The symptoms of incontinence vary according to the cause of the condition, and can range from minor leaks during a sneeze or physical activity to complete inability to hold in urine. Doctors generally classify urinary incontinence into four patterns: urge incontinence, stress incontinence, overflow incontinence, and total incontinence. Some people have a combination of types (mixed incontinence).
- Urge incontinence. People who suffer from urge incontinence experience an unpredictable overwhelming need to urinate that stems from a sudden, involuntary contraction of the bladder muscle. Typically, patients are unable to hold their urine until they can reach a bathroom, and experience modest amounts of urine loss. Older adults suffer most from this form of incontinence. An overactive bladder caused by a medication or an illness that interferes with the brain’s ability to control the bladder (for example, stroke or Parkinson’s disease) is often to blame. Obstruction to the flow of urine out of the bladder from an enlarged prostate gland also may affect the bladder and cause episodes of urge incontinence.
- Stress incontinence. People who suffer from stress incontinence experience predictable urinary leakage during activities that increase abdominal pressure, such as coughing, sneezing, exercise, laughing, and lifting heavy objects. This form of incontinence results when the urinary sphincter is weak and fails to stay closed during these activities. This form of incontinence is most common in postmenopausal women. Much less commonly, it can occur in men who have had some types of prostate surgery.
- Overflow incontinence. People who suffer from overflow incontinence experience periodic urine leakage, in which urine leaks out of a bladder that is distended and overfilled. In men, prostate enlargement and prostate cancer can block the bladder outlet and make the bladder distended and leaky. Scar tissue from prostate surgery sometimes narrows the urethra or bladder neck and causes overflow incontinence. Nerve damage caused by a spinal cord injury, an illness, or a medication can also contribute to this form of urinary incontinence.
- Total incontinence. People who suffer from total incontinence experience constant unrelenting urine leakage. This type of incontinence is very severe, and fortunately very uncommon. It may result from a number of causes including neurological problems, injuries, and various types of pelvic surgery.
- Mixed incontinence. People who suffer from mixed incontinence have a combination of the various forms of incontinence. Stress incontinence and urge incontinence frequently appear together.
Urinary incontinence can occur in anyone at any age, but is more common in women and in older adults Table 01. A third of older adults have some degree of incontinence. This does not mean that losing urinary control is a normal part of the aging process; however, it can be a consequence of illnesses that are more prevalent in older age groups, such as dementia, diabetes, Parkinson’s disease, and stroke. Likewise, medications taken by many older adults and procedures that are more common in this group (such as hysterectomy and prostatectomy) can predispose a person to incontinence.
Women are twice as likely as men to suffer from incontinence. Pregnancy and injury to the structures that govern continence during childbirth may be to blame. A number of menopausal and postmenopausal women experience stress incontinence due to declining estrogen levels. Tissues in the urethra and vaginal area in particular may become dry and less elastic when estrogen levels decline, which may contribute to incontinence.
Table 1. Medications That Affect Continence
Drug name Associated condition Alpha-adrenergic agonists Clonidine Guanfacine Methyldopa Hypertension Alpha-adrenergic antagonists Doxazosin HCl Terazosin HCl Hypertension, benign prostatic hyperplasia Anticholinergics PropanthelineTolterodine Oxybutynin Dicyclomine Overactive bladder, urinary incontinence, irritable bowel syndrome (Dicyclomine) Calcium channel blockers Amlodipine besylateFelodipineNifedipineNisoldipineVerapamil HCl Angina, hypertension Diuretics Ethacrynic acid Furosemide Edema Narcotics MorphineOpiumCodeine Relief of moderate to severe pain Sedatives Pentobarbital Phenobarbital Insomnia, convulsions
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