The uncontrollable leaking of urine is called urinary incontinence. Somewhere between a quarter and a third of American men and women suffer from urinary incontinence. The exact number is unknown because many suffer in silence without reporting their symptoms to a health care provider. Because many are embarrassed when suffering from urinary incontinence, the problem can affect many aspects of one’s life. Luckily, however, urinary incontinence can often be managed with the help of a doctor.
Urine leakage is not a condition in and of itself. Urinary incontinence is a symptom that can be brought on by many different conditions. Men and women may suffer from urinary incontinence for different reasons, but regardless of gender, urine leakage is not a normal part of aging.
Types of Urinary Incontinence
There are four types of urinary incontinence: Overactive Bladder, Stress Urinary Incontinence, Mixed Incontinence, and Overflow Incontinence.
Overactive Bladder (OAB) is a common condition that can lead to urinary incontinence. OAB is estimated to affect around 30% of men and 40% of women in the United States. OAB is characterized by urgency incontinence. This is a sudden, strong, uncontrollable urge to urinate. Those with OAB may have a disconnect between the brain and bladder, where the brain tells the bladder it needs to empty even if it is not full. Or OAB can be caused by overactive bladder muscles which contract before the bladder is full, causing a “gotta go” feeling.
Men are more vulnerable to OAB when other prostate problems are present. Women become more susceptible after menopause. There are several treatment options for OAB, ranging from behavioral changes to, when severe, surgery.
Main symptom: urgency which may or may not lead to leakage
Stress Urinary Incontinence
Stress Urinary Incontinence (SUI) is caused by weak pelvic muscles. SUI is an extremely common condition, although more common in women than men. SUI is characterized by urinary incontinence during physical activity due to stretched pelvic floor muscles. Activity puts pressure on these weakened muscles causes leakage. Activities that may trigger urinary incontinence due to SUI may include walking, lifting, bending, sneezing, or coughing. SUI can range from mild to severe, with differing amounts of leakage occurring depending on the severity.
SUI is currently not treated medicinally, but there are lifestyle adjustments that can be made to lessen the urinary incontinence accompanying SUI. Kegel exercises may help strengthen pelvic muscles and vaginal/urethral devices or pads can be helpful.
Main symptom: urine leakage when active
Mixed Incontinence (OAB and SUI)
It is very possible for a person to suffer from both OAB and SUI. This would lead to leakage during activities, as well as strong urgency.
Main symptom: urgency AND leakage when active
Overflow incontinence is characterized either by a body which makes too much urine for the bladder to hold or a bladder which cannot empty when full, causing leakage. There could also be a blockage in the flow of urine or an irregularity with the contractions of the bladder muscles. This can cause the need to urinate frequently in small amounts, or an almost constant dribbling of urine.
Overflow incontinence is most common in men with existing prostate problems or men who have undergone prostate surgery. It is rare in women, but can occur due to dropped bladders, bladder surgeries, or diabetes.
Main symptom: frequent, small urinations or constant dribbling of urine
There are many different devices that can be helpful for both urinary incontinence and urinary retention, which is when the bladder does not empty completely. The devices available on the market currently can help both men and women and give those who suffer from urinary incontinence more freedom over their daily lives.
One device that can be helpful in managing urinary incontinence is catheters. A catheter is a soft tube which is placed into the bladder to assist with draining. Indwelling catheters, in specific, are inserted into the bladder and stay in place all day and night. For both men and women, the two types of indwelling catheters are Foley, which are placed in the urethra, and suprapubic, which are inserted into the public bone through a cut. Both types drain urine to a collection bag that is located on the outside of the body. Suprapubic catheters are typically a more long term solution than Foley catheters, which should be used for a maximum of 2 years.
Catheters vary in material, size, and shape and those choices are made dependent on each individual’s allergies and doctor’s recommendations. There is also maintenance that must be tended to to ensure infections do not occur. This includes replaced catheter tubes, of either kind, at least once per month.
External Collecting Systems
There is another type of catheter, known as Texas or condom catheters, that are fairly common options for men who must utilize catheters. These catheters are placed over the penis with a special condom with a hole at the tip. A tube is connected from the hole in the tip to a collection bag.
There is a similar external collection device for women that funnels urine through a pouch that is stuck to the labia. These are uncommon because the labia often do not form a tight seal and urine can then leak, leading to indwelling catheters being more common for women.
Urine Drainage Bags
All of the aforementioned catheter devices are connected to urine drainage bags. These bags come in different sizes for different uses. For example, overnight bags are large, holding up to 2 liters of urine, and are not concealable. Smaller bags, called leg bags, hold up to 800 milliliters and can be hidden. These bags are strapped to the calf or thigh and easily worn under clothing, allowing for more freedom than overnight bags. Cleaning maintenance is important to keep the bags clean and odorless.
Catheters do not necessarily have to be worn at all times, like those types listed above. Intermittent catheters are also known as “in and out” catheterization because they are inserted into the urethra 3 to 5 times per day, and each one is thrown out after use. A catheter which is only used once before disposal lowers the chance of infection from indwelling catheters.
Both men and women are capable of intermittent catheterization and there are several options, some of which may work better than others for any given individual.
Adult diapers and pads can be helpful in living with incontinence and can lessen the chance for embarrassing accidents. Many different designs are available, including both disposable and reusable options, so there is a high chance of finding one which works for you. Things to consider when choosing a product are ease of use, absorbency, materials, and cost.
Options like a bedside commodes or occasionally bedpans can help individuals who cannot access a normal toilet. There are several things to consider, such as height, weight, cost, ease of emptying, seat type, and surface material.
Devices known as urinals can also be useful for some individuals. These jug-type devices are to be urinated in directly when restrooms or other substitutes are not available. These are typically more useful for men.
Some incontinence products may end up causing rashes, redness, and skin breakdown, especially if used for an extended time. Many skin care products and upkeep of hygiene can help lessen these symptoms. Antimicrobials, cleaners, skin barriers, wipes, creams, and lotions may all be part of a healthy skin care regime. Users of these products will want to take care to not dry out their skin as a side effect of the skin care products.