Doctor's Notes on Bladder Control Problems
Bladder control problems (urinary incontinence) involve difficulty stopping the flow of urine from the bladder. There are several types of urinary incontinence and many people have more than one type. Stress incontinence and urge incontinence are the most common. Other types of incontinence include mixed incontinence, overflow incontinence, neuropathic incontinence, fistulas, traumatic incontinence, congenital incontinence, and obstruction to urine flow.
Incontinence is uncontrollable leakage of urine from the bladder and is the main symptoms of bladder control problems. Other symptoms of bladder control problems include urinary urgency, urinary hesitancy, urinary frequency, pain or burning with urination, blood in the urine, nighttime urination, dribbling, and straining. Other symptoms of bladder control problems may include bedwetting, dribbling immediately after urination, and an inability to reach the bathroom in time.
Bladder Control Problems Symptoms
Incontinence is a symptom itself. It is uncontrollable leakage of urine from the bladder. Words used to describe bladder control problems include the following:
- Urgency: The feeling of having to urinate very soon
- Hesitancy: When trying to urinate, difficulty getting a urine stream going
- Frequency: Having to urinate often
- Dysuria: Pain or burning with urination (This is usually associated with a bladder infection.)
- Hematuria: Blood in the urine (red or pinkish urine)
- Nocturia: Urination at night (having to wake up to urinate)
- Dribbling: Continuing to drip or dribble urine after finishing urination
- Straining: Having to squeeze or bear down on the external sphincter to urinate
Some people with incontinence experience the following problems:
- Bedwetting (nocturnal enuresis) can stem from a blockage, nerve problem, or some unknown cause. It is most common in children younger than 3 years of age, but it occurs in 15% of children 3-5 years of age and in 1% of school-aged children. The percentages decrease as children get older.
- Dribbling incontinence occurs immediately after urination. In men, it may result from retained urine in the urethra in front of the sphincter. In women, it may result from retained urine in a urethral diverticulum (a saclike outpouching of the urethral wall).
- Functional incontinence occurs if you are unable to reach the bathroom. You may physically "not make it" or not know you need to urinate because of some mental disability.
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.
Urinary incontinence refers to a loss or leaking of urine due to faulty bladder control. An estimated 25% to 33% of people in the United States suffer from urinary incontinence. That means millions of people live with the condition. There are many different types of urinary incontinence. Although both men and women suffer from the condition, several factors unique to women increase the risk of urinary incontinence in females. It’s a common misconception that this is a normal part of aging. It is not. Thankfully, there are lots of ways to manage urinary incontinence and minimize the effect it has on your life.
Urinary incontinence is more than a health concern. It affects people on a social, psychological, and emotional level. People who have urinary incontinence may avoid certain places or situations for fear of having an accident. Urinary incontinence can limit life, but it doesn’t have to. The concern is treatable once the underlying cause is identified and addressed.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.