The specific causes of incontinence are numerous. Though many cases do not fit a clear-cut classification, they generally fall into one of three main categories:
Stress incontinence is the most common type among women. Its hallmark is the involuntary loss of urine during physical activity, sneezing, or coughing. The disorder may have its roots in the unique stress that pregnancy places on the urinary tract. However, symptoms may not be noticed until menopause, when the bladder tissues start to sag due to a drop in estrogen levels. Estrogen supplements often improve the condition. Other remedies include Kegel exercises (rhythmic flexing of the muscles surrounding the vagina, anus, and urethra), and surgery to reposition the bladder.
Urge incontinence is marked by an urgent, and quickly irresistible desire to urinate. In most cases, uninhibited bladder contractions are at fault. They may be a result of damage to the central nervous system from stroke or diseases such as multiple sclerosis, or may be caused by urinary infections or bladder tumors. Tolterodine (Detrol), a drug that blocks the nerve impulses responsible for bladder contractions, can provide a measure of relief.
A variant of this disorder is reflex incontinence, in which unintended urination occurs without feelings of urgency.
Overflow incontinence happens when the bladder cannot empty normally and becomes overdistended. This condition usually involves frequent, sometimes nearly constant, urine loss. Causes include neurologic abnormalities such as spinal cord injury and conditions that block outflow such as an enlarged or cancerous prostate or a stricture of the urethra.
Treatment depends on the cause of the problem. Medications prescribed for incontinence include bladder relaxants such as propantheline, flavoxate (Urispas), dicyclomine (Bentyl), oxybutynin (Ditropan), tolterodine (Detrol), and the antidepressant imipramine (Tofranil). Estrogen replacement therapy is another possibility. Surgery and behavioral techniques such as pelvic muscle exercises, biofeedback, and bladder training may also be employed.
