Urinary incontinence -- the loss of bladder control -- is a common and often embarrassing problem for both women and men. The severity can range from the occasional urine leak when a person coughs or sneezes, to having an urge to urinate that's so sudden and strong that the person does not get to a toilet in time.
It's a syndrome that's twice more common in females than it is in males, and according to internist Dr. Sheena Antonio-Collie is under-diagnosed and under-reported, because a lot of women don't like to talk about it.
"It's common, it's vexing and profoundly affects your quality of life," said Dr. Antonio-Collie at the recent three-speaker Distinguished Lecture Series at Doctors Hospital of the involuntary leakage of urine. Doctors Frederick Smith and Sheldon Price also spoke.
There are four main types of urinary incontinence -- stress, urge, mixed and overflow. Functional is sometimes included as a fifth type.
Stress and urge incontinence are the two most common forms of incontinence.
In stress incontinence, a person coughing or sneezing may have leakage, because they can't control their muscles well.
People with urge incontinence have that feeling that they have to go and can't stop it, even though they should be able to hold their urine.
When the bladder never truly empties, and you get a little bit of leakage, and you just keep going and going and going, that is known as overflow incontinence.
In women, urinary incontinence can start as early as age 20, but it is more common in older females over age 50. In women, stress and urge incontinence are the two most common forms of incontinence, according to Dr. Antonio-Collie. Some women have mixed incontinence as well, according to the medical professional.
Causes and risk factors
Causes and risk factors in women include symptomatic urinary tract infections. (Bacteria trigger a localized infection and it acts as an irritant and all of a sudden you want to pee). Women who are in menopause, or past menopause can develop atrophy of the vagina, the result of the decreasing estrogen and that can cause a decrease in strength of the pelvic muscles and lead to urinary incontinence. Constipation can also cause pressure on the bladder and that can result in incontinence. According to Dr. Antonio-Collie, adverse affect of medications like diuretics can also lead to incontinence.
Besides diabetes and spinal cord injury, two of the most common medical causes of medical incontinence that lead to weak pelvic muscles include pregnancy, pelvic surgery like hysterectomy, advancing age, obesity (huge belly puts pressure on the muscles) and smoking which also acts as and irritant.
Treatment options
Doctors will recommend patients maintain a voiding diary to made a determination as to what type of incontinence a person has.
"Just like the causes are diverse, the treatments are also diverse and it always is an individualized treatment. In general the first choice of treatment is the least invasive one and the goal is to improve quality of life and restoring a satisfactory pattern of voiding incontinence," said Dr. Antonio-Collie. "You start with supportive treatment, bladder education and retraining, appropriate use of toilet substitutes like urinals and bedside commodes, modification of your fluid intake, because sometimes you may just be taking in too much water. Diet changes as well will help because sometimes certain things we're eating need to be changed as well. And weight loss -- if you have a lot of belly that's putting a lot of pressure down there, you obviously need to make some changes," she said.
If the cause is a urinary tract infection, antibiotics are given. If it's the result of stool impaction, a change to a high fiber diet is suggested. The doctor says sometimes they have to manually go in and pull out the stool if necessary. If the incontinence is the result of medications, changes have to be done.
While urinary incontinence complications are not life-threatening, Dr. Antonio-Collie said for most people it's a threat to their quality of life as they have low self-esteem -- they don't want to smell and don't go anywhere. She also said urinary incontinence can be a skin irritant for a person who is urinating on themselves and have to change their diapers frequently to avoid irritation. The doctor said it also increases the burden on caregivers as well, if the sufferer is not independent and has to be changed frequently. She also said the cost of the products that are one-time use products are exorbitant.
"Although urinary incontinence is a vexing problem, women ought to be proactive to both prevent and treat these issues," said Dr. Antonio-Collie.
Nephrologist Dr. Frederick Smith said in most instances, females tend to get control of their bladder quicker than guys do, and as a result younger males get incontinence, but that as females get older they tend to lose control a little quicker.
"In young guys we have problems with incontinence because we gain control not as quick as females do, so it takes us a while to gain control, and as we get older, we have the problem because we have a prostate and as we get older the prostate gets bigger," Dr. Smith.
He said men suffering with the inability to control their urine don't have to suffer and that they can be fixed, but only in certain places -- either before the urine comes down to the bladder, or after it comes out of the bladder.
"We pee because our brain says it's time to pee because the bladder feels like it's full. Essentially we send a signal that goes down the spinal cord that goes to the bladder that says squeeze and it empties through the urethra. That's how we start to produce the urine. If you want to fix it for a guy, what you do is create something that acts like a muscle, you create something that's going to squeeze -- an artificial sphincter. The other thing you can do and what most of us don't want to have to do is have a tube coming out of our side and we can redirect the urine to that outside," he said.
In an effort to control urinary incontinence, Dr. Smith encouraged them to control their diabetes, hypertension, and obesity.
"The most common disease we have in our country is diabetes ... heart disease is because of the diabetes ... hypertension ... obesity is the next one and it causes problems. Diabetes we get nerve problems and diabetes affects the nerves in the back, so the bladder is unable to respond to those nervous impulses, you get a full bladder and you have problems with that. If we control our problems, or our medical conditions, then we should be able to control the rate our brain affects things and the spinal cord then being able to empty," said Dr. Smith. He also encouraged exercise to regain control of the muscle.
When maintaining their voiding diaries he said patients are asked to note information on how often they go to the bathroom; how much water they drink and whether they feel like they are passing urine even when they're not passing urine; and whether they have to push to get it done. Dr. Smith said patients have to write down what they put into their bodies so that medical professionals know what's coming out is relative to what is being put in. Patients also take a physical exam.
Treatment
"Two ways you can fix it is medical treatment or surgical treatment. The other thing you can do is behavioral modifications," he said.
Multiple treatments include behavioral changes, exercises medication and surgical treatment.
According to Sheldon Prince, who also spoke during the talk, the benefits of dealing with urinary incontinence for men include increased sexual sensation, control of premature ejaculation and enhanced enjoyment. And women who have given birth strengthen their pelvic muscles. He urged both sexes to exercise.

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