If you suffer from incontinence, see your doctor. Your doctor will take your medical history, give a physical examination and possibly order x-rays and tests to help determine the cause of the problem. S/he may order a cystogram to x-ray you as you urinate. A cystoscope may be used to look through your urethra into the bladder. Urodynamic testing may also be performed. This test involves having your bladder filled with water to see how much it can hold and how much pressure it can withstand. Prostate trouble or ovarian cancer may also be investigated. 

Types of Incontinence

There are five major categories of urinary incontinence: overflow, stress, urge, functional, and reflex.

• Overflow incontinence is caused by bladder dysfunction. The bladder does not contract properly or there is an obstruction to the bladder or urethra. The bladder does not empty completely and there is frequent urine leakage.
• Stress incontinence occurs when there is involuntary urine loss after pressure on the abdomen, coughing, laughing, sneezing, hugging, and lifting something heavy or sexual activity. This is because the muscles that close off the urethra have weakened and cannot withstand sudden increased pressure on the bladder.
• Urge incontinence, also known as overactive bladder, is a sudden, uncontrollable need to urinate. It is most often noticed when a woman is heading toward the bathroom, entering the house or turning into the driveway.
• Functional incontinence is when disability interferes with getting to the bathroom in time. It can be multiple sclerosis, Alzheimer's disease, arthritis, even a broken leg.
• Reflex incontinence is a loss of control without warning. It can be a side effect of medication, illness or dietary intake.  

Causes of Incontinence 

Childbirth can weaken the pelvic muscles, causing the bladder to lose some support, resulting in stress incontinence. The lack of estrogen after menopause can cause the bladder to drop. Being overweight can cause added pressure on the bladder and surrounding muscles. A constriction or blockage of the bladder outlet can result in urinary retention and subsequent overflow incontinence. Gynecologic surgery can damage or weaken the pelvic muscles. An enlarged prostate can be responsible for overflow incontinence. Medications and alcohol can interfere with the functioning of the bladder and urethral nerves. Incontinence can occur during kidney or urinary tract infections.  

Treatment 

Kegel exercises are very effective in dealing with incontinence. They must be done correctly and for a long time. It can take up to two or three months for the muscles to get strong enough to see a difference. Kegels can be done anywhere once you have learned how to do them. You can begin by lying down and relaxing. Squeeze the muscles you would squeeze if you were trying to stop the flow of urine. Try to hold this squeeze for four counts and relax for four counts. Practice until you can do this for five minutes. Once these muscles have been strengthened, you can squeeze them before you sneeze or cough, before you lift something heavy, or as you are on your way to the bathroom.  

Various lifestyle changes may provide some relief. Many patients find that cutting down on caffeine and carbonated drinks is helpful. It is not clear if there is a real connection between smoking and incontinence. The studies done on this point are conflicting. Physicians regularly suggest weight loss, but it is not clear what the patient can expect without a significant loss.  Urge incontinence can be effectively treated with medication in nearly 75% of the women with the problem. Kegel exercises will also help, as will bladder training, electrical stimulation therapy to the nerves going to the bladder and biofeedback. Bladder training is a very helpful treatment involving urination on a regular basis whether or not the urge is there. The patient gradually increases the time between bathroom visits until an acceptable interval is achieved. 

A recent study has indicated that daily oral estrogen therapy was associated with increased urinary incontinence in older postmenopausal women with weekly incontinence. Accordingly, estrogen therapy should not be a recommended treatment.   A study involving moderately overweight women indicated that a weight loss of at least 5% of their weight resulted in greater than 50% reduction in incontinence frequency. A modest weight loss may be an effective treatment option for incontinence and should be considered as a part of nonsurgical therapy. 

Coping 

There are many things you can do for yourself to assist in dealing with incontinence.

• Wear absorbent pantiliners or pants to prevent leaking through to your outside clothing.
• Keep a diary of bladder accidents - what you were doing and how much you leaked. This diary may help your doctor determine what is wrong and which treatment to use.
• Wear a condom to catch leaks if you are a man. Be sure to leave a small space at the tip of the condom.
• Make frequent bathroom visits.
• Know where bathrooms are when you are away from home.
• Avoid drinking liquids two to three hours before bedtime.

Fear of accidents can prevent people from engaging in activities and seriously disrupt quality of life. In addition, rushing to the bathroom to avoid an incontinent episode increases the risk of falls and subsequent fractures in elderly women. With the wide range of treatment options available today, the prognosis for those suffering from incontinence is promising.