Do you have incontinence? Fortunately, there may be a clear cause, and treatments can help. Here are 13 health conditions or problems that could result in urinary trouble.
July 17, 2015
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Causes of incontinence
Do you have to go to the bathroom all the time or have “accidents” if you can’t get there fast enough?
You may have stress incontinence or urge incontinence. (Or even a combination of the two.)
Fortunately, there may be a clear cause, and treatments can help. Here are 13 health conditions or problems that could result in incontinence.
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Giving birthspecifically through a vaginal deliveryis a common cause of stress incontinence.
“This alters the normal support of the bladder and urethra,” the tube through which urine is drained from the body, explains Christopher Wolter, MD, an assistant professor of urology at the Mayo Clinic, in Scottsdale, Ariz.
When the bladder doesn’t have the proper support, you have less control. Fortunately, conservative measures such as strengthening exercises and minor surgery help 85% of people with stress incontinence, says Erin Bird, MD, an associate professor of surgery at Texas A&M Health Science Center College of Medicine, in Temple.
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Incontinence during pregnancy—another form of stress incontinence—can be caused by the weight of the growing fetus on the bladder structures or by certain hormonal changes, which increase urinary output.
Kegel exercises can help strengthen the pelvic floor muscles during and after pregnancy, Dr. Bird says.
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Because a woman’s uterus shares muscles with the bladder, having a hysterectomy to remove the uterus (or any other pelvic surgery for that matter) runs the risk of damaging the bladder’s muscle support system.
Surgery, just like childbirth and pregnancy, can weaken the pelvic floor muscles, which support the bladder, uterus, as well as the vagina and rectum, leading to stress incontinence.
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Urinary incontinence risk rises with age, not just in women but also in men (who experience incontinence about half as often as women).
Part of the problem is simple wear and tear. "There are changes in the components of the tissue supporting the urinary system," says Annette Sessions, MD, an assistant professor of clinical urology at the University of Rochester Medical Center, in New York. "They’re not as full and supple. That’s all there is to it."
Another cause can be brain damage from a stroke or dementia, which interferes with the central nervous system's ability to send the right signals to the bladder.
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Apart from aging, the main reason men may experience incontinence is if they’ve undergone surgery for prostate cancer, according to Dr. Bird.
“The anatomical sphincter muscle is injured (during the procedure),” explains Dr. Bird, who is also section chief of genitourinary reconstruction and voiding dysfunction at Scott & White, in Temple.
Because of this common side effect (in addition to possible erectile dysfunction), many doctors recommend “watchful waiting” for some prostate tumors, which may grow so slowly that the risk of surgery outweighs the benefits of tumor removal.
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The prostate gland can be another source of incontinence if it’s been enlarged for a long time. Almost all men experience prostate enlargement, known as benign prostatic hyperplasia, often after the age of 40.
“The (enlarged) prostate gland can cause an obstruction and that obstruction causes an enlargement or thickening of the actual bladder muscle, which increases the chances of the bladder becoming unstable,” Dr. Wolter explains. “If progressively more urine accumulates, there is eventually overflow (incontinence), especially in times of increased physical stress.”
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Incontinence can also be due to having diabetes, especially if the diabetes is poorly controlled or is long standing. The problem is usually due to neuropathy, the nerve damage that can be a complication of this common condition.
"There is damage to the nerves supplying the bladder, so they may not feel that they’re bladder is swollen," Dr. Sessions says. "They’ve lost the perception of when the bladder is full."
And a diabetes-related rise in blood sugar can increase urinary output. (Getting up multiple times at night to use the bathroom is an early sign of both type 1 and type 2 diabetes.)
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“Obesity (which often goes along with diabetes) definitely puts people at risk for stress incontinence,” Dr. Wolter says. “It will put more pressure on the bladder and the pelvic floor structures themselves.”
But the obesity-incontinence link is more common in women than men, due to anatomical differences.
The good news is that incontinence treatments that work in normal-weight women are just as effective in obese women, so it’s definitely worth seeking treatment, Dr. Bird says.
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People who use the club drug ketamine, commonly known as "Special K," for two or more years are more likely to develop urinary incontinence, according to a 2009 study.
"It’s basically a veterinary anesthetic so I could see how this would cause incontinence akin to someone who has dementia," says Dr. Wolter, who has not seen this in his own practice.
What he has seen, however, is difficulty urinating and overflow problems in people taking a lot of narcotics.
Many women experience a urinary tract infection (UTI) at some point, and this common problem can sometimes cause temporary incontinence. One of the main symptoms of UTI is feeling an urgent need to urinate.
While many women can make it to the bathroom in time, sometimes the need is just too overpowering.
“This cause of incontinence would resolve with treatment for the infection,” Dr. Bird says.
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Although not a common occurrence, uterine fibroids can cause incontinence if they are large enough and if they push directly on the bladder.
The scenario makes sense, given that the uterus and the bladder do sit side by side, but this is a less likely cause of incontinence, says Dr. Wolter.
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Incontinence as a result of pregnancy, childbirth, or surgery doesn’t always immediately follow the event.
It can come years or decades after the fact, often during or after menopause, simply because many of the mechanisms that allow the bladder to do its job properly are estrogen sensitive.
“The estrogen (in younger years) may have been protective enough to compensate for previous structural damage,” Dr. Wolter says. When the estrogen starts to wane, so does bladder control.
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Here you can relax. Cancer of the bladder can manifest as incontinence, but it’s rare.
“When there’s a problem with urinary control, it is bothersome but not (usually) malignant, though it does interfere with quality of life,” Dr. Bird says. “Cancer is not what we usually think.”
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