Incontinence is fairly rare in children. Infants and children up to the time of toilet training are not considered incontinent, but merely untrained. Occasional accidents in children up to age 6 years, especially with urine, are not unusual.

Nighttime incontinence is usually referred to as bedwetting or nocturnal enuresis in children, and is normal until the age of 6 years. In young girls, and occasionally adolescent females, slight leakage of urine may be associated with laughing.

Incontinence in children may be associated with urinary tract infections, spinal injuries, urinary tract anatomical abnormalities, and neurological abnormalities that result in abnormal bladder control.

Incontinence is seen more frequently among the elderly. Almost 20% of older people living at home, one-third of those in hospitals, and one-half of all nursing home residents suffer from some type of urinary incontinence. Women are more likely than men to be affected by urinary incontinence.

Incontinence is not a hopeless situation, and should be addressed. Although incontinence is usually not an emergency, problems with incontinence should be reported to the doctor. The gynecologist and the urologist are the specialists who are most familiar with incontinence, can evaluate the causes of incontinence, and recommend several treatment approaches.

NORMAL URINATION:
The ability to hold urine and maintain continence is dependent on normal anatomy and function of the lower urinary tract and the nervous system. Additionally, the person must possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.

The process of urination involves two phases: 1) the filling and storage phase, and 2) the emptying phase. Normally during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine.

The first sensation of the urge to urinate occurs when approximately 200 ml of urine is stored. The healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.

The average person can hold approximately 350 to 550 ml of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable, expandable bladder wall muscle (detrusor).

The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. Additionally, the body must also be able to simultaneously relax the sphincter to allow the urine to pass out of the body.

TYPES OF INCONTINENCE:
Incontinence can be classified as acute (sudden onset), or persistent (long duration). Acute incontinence is usually caused by sudden changes in the urinary tract (such as infection, increased urine amounts), or changes in the ability to urinate. Persistent incontinence is usually caused by chronic (long-term) conditions, and can be further classified based on the type of symptoms the person exhibits. The common types of incontinence are:

• Stress incontinence
• Urge incontinence
• Overflow incontinence
• Functional incontinence

• Mental confusion (delirium)
• Restricted mobility
• Urinary tract infection
• Prostate infection
• Inflammation of the urinary tract
• Stool impaction
• Side effects of medications (such as diuretics, tranquilizers, anticholinergics, and antidepressants)
• Polyuria (increased urine amounts)
• Psychological factors

• Sphincter weakness (following prostate surgery in men, or vaginal surgery in women)
• Pelvic prolapse (in women)
• Nervous system impairment (Multiple sclerosis, Parkinson's disease, strokes, spinal cord injury)
• Mental or psychological changes (Alzheimer's disease, acute confusion, depression)
• Bladder cancer
• Pelvic muscle weakness, especially in women who have had multiple pregnancies
• Enlarged prostate in middle-aged or older men
• Nerve or muscle damage after pelvic radiation
• Developmental problems of the bladder
• Pelvic, prostate, or rectal surgery
• Bladder spasms

There are many things you can do to manage incontinence, but they should not be done at the exclusion of a visit to your health care provider. Treatment usually focuses on identifying the cause and type of the incontinence, treating or managing the incontinence appropriately, and preventing complications (skin breakdown, injury, social embarrassment).

The various treatment options may be appropriate for several types of incontinence. Treatment options may involve use of various medications to enhance bladder function, bladder training to enhance continence, and various surgical treatments (based on eliminating the cause of the incontinence).

Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.

Treatment usually includes performing Kegel exercises, bladder retraining, biofeedback, and electrical stimulation.

Surgery may be required in specific instances of urinary incontinence, such as to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women.

Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters. These are synthetic cuffs that are surgically placed around the urethra to help retain urine.

People with overflow incontinence, and those who cannot empty their bladder completely, may use catheters to manage the incontinence (either long-term indwelling catheters or intermittent short-term catheterization), but this procedure exposes the person to potential infection.

Most incontinent people are able to manage minor incontinent episodes through the use of various urinary incontinence products (undergarments and pads).

Additional preventative measures include avoiding bladder or urethral irritants such as:

• Too much alcohol or coffee
• Cigarettes (if they make you cough)
• Diuretics (water pills)
• Beta-blockers
• Various anti-spasmodic medications
• Antidepressants
• Antihistamines
• Cough/cold medications
• Ventolin (albuterol) or other beta agonists

• Characteristics:
  • Describe your problem.
  • When does this occur?
  • How long has incontinence been a problem?
  • How much of a problem has this condition become?
  • How many times does this happen each day?
  • Are you aware of the need to urinate before you leak?
  • Are you immediately aware that you have passed urine?
  • Are you wet most of the day?
  • Do you wear diapers in case of accidents? Occasionally? All the time?
  • Do you avoid social situations in case of accidents?
• Aggravating factors:
  • Do you have a urinary tract infection now? In the past?
  • Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
  • Is it more difficult to control your urine when running, jumping, or walking?
  • Is the incontinence worse when sitting up or standing?
  • Do you suffer from constipation?
• Relieving factors:
  • Is there anything you can do to reduce or prevent accidents?
  • Have you ever been treated for this condition before? Did it help?
  • Have you tried pelvic floor exercises (Kegel)? Did it help?
• Associated factors:
  • What surgeries have you had?
  • What injuries have you had?
  • What medications do you take?
  • Do you drink coffee? How much?
  • Do you drink alcohol? How much? How often?
  • Do you smoke? How much each day?
• Other:
  • Are there any other symptoms present?

• Urinalysis
• Urine culture to check for infection if indicated
• Cystoscopy (inspection of the inside of the bladder)
• Urodynamic studies (tests to measure pressure and urine flow)
• Uroflow (to measure pattern of urine flow)
• Post void residual (PVR) to measure amount of urine left after urination