Bladder Control Problems (cont.)
Bladder Control Problems Causes
Incontinence is a symptom with a wide variety of causes. The most common causes include the following:
- Urinary tract infection
- Side effect of medication: Examples include alpha-blockers, calcium channel blockers, antidepressants, antihistamines, sedatives, sleeping pills, narcotics, caffeine-containing preparations, and water pills (diuretics). Occasionally, the medicines used to treat some forms of incontinence can also worsen the incontinence if not prescribed correctly.
- Impacted stool: Stool becomes so tightly packed in the lower intestine and rectum that a bowel movement becomes very difficult or impossible.
- Weakness of muscles in the bladder and surrounding area: This can have a variety of causes.
- Overactive bladder
- Bladder irritation
- Blocked urethra, usually due to enlarged prostate (in men)
- Prior prostate, bladder, or pelvic surgery
- Nerve damage or neurological diseases (spinal cord injury, stroke, etc.)
Many of the causes are temporary, such as urinary tract infection. The incontinence improves or goes away completely when the underlying condition is treated. Others are longer lasting, but the incontinence can usually be treated.
Risk factors: Underlying causes or contributors to urinary incontinence include the following:
- Smoking: The connection with incontinence is not completely clear, but smoking is known to irritate the bladder in many people.
- Obesity: Excess body fat can reduce muscle tone, including the muscles used to control urination.
- Chronic constipation: Regular straining to have a bowel movement can weaken the muscles that control urination.
- Diabetes: Diabetes can damage nerves and interfere with sensation.
- Spinal cord injury: Signals between the bladder and the brain travel via the spinal cord. Damage to the cord can interrupt those signals, disrupting bladder function.
- Disability or impaired mobility: People who have diseases such as arthritis, which make walking painful or slow, may have "accidents" before they can reach a toilet. Similarly, people who are permanently or temporarily confined to a bed or a wheelchair often have problems because of their inability to get to a toilet easily.
- Neurologic disease: Conditions such as stroke, multiple sclerosis, Alzheimer's disease, or Parkinson's disease can cause incontinence. The problem can be a direct result of a disrupted nervous system or an indirect result of having restricted movement.
- Surgery or radiation therapy to the pelvis: Incontinence can result from certain surgeries or medical therapies.
- Pregnancy: One-third to one-half of pregnant women have problems controlling their bladder. In most of these women, incontinence stops after delivery. However, 4%-8% of pregnant women experience renewed incontinence after delivery (postpartum). Risk factors for postpartum incontinence include vaginal delivery, long second stage of labor (the time after the cervix is fully dilated), and having large babies.
- Menopause: Studies have not demonstrated a consistent increase in risk of incontinence following menopause. The relationship between postmenopausal hormone replacement therapy and incontinence is unclear.
- Hysterectomy: Women who have had a hysterectomy may have incontinence later in life.
- Enlarged prostate: In men with an enlarged prostate, the prostate can block the urethra, causing urine leakage. However, less than 1% of men treated for benign (noncancerous) enlargement of the prostate report incontinence.
- Prostate surgery: Up to 87% of men whose prostate has been removed report problems with incontinence.
- Bladder disease: Certain disorders of the bladder, including bladder cancer, can sometimes cause incontinence.
Medically Reviewed by a Doctor on 7/21/2014
George Lazarou, MD, FACOG
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