Who do you know that could be a “silent sufferer”? You? One or more of your family members? People at the office? Staff members or patients at the medical practice where you work? Those you know in retirement communities or nursing homes? People at your church or synagogue? Your neighbors? Members of organizations in which you participate? Your Social Media “friends”?
If you yourself suffered from incontinence and found an effective treatment for the problem, somebody at some point suggested a potential source for a solution. How long did you suffer before you heard of a way out? Don’t you wish someone had told you sooner?
Many people would rather suffer silently than discuss their urinary or fecal incontinence. The topic is just too embarrassing and unpleasant—and after all, incontinence is a normal part of aging, isn’t it?
Incontinence is never normal. And you should know that if you don’t raise the topic with people at risk for incontinence, they probably won’t talk about it. Knowing what to ask depends on your understanding of how the bladder normally functions and what can go wrong.
Types of urinary incontinence
Urinary incontinence is a leakage of urine, no matter how much or how often. The National Association for Continence estimates that 25 million Americans have either chronic or transient urinary incontinence—problems that can lead to depression, isolation, diminished self- esteem, and work-related difficulties.
Urinary incontinence and urine retention can result from one or more problems:
• failure of the bladder to store urine
• failure of the bladder to empty adequately
• a combination of failure to store and failure to empty
• sensory problems, such as pain during bladder filling or neurologic disorders that impair stimuli transmission to or from the bladder.
The problem may be acute or chronic. Acute incontinence is the sudden onset of urine leakage caused by physical deficits (arthritis, bladder infection, difficulty ambulating) or environmental factors (delay in answering call lights). When the physical deficit or environmental factor is corrected, the incontinence disappears. To recall the conditions that cause acute incontinence, use the acronym DIAPPERS:
- Delirium or confusion
- Atrophic vaginitis
- Pharmacologic therapy
- Psychological problems (depression)
- Restricted mobility
- Stool impaction.
Chronic incontinence results from a disease process. Types of chronic incontinence include:
- Stress urinary incontinence is leakage of small amounts of urine when intra-abdominal pressure exceeds intraurethral pressure, such as during sneezing, coughing, laughing, or rising from a seated position. Contributing factors include traumatic vaginal birth, low estrogen levels, and lax pelvic floor muscles.
- Overactive bladder is characterized by urinary frequency (voiding more than eight times a day) and urgency (a sudden, strong urge to void). This type of incontinence results from involuntary bladder contractions caused by damage to nerves of the bladder, the brain or spinal cord, or the muscles that maintain continence. Overactive bladder is often associated with urge incontinence.
- Urge incontinence is leakage of large amounts of urine after a sudden, strong urge to void. It’s caused by involuntary bladder contractions, resulting from damage to nerves of the bladder, the brain or spinal cord, or the muscles that maintain continence.
- Overflow urinary incontinence is caused by incomplete bladder emptying that results in a spillover of small amounts of urine. Rare in women, this type of incontinence results from an obstruction such as benign prostatic hyperplasia (BPH), diabetic nerve damage, or diseases causing muscle weakness.
- Mixed urinary incontinence is a combination of stress incontinence and urge incontinence.
- Urine retention of more than 50 mL of urine in the bladder after voiding contributes to overflow incontinence. Retention can be caused by ineffective contraction of the detrusor bladder muscle, obstruction, tumors in the bladder neck or urethra, or strictures or scar tissue in the urethra. Intrinsic sphincter deficiency may occur after a prostatectomy if the sphincter is damaged above the genitourinary diaphragm. (See Understanding chronic incontinence in PDF by clicking download now button.)
At risk for incontinence
Urinary incontinence has modifiable and nonmodifiable risk factors. Modifiable risk factors include obesity, drugs, pelvic floor laxity, multiple vaginal deliveries, smoking, alcohol use, and caffeine intake. Nonmodifiable risk factors include advancing age, prostate surgery, and pelvic radiation therapy. White women have higher rates of moderate to severe incontinence than African-American women. Other risk factors include environmental factors, such as inaccessible toilets, and physical deficits that impair a person’s ability to use the toilet independently. Conditions such as diabetes, multiple sclerosis, and Parkinson’s disease as well as poor overall health also put people at risk.
According to the Agency for Healthcare Research and Quality, these are high-risk patients for urinary leakage
- elderly patients
- frail adults
- patients with a history of stroke, diabetes, obesity, or poor overall health
- patients who have multiple comorbidities
- pregnant women
- women after vaginal childbirth
- women with vaginal prolapse
What do you say to someone close to you who complains about their incontinence?
If someone you know and care about complains of leakage, reassure them that they are not alone and suggest that they discuss the subject openly with their primary care physician or a Urogynecologist.
There are a number of proven avenues for diagnosis and treatment. No one should suffer silently. Everyone affected should determine how to get their lives back.