Urinary incontinence (UI) is simply the loss of bladder control. The person with UI is unable to control the release of urine from the bladder. It affects all age groups, peaking during menopause in women, and with increasing age in men.

There are four main types of UI:

1. Urge incontinence (overactive bladder) - This is the most common type. The bladder is contracting even when it is not full. There is a sudden overwhelming urge to urinate, and within a minute or two, urine is involuntarily voided. Persons with urge incontinence may, urinate more than eight times in 24 hours, and this affects their sleep. Ageing (of the bladder muscle), urinary tract infection, bowel problems, damage to the nervous system associated with stroke and spinal cord injury are risk factors.

2. Stress incontinence - This is not related to psychological stress. Urine is lost involuntarily when physical pressure (stress) is placed on the bladder during coughing, sneezing, laughing, exercising or lifting heavy objects. Pregnancy (hormonal changes, increased weight in the womb, weakening of muscles near the bladder with delivery) is often associated with stress incontinence. Being overweight or postmenopausal are other associated factors.

3. Overflow incontinence - This shows itself in frequent dribbling of urine. The person with this condition is unable to completely empty the bladder which leads to an overflow of urine. When the bladder is damaged or its exit (urethra) is blocked by an enlarged prostate gland in men or when there is nerve damage from diabetes, overflow incontinence may result.

4. Functional incontinence - This results when the person has another medical condition which prevents him or her from making it to the toilet in time. Physical disability, arthritis, depression, Alzheimer's and Parkinson's diseases are associated conditions.

Treatment

In most cases, UI can be improved through a combination of drug therapy and behavioural techniques. Behavioural techniques are usually tried first. Avoiding caffeine, alcohol, acidic foods and drinks is a start. Losing weight, quitting smoking and eating enough fibre to prevent constipation may also help.

Pelvic floor muscle exercises improve urinary control. In these Kegel exercises, we squeeze the muscles that we would use if we were trying to prevent ourselves from urinating, hold them for a count of four then release them. At least 40 contractions are done twice per day, for eight weeks.

Bladder training is a helpful technique where the client learns to resist the urge to urinate. Delay tactics like relaxation and distracting oneself are helpful in this regard. Scheduling toilet trips for every two to four hours is also useful.

Medications

Medications used for UI may calm the overactive bladder, but their numerous side effects limit their use. Tolterodine (Detrusitol) and oxybutinin are examples. Unfortunately, one of their side effects is dry mouth which encourages the client to drink more water, which is not helpful for incontinence.

Chewing gum to produce more saliva may be helpful for the dry mouth.

Imipramine, an antidepressant, actually helps to treat UI. When prostate problems which trigger UI are treated, the UI usually improves. Surgery is another option, or a catheter (soft tube) can be inserted into the tube leading up to the bladder. The catheter is connected to a bag which holds the urine outside the body. This bag is emptied as necessary.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.