Urinary (or bladder) incontinence also referred to as loss of bladder control or uncontrollable urination as is when you are not able to keep urine from leaking from your urethra, the tube that carries urine out of your body from your bladder. It can range from an occasional leakage of urine, to a complete inability to hold any urine.
The National Association For Continence has sponsored epidemiological surveys of adults across the United States in order to quantify the prevalence of bladder control problems in the community. These studies have identified that urinary incontinence and related symptoms of overactive bladder are important causes of depression and a risk factor for nighttime falls. The causes of urinary incontinence are often attributed to overactive bladder, low bladder capacity, or over-production of urine at night (nocturnal polyuria), secondary to spinal injury. The treatment for patients with urinary incontinence is usually bladder relaxants for overactive bladder, and urinary pads to absorb urine.
Several authors have reported the effectiveness of chiropractic adjustments on elderly patients with urinary incontinence. Stude et al reported a case study of a fourteen year old female patient recovered completely from traumatically induced urinary incontinence using manual manipulation. Chiropractic adjustment seems to be effective in childhood enuresis and functional enuresis as reported in several studies. (Chiropractic Adjustments Reduced Urinary Incontinence, John Zhang, MD, PhD, Phillip Haselden, DC, Rodger Tepe, PhD., Logan College of Chiropractic).
The 4 main types of bladder incontinence are:
- Stress incontinence -- occurs during certain activities like coughing, sneezing, laughing, or exercise
- Urge incontinence -- involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don't have enough time between when you recognize the need to urinate and when you actually do urinate
- Overflow incontinence -- occurs when the bladder cannot empty completely, which leads to dribbling.
- Mixed incontinence -- involves more than one type of urinary incontinence.
Bowel incontinence, a separate topic, is the inability to control the passage of stool.
Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.
Infants and children are not considered incontinent, but merely untrained, up to the time of toilet training. Occasional accidents are not unusual in children up to age 6 years. Young (and sometimes teenage) girls may have slight leakage of urine when laughing.
Night-time urination in children is normal until the age of 5 or 6.
See your MD for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.
The following methods are used to strengthen the muscles of your pelvic floor:
- Bladder retraining -- this involves urinating on a schedule, whether you feel a need to go or not. In between those times, you try to wait to the next scheduled time. At first, you may need to schedule 1-hour intervals. Gradually, you can increase by 1/2-hour intervals until you are only urinating every 3 - 4 hours without leakage. Click here for article "How to Train Your Bladder";
- Kegel exercises -- contract the pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises three times per day. You can do Kegel exercises any time, any place. Click here for article "Pelvic Floor (Kegel) Exercises";
To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. Do NOT contract your abdominal, thigh, or buttocks muscles. And Do NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.
Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 - 4 days.
Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.
Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.
For leakage, wear absorbent pads or undergarments. There are many well designed products that go completely unnoticed by anyone but you.
Call your local emergency number (such as 911) or go to an emergency room if any of the following accompany a sudden loss of urine control:
- Difficulty talking, walking, or speaking
- Sudden weakness, numbness, or tingling in an arm or leg
- Loss of vision
- Loss of consciousness or confusion
- Loss of bowel control
Call your MD if:
- You have been constipated for more than 1 week
- You have difficulty starting your urine flow, dribbling, nighttime urination, pain or burning with urination, increased frequency or urgency, or cloudy or bloody urine
- You are taking medications that may be causing incontinence -- do NOT adjust or stop any medications without talking to your doctor.
- You are over 60 years old and your incontinence is new, especially if you are also having trouble with your memory or caring for yourself
- You have the urge to go often, but are only passing small amounts of urine
- Your bladder feels full even after you have just urinated
- Incontinence persists for more than 2 weeks even with exercises to strengthen your pelvic muscles
What to expect at your health care provider's office
Your medical doctor will take your medical history and perform a physical examination, with a focus on your abdomen, genitals, pelvis, rectum, and neurologic system.
Medical history questions may include:
- How long has incontinence been a problem for you?
- How many times does this happen each day?
- Are you aware of the need to urinate before you leak?
- Are you immediately aware that you have passed urine?
- Are you wet most of the day?
- Do you wear protective garments in case of accidents? How often?
- Do you avoid social situations in case of accidents?
- Have you had urinary tract infections in the past? Do you think that you may have one now?
- Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
- Is it more difficult to control your urine when running, jumping, or walking?
- Is your incontinence worse when sitting up or standing?
- Are you constipated? For how long?
- Is there anything you do to reduce or prevent accidents?
- Have you ever been treated for this condition before? Did it help?
- Have you tried pelvic floor exercises (Kegel)? Do they help?
- What procedures, surgeries, or injuries have you had?
- What medications do you take?
- Do you drink coffee? How much?
- Do you drink alcohol? How much?
- Do you smoke? How much each day?
- Do you have diabetes or a family history of diabetes?
- Do you have any other symptoms?
Diagnostic tests that may be performed include:
- Urine culture to check for infection, if indicated
- Cystoscopy (inspection of the inside of the bladder)
- Urodynamic studies (tests to measure pressure and urine flow)
- Uroflow (to measure pattern of urine flow)
- Post void residual (PVR) to measure amount of urine left after urination.
Other tests may be performed to rule out pelvic weakness as the cause of the incontinence. One such test is called the "Q-tip" Test. This test involves measurement of the change in the angle of the urethra when it is at rest and when it is straining. An angle change of greater than 30 degrees often indicates significant weakness of the muscles that support the bladder. (Reference: HealthCentral Website)
From a chiropractic natural treatment perspective (once medical organic indicators/markers have been ruled out), chiropractic evaluation and care of the musculo-skeletal system and the Autonomic Nervous System (ANS) may improve urinary continence in some patients. A recently published case-series report indicates chiropractic care may be beneficial for certain individuals suffering from urinary incontinence.
The report reviews 21 patients aged 13 to 90 years with a history of urinary incontinence for the preceding 4 months to 49 years with associated muscle dysfunction and low back and/or pelvic pain. Incontinence was so bad in 18 of the 21 that they had been wearing incontinence pads during the previous days and nights upon presenting themselves for treatment. All patients were evaluated and treated chiropractically for muscle impairments in the lumbar spine, pelvis and pelvic floor and low back and/or hip pain. Treatments included chiropractic manipulative therapy, flexion distraction manipulation and/or the use of a percussion instrument (Activator) for the treatment of myofascial trigger points. The urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate the improvements of urinary incontinence for each patient remained stable.
Source: Journal of Chiropractic Medicine; online. March 9, 2012.