80 percent chance of being a bedwetter also. Experts believe that other, undetermined genes also may be involved in incontinence.Obstructive sleep apnea
Nighttime incontinence may be one sign of another condition called obstructive sleep apnea, in which the child's breathing is interrupted during sleep, often because of inflamed or enlarged tonsils or adenoids. Other symptoms of this condition include snoring, mouth breathing, frequent ear and sinus infections, sore throat, choking, and daytime drowsiness. In some cases, successful treatment of this breathing disorder may also resolve the associated nighttime incontinence.Structural problems
Finally, a small number of cases of incontinence are caused by physical problems in the urinary system in children. A condition known as urinary reflux or vesicoureteral reflux, in which urine backs up into one or both ureters, can cause urinary tract infections and incontinence. Rarely, a blocked bladder or urethra may cause the bladder to overfill and leak. Nerve damage associated with the birth defect spina bifida can cause incontinence. An ectopic ureterEctopic ureter
Ectopic ureter is a medical condition where the ureter, rather than terminating at the urinary bladder, terminates at a different site. In males this site is usually the urethra, in females this is usually the urethra or vagina...
, a misplacement of the ureter outside the bladder, can also commonly cause incontinence. In these cases, the incontinence can appear as a constant dribbling of urine.
Causes of daytime incontinence
Daytime incontinence that is not associated with urinary infection or anatomic abnormalities is less common than nighttime incontinence and tends to disappear much earlier than the nighttime versions. One possible cause of daytime incontinence is an overactive bladder. Many children with daytime incontinence have abnormal voiding habits, the most common being infrequent voiding. This form of incontinence occurs more often in girls than in boys.An overactive bladder
Muscles surrounding the urethra (the tube that takes urine away from the bladder) have the job of keeping the passage closed, preventing urine from passing out of the body. If the bladder contracts strongly and without warning, the muscles surrounding the urethra may not be able to keep urine from passing. This often happens as a consequence of urinary tract infection and is more common in girls.Infrequent voiding
Infrequent voiding refers to a child's voluntarily holding urine for prolonged intervals. For example, a child may not want to use the toilets at school or may not want to interrupt enjoyable activities, so he or she ignores the body's signal of a full bladder. In these cases, the bladder can overfill and leak urine. Additionally, these children often develop urinary tract infections (UTIs), leading to an irritable or overactive bladder.Other causes
Some of the same factors that contribute to nighttime incontinence may act together with infrequent voiding to produce daytime incontinence. These factors include a small bladder capacity, constipation and food containing caffeine, chocolate or artificial coloring.Sometimes overly strenuous toilet training may make the child unable to relax the sphincter and the pelvic floor to completely empty the bladder. Retaining urine (incomplete emptying) sets the stage for urinary tract infections.
Children may also be affected by giggle incontinence
Giggle incontinence
Giggle incontinence, giggle enuresis or enuresis risoria is the involuntary release of urine in response to giggling or laughter. The bladder may empty completely or only partially....
, an involuntary response to laughter.
Growth and development
Most urinary incontinence fades away naturally. Here are examples of what can happen over time:- Bladder capacity increases.
- Natural body alarms become activated.
- An overactive bladder settles down.
- Production of ADH becomes normal.
- The child learns to respond to the body's signal that it is time to void.
- Stressful events or periods pass.
Many children overcome incontinence naturally (without treatment) as they grow older. The number of cases of incontinence goes down by 15 percent for each year after the age of 5.
Medications
Nighttime incontinence may be treated by increasing ADH levels. The hormone can be boosted by a synthetic version known as desmopressinDesmopressin
Desmopressin is a synthetic replacement for vasopressin, the hormone that reduces urine production. It may be taken nasally, intravenously, or as a tablet...
, or DDAVP, which recently became available in pill form. Patients can also spray a mist containing desmopressin into their nostrils. Desmopressin is approved for use by children.
Another medication, called imipramine
Imipramine
Imipramine , also known as melipramine, is an antidepressant medication, a tricyclic antidepressant of the dibenzazepine group...
, is also used to treat sleepwetting. It acts on both the brain and the urinary bladder. Unfortunately, total dryness with either of the medications available is achieved in only about 20 percent of patients.
If a young person experiences incontinence resulting from an overactive bladder, a doctor might prescribe a medicine that helps to calm the bladder muscle. This medicine controls muscle spasms and belongs to a class of medications called anticholinergic
Anticholinergic
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicycloverine, and the classic example is atropine....
s.
Bladder training and related strategies
Bladder training consists of exercises for strengthening and coordinating muscles of the bladder and urethra, and may help the control of urination. These techniques teach the child to anticipate the need to urinate and prevent urination when away from a toilet. Techniques that may help nighttime incontinence include:- Determining bladder capacity
- Stretching the bladder (delaying urinating)
- Drinking less fluid before sleeping
- Developing routines for waking up
Unfortunately, none of the above has demonstrated proven success.
Techniques that may help daytime incontinence include:
- Urinating on a schedule, such as every 2 hours (this is called timed voiding)
- Avoiding caffeine or other foods or drinks that may contribute to a child's incontinence
- Following suggestions for healthy urination, such as relaxing muscles and taking your time
Moisture alarms
At night, moisture alarmsBedwetting alarm
A bedwetting alarm is an electronic device used as a treatment option for nocturnal enuresis. The alarm activates when the wearer urinates. Alarms come in several different styles: wearable alarms, wireless alarms, and pad-type alarms...
can awaken a person when he or she begins to urinate. These devices include a water-sensitive pad worn in pajamas, a wire connecting to a battery-driven control, and an alarm that sounds when moisture is first detected. For the alarm to be effective, the child must awaken or be awakened as soon as the alarm goes off. This may require having another person sleep in the same room to awaken the bedwetter.
See also
- Double dye testDouble dye testDouble dye test is useful for diagnosing vesicovaginal or ureterovaginal fistulae. For this test, the patient takes oral phenazopyridine 200 mg TDS, and indigo carmine or methylene blue is filled in to the empty urinary bladder via a urethral catheter...
- National Public Toilet MapNational Public Toilet MapThe National Public Toilet Map is part of the Australian government's National Continence Management Strategy . The map allows more Australians with urinary and fecal incontinence problems to live and participate in their communities with dignity and confidence, by making it easier for them to find...
(in Australia) - National Association For ContinenceNational Association For ContinenceNational Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction, and related pelvic floor disorders...