Urinary Incontinence

What is urinary incontinence (UI)?

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

What are the types of urinary incontinence (UI)?

There are several different types of UI. Each type has different symptoms and causes:

• Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
• Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
• Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
• Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
• Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
• Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
• Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
  • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
  • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.

Who is at risk for urinary incontinence (UI)?

In adults, you are at higher risk of developing UI if you:

• Are female, especially after going through pregnancy, childbirth, and/or menopause
• Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
• Are a man with prostate problems
• Have certain health problems, such as diabetes, obesity, or long-lasting constipation
• Are a smoker
• Have a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children.

How is urinary incontinence (UI) diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
• A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
• Urine and/or blood tests
• Bladder function tests
• Imaging tests

What are the treatments for urinary incontinence (UI)?

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including:

• Lifestyle changes to reduce leaks:
  • Drinking the right amount of liquid at the right time
  • Being physically active
  • Staying at a healthy weigh
  • Avoiding constipation
  • Not smoking
• Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
• Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as:

• Medicines, which can be used to
  • Relax the bladder muscles, to help prevent bladder spasms
  • Block nerve signals that cause urinary frequency and urgency
  • In men, shrink the prostate and improve urine flow
• Medical devices, including
  • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
  • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
• Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
• Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
• Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Bladder Diseases

The bladder is a hollow organ in your lower abdomen that stores urine. Many conditions can affect your bladder. Some common ones are:

• Cystitis - inflammation of the bladder, often from an infection
• Urinary incontinence - loss of bladder control
• Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time
• Interstitial cystitis - a chronic problem that causes bladder pain and frequent, urgent urination
• Bladder cancer

Doctors diagnose bladder diseases using different tests. These include urine tests, x-rays, and an examination of the bladder wall with a scope called a cystoscope. Treatment depends on the cause of the problem. It may include medicines and, in severe cases, surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Menopause

What is menopause?

Menopause is the time in your life when you stop having your period and can no longer get pregnant. You have reached menopause when you have not had a period for 12 months.

The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins in when you are in your 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

What is early menopause?

Early, or premature menopause happens when your ovaries stop making hormones and periods stop before age 40. This can happen on its own (with no known cause). It can also happen because of surgery to remove the ovaries or uterus. Medical treatments such as chemotherapy or hormone therapy to treat breast cancer may also cause early menopause.

A condition called primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are age 40. But this condition is different from early menopause. If you have POI, you may still have periods, even though they might not come regularly. And you might still be able to get pregnant.

What are the symptoms of menopause?

During the menopausal transition, your ovaries start to make less of the estrogen and progesterone hormones. The changes in these hormones cause the symptoms of menopause, which can include:

• A change in your periods; they may be:
  • Irregular, with more or less time in between periods.
  • Shorter or longer.
  • Lighter or heavier.
• Hot flashes, a sudden warm feeling in your face, neck, and chest. They may cause you to sweat. If they happen at night and cause sweating, they are called night sweats.
• Trouble sleeping, such as trouble falling asleep or getting back to sleep when you wake up. Over time, a lack of sleep can lead to fatigue and memory problems.
• Vaginal dryness, which may cause pain or discomfort during sexual intercourse.
• Mood changes, which can make you feel moody, anxious, or more irritable.
• Bladder issues, such as urinary incontinence (loss of bladder control) and urinary tract infections (UTIs).

You may also have other physical changes which could put you at risk for certain diseases. For example, the loss of estrogen can:

• Cause you to lose bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily.
• Raise your cholesterol levels and increase your risk of heart disease and stroke.

What are the treatments for the symptoms of menopause?

You may not need treatment for the symptoms of menopause. But if you do, there are several different types of treatments:

Lifestyle changes

You may find that you can manage your symptoms with lifestyle changes. Here are some changes that might make you feel better:

• If you have hot flashes, dress in layers that can be removed at the start of a hot flash. You may want to carry a portable fan to use when you get a hot flash.
• Avoid alcohol, spicy foods, and caffeine. They can make your menopause symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Being overweight or having obesity can make hot flashes worse.
• Have good sleep habits. Keep your bedroom dark, quiet, and cool.
• Get regular exercise. It can help you sleep better, improve your mood, and help lower your risk for many age-related diseases.
• Lower stress, for example by using relaxation techniques such as meditation, deep breathing, and muscle relaxation exercises.

If lifestyle changes are not enough to improve your symptoms, you may want to contact your health care provider. They will talk to you about your symptoms, family and medical history, and preferences. They also can explain the risks and benefits of the treatments.

Non-hormone treatments

There are various non-hormone treatments for menopause symptoms, such as:

• Medicines for hot flashes, including certain antidepressants, a medicine just for hot flashes, an antiseizure medicine, and a blood pressure medicine. Some of these medicines may also help with sleep problems.
• Medicines for urinary incontinence.
• Medicines to treat or help prevent osteoporosis.
• Low-dose birth control pills for very heavy bleeding or periods that are close together.
• Water-based lubricants to treat vaginal dryness.
• Medicines for painful intercourse that is caused by vaginal changes from menopause.
• Cognitive behavioral therapy (CBT), a type of talk therapy, for trouble sleeping.

Hormone treatmentsmenopausal hormone therapy

Like all medicines, MHT has benefits and risks. Talk with your provider about whether it is safe for you. If you decide to take MHT, your provider may recommend taking the lowest dose that works for the shortest time needed.

Supplements, herbs, and "natural" hormone creams

There are various products that are marketed for menopause symptoms. They include supplements, herbs, and over-the-counter "natural" hormone creams. There has been research on many of these products. So far, none of them has clearly been shown to be helpful. Also, there is little information on the long-term safety of these products. Some supplements can have harmful side effects or interact with medicines. Check with your provider before you take use any of them.

Pelvic Floor Disorders

The pelvic floor is a group of muscles and other tissues that form a sling or hammock across the pelvis. In women, it holds the uterus, bladder, bowel, and other pelvic organs in place so that they can work properly. The pelvic floor can become weak or be injured. The main causes are pregnancy and childbirth. Other causes include being overweight, radiation treatment, surgery, and getting older.

Common symptoms include:

• Feeling heaviness, fullness, pulling, or aching in the vagina. It gets worse by the end of the day or during a bowel movement.
• Seeing or feeling a "bulge" or "something coming out" of the vagina
• Having a hard time starting to urinate or emptying the bladder completely
• Having frequent urinary tract infections
• Leaking urine when you cough, laugh, or exercise
• Feeling an urgent or frequent need to urinate
• Feeling pain while urinating
• Leaking stool or having a hard time controlling gas
• Being constipated
• Having a hard time making it to the bathroom in time

Your health care provider diagnoses the problem with a physical exam, a pelvic exam, or special tests. Treatments include special pelvic muscle exercises called Kegel exercises. A mechanical support device called a pessary helps some women. Surgery and medicines are other treatments.

NIH: National Institute of Child Health and Human Development

Alzheimer's Caregivers

A caregiver gives care to someone who needs help taking care of themselves. It can be rewarding. It may help to strengthen connections to a loved one. You may feel fulfillment from helping someone else. But sometimes caregiving can be stressful and even overwhelming. This can be especially true when caring for someone with Alzheimer's disease (AD).

AD is an illness that changes the brain. It causes people to lose the ability to remember, think, and use good judgment. They also have trouble taking care of themselves. Over time, as the disease gets worse, they will need more and more help. As a caregiver, it is important for you to learn about AD. You will want to know what happens to the person during the different stages of the disease. This can help you plan for the future, so that you will have all of the resources you will need to be able to take care of your loved one.

As a caregiver for someone with AD, your responsibilities can include:

• Getting your loved one's health, legal, and financial affairs in order. If possible, include them in the planning while they can still make decisions. Later you will need to take over managing their finances and paying their bills.
• Evaluating their house and making sure it's safe for their needs
• Monitoring their ability to drive. You may want to hire a driving specialist who can test their driving skills. When it is no longer safe for your loved one to drive, you need to make sure that they stop.
• Encouraging your loved one to get some physical activity. Exercising together may make it more fun for them.
• Making sure that your loved one has a healthy diet
• Helping with daily tasks like bathing, eating, or taking medicine
• Doing housework and cooking
• Running errands such as shopping for food and clothes
• Driving them to appointments
• Providing company and emotional support
• Arranging medical care and making health decisions

As you care for your loved one with AD, don't ignore your own needs. Caregiving can be stressful, and you need to take care of your own physical and mental health.

At some point, you will not be able to do everything on your own. Make sure that you get help when you need it. There are many different services available, including:

• Home care services
• Adult day care services
• Respite services, which provide short-term care for the person with AD
• Federal and state government programs that can provide financial support and services
• Assisted living facilities
• Nursing homes, some of which have special memory care units for people with AD
• Palliative and hospice care

You might consider hiring a geriatric care manager. They are specially trained professionals who can help you to find the right services for your needs.

NIH: National Institute on Aging