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Urinary Incontinence


An in-depth report on the causes, diagnosis, treatment, and prevention of urinary incontinence.

Alternative Names


Risk Factors

About 13 million adults experience incontinence at some point. This figure, however, may underestimate the problem because most patients are reluctant to discuss incontinence with their doctors. In fact, research has shown that a number of patients will not admit to having the problem even when questioned directly. What's more, although a third of American men and women ages 30-70 have experienced at least some loss of bladder control, most have not been diagnosed by a doctor. A recent survey of more than 1,400 Americans found that despite the prevalence of bladder control loss, an alarming 64 percent of those experiencing symptoms are not currently taking measures to manage their condition. The survey, sponsored by the National Association for Continence, also found that, on average, adults waited six years after first experiencing symptoms before discussing them with a doctor.

Incontinence in Children and Young People

While uncommon in children over age five, one study reported that the following children experienced incontinence:

  • 10% of 5-year-olds.
  • 5% of 10-year-olds.
  • 1% of 18-year-olds.

Before puberty, when incontinence occurs, it is twice as common in boys as in girls. Most young people who experience nighttime wetting do not have any serious physical or emotional disorders. It is often difficult to diagnose incontinence in this population.

In children without obvious anatomical or structure problems, many cases probably result from a combination of factors, including one or more of the following:

  • Birth defects or inborn conditions that cause problems in the urinary tract.
  • Slower physical development.
  • An overproduction of urine at night.
  • A lack of ability to recognize bladder filling when asleep.
  • Anxiety.
  • Inherited factors (indicated by a strong family history of bedwetting).
  • Complications of diabetes, stroke, multiple sclerosis, and Parkinsons disease.
  • High impact exercise, particularly in young women.

Bedwetting in children is not considered to be incontinence. Of interest, however, one study reported that adult women who regularly wet their bed when they were six years old were more likely to have urge incontinence than were women who did not bedwet during childhood.

Incontinence in the Elderly

All older adults are susceptible to incontinence. One in 10 people over age 65 have some type of bladder control loss. About half of the elderly who are house bound or in nursing homes experience incontinence; between 25% to 30% of older adults have urinary leakage problems after hospitalization for a serious illness. Urge incontinence accounts for two-thirds of incontinence cases in the elderly.

Incontinence in Women

Six out of every seven cases of adult incontinence occurs in women. Between 10% and 30% of women experience incontinence during their lifetimes, with the highest rates occurring in women who have born children. In one major 2003 Norwegian study of women under 65, 20% experienced incontinence, with 8.7% of women reporting moderate to severe incontinence.

Major Biologic Gender Differences. Younger women are generally more at risk for urinary incontinence than younger men because of two important biologic differences:

  • The urethras in women are shorter than in men (around two inches versus 10 inches).
  • Women bear children. The risk for incontinence from bearing children occurs only in middle-aged women. According to a 2002 study, elderly women have the same high risk for incontinence--about 50%--regardless of whether they had children or not.

Birth Conditions. The more children a woman has the greater the risk for incontinence as a middle-aged adult. In fact, the overall risk for incontinence in women under 50 who have borne children is about 30%. The risk is highest, however, with the first child, and there is an increased risk in women who have their first child over age 30. Some studies suggest that women who used the drug oxytocin for inducing labor are at higher risk for urinary incontinence later on than those who don't. Such medically induced labor tends to subject the muscles and nerves in the pelvis to greater force than does natural labor.

The method of birth can affect risk in middle-aged women. For example, a major 2003 study, a Cesarean section was associated with a much lower risk for stress incontinence before age 50 than a vaginal delivery. (The method of delivery had no effect on the risk for urge incontinence, nor did it affect the rates of incontinence in women older than 65.) The lower risk was the same whether or not the woman went through labor before her Cesarean delivery.

High-Impact Exercisers. Women who engage in high-impact exercise are susceptible to urinary leakage, particularly women with a low foot arch. Shock to the pelvic area is increased as the foot makes impact with hard surfaces. Those at highest risk for urinary leakage are gymnasts, followed by softball, volleyball, and basketball players.

Smokers. Studies have reported a higher risk for incontinence, notably mixed incontinence, in women who are current or former heavy smokers (more than a pack a day).

Obesity. Being overweight is a major risk factor for all types of incontinence. The more a woman weighs, the greater her risk.

Medical Factors in Older Women. Urge incontinence is reported to be more common among older postmenopausal women with one or more of the following:

  • Diabetes.
  • Two or more urinary tract infections within a past year.

Incontinence in Men

The rate of incontinence in men (about 1.5% to 5%) is much lower than in women. In older men, prostate problems and their treatments are the most common factors that affect the urinary tract.

Factors in Temporary Incontinence

A number of conditions can cause temporary incontinence in anyone, including the following:

  • Urinary tract infections.
  • Excess fluid intake.
  • Constipation.
  • Severe depression.
  • Restricted mobility.

Drugs. Drugs are most often the cause of temporary incontinence.

  • Drugs that affect the adrenergic system (a nerve-cell and hormonal pathway that regulates the sphincter muscle) are common causes incontinence. For example, alpha-adrenergic blockers, such as terazosin (Hytrin), used for benign prostatic hypertrophy, can cause incontinence by over-relaxing the muscles. On the other hand, men with enlarged prostates who suffer from urinary problems may be helped by the increase of urine flow after using terazosin.
  • Alpha-adrenergic agonists, such as pseudoephedrine (found in some oral decongestants) strengthen the muscles and may cause overflow incontinence in susceptible people.
  • Beta-adrenergic blockers, such as propranolol (Inderal), prescribed for hypertension and angina, relax the sphincter.
  • Diuretics, used for high blood pressure, often rapidly introduce high urine volumes into the bladder.
  • Calcium-channel blockers can cause overflow incontinence by relaxing the bladder detrusor muscles.
  • Colchicine, a drug used for gout, can cause urge incontinence.
  • Other medications and substances that increase the risk for incontinence are caffeine, sedatives, antidepressants, antipsychotics, and antihistamines.

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