Urinary incontinence (UI) is the unintentional loss of urine. UI is a problem for more than 17 million Americans - 85 percent of them women. Although about half of the elderly have episodes of incontinence, bladder problems are not a natural consequence of aging, and they are not exclusively a problem of the elderly.

Although UI can be improved in 8 out of 10 cases, fewer than half of those with bladder problems ever discuss the condition with their health care professional. The disorder, therefore, often goes untreated.

What are the types of UI?

There are four common types of incontinence:

1. Stress incontinence happens when the bladder can't handle the increased compression during exercise, coughing, or sneezing. This form of incontinence usually occurs in women under 60 and in men who have had prostate surgery.

2. Urge incontinence is caused by a sudden, involuntary bladder contraction. This form is more common in older adults.

3. Mixed incontinence is a combination of both stress and urge incontinence, and is most common in older women.

4. Overflow incontinence, in which the bladder becomes too full because it can't be fully emptied, is a rarer type of the disorder. The condition is caused by a bladder obstruction or injury. In men, it can be the result of an enlarged prostate.

Symptoms and causes

Stress incontinence

This causes urine to leak when there is an increase in pressure from within the abdomen such as when coughing, sneezing, laughing or carrying heavy weights. It develops when the normal control mechanism for keeping the outlet of the bladder closed is weakened. This can happen when the urethra moves out of the normal position (prolapses), as it can when the pelvic floor muscles are weakened. Stress incontinence is much more common in women than men and can be triggered by childbirth, hysterectomy and the menopause.

Urge incontinence

With this type, there is a strong urge to pass frequent, small amounts of urine. This is caused by the muscle of the bladder wall known as the detrusor muscle - being overactive. This means it contracts to squeeze out urine before the bladder is completely full.

Urge incontinence can also be caused by a bladderinfection. Diabetes can cause excessive production of urine and very frequent trips to the toilet.

Mixed incontinence

Some women get both urge and stress incontinence. The two may or may not be linked.

Overflow incontinence

This happens when urine held by the bladder builds up to the point where the bladder can no longer expand. It can be caused by an obstruction in the urinary tract or damage to the nerves that supply the bladder.

The Recommended Treatments for UI?

Treatment for UI depends on the type of incontinence, its causes, and the capabilities of the patient. Here are commonly recommended treatments:

Pelvic Muscle Rehabilitation-to improve pelvic muscle tone and prevent leakage.

• Kegel exercises. Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. Should be performed 30-80 times daily for at least 8 weeks.

• Biofeedback. Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.

• Vaginal weight training. Small weights are held within the vagina by tightening the vaginal muscles. Should be performed for 15 minutes, twice daily, for 4 to 6 weeks.

• Pelvic floor electrical stimulation. Mild electrical pulses stimulate muscle contractions. Should be done in conjunction with Kegel exercises.

Behavioral Therapies-to help people regain control of their bladder.

• Bladder training teaches people to resist the urge to void and gradually expand the intervals between voiding.

• Toileting assistance uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.

Pharmacologic Therapies - to improve incontinence medically.

• Oxybutynin (brand name: Ditropan) prevents urge incontinence by relaxing sphincter muscles.

• Tolterodine (brand name: Detrol, Detrol LA) is indicated for the treatment of an overactive bladder with symptoms of urinary frequency, urgency, or urge incontinence.

• Estrogen, either oral or vaginal, may be helpful in conjunction with other treatments for postmenopausal women with UI.

Surgical Therapies-to treat specific anatomical problems.

• Sling procedures, bulking injections (such as collagen) and other surgical procedures support or move the bladder to improve continence.