URINARY INCONTINENCE

Urinary incontinence is the inability to hold one’s urine, or the involuntary loss of urine from the bladder.
Urinary incontinence may be temporary or permanent. Temporary urinary incontinence can occur asa result of a bladder infection, or after an indwelling catheter that has been in place for a long time is removed.
Permanent urinary incontinence can be caused by many things, including:
■ Decreased muscle tone in the bladder or the muscles that support the bladder, such as occurs after
childbirth or from obesity Injuries or illnesses that affect the spinal cord, the brain, or the nerves that control bladder function
■ Dementia
Urinary incontinence can be emotionally devastating for both the incontinent person and the person’s caregivers. For the person who is incontinent, having wet clothes or smelling like urine can be very embarrassing.
In addition, being incontinent of urine places a person at risk for developing skin problems (such asrashes and pressure ulcers) and for falling (as the person rushes to the bathroom to avoid having an accident).
For the caregiver, caring for a person who is incontinent of urine can be frustrating and emotionally draining. It is not uncommon to change a person’s clothes or bedding, only to have the person wet herselfall over again. Because caring for an incontinent person
can be so emotionally trying and time consuming, incontinence is the factor that most often leads family members to have a relative admitted to a long-term care facility.

Types of Urinary Incontinence
There are many types of urinary incontinence.
■ Stress incontinence is probably the most common type of urinary incontinence. In stressincontinence, urine leaks from the bladder when the person coughs, sneezes, or exerts herself. Stress incontinence can also occur if a persondelays voiding and the bladder becomes too full. Childbirth, obesity, and loss of muscle tone as a result of aging are all factors that can contribute to stress incontinence. Stress incontinence can also occur in men after prostate surgery. Stress incontinence can often be corrected with exercises or surgery.
■ Urge incontinence is the involuntary release of urine right after feeling a strong urge to void. This type of incontinence is common in people with urinary tract infections because irritation of  the bladder causes the bladder muscle to spasm, expelling the contents of the bladder with little warning. Other conditions that decrease the ability of the bladder to hold urine, such as an enlarged prostate gland or increased intake of caffeinated beverages or alcohol, can also cause urge incontinence.
■ Functional incontinence occurs in the absence of physical or nervous system problems affecting the urinary tract. The person just cannot make it to the bathroom in enough time, or wait until a bedpan or urinal is provided. It is thought that being in a strange environment (as a hospital or long-term care facility would be to someone who has just been admitted) contributes to functional
incontinence. Confusion, disorientation, and loss of mobility are also contributing factors.
■ Overflow incontinence occurs when the bladder is too full of urine. Overflow incontinence is associated with urinary retention, which is the inability of the bladder to empty either completely during urination, or at all. Urinary retention can result from blockage of the bladder outlet (such as occurs with an enlarged prostate gland or from swelling of the urethra during labor or childbirth), or from pain following a surgical procedure. Some injuries that involve the spinal cord can also keep the bladder from emptying fully, leading to urinary retention. Because the bladder does not empty completely when the person voids, it refi lls with urine quickly, andthe urine simply overfl ows. A person with overflow incontinence may “dribble” urine in between visits to the bathroom. If a person cannot empty his bladder completely, it may be necessary to insert a catheter (either temporarily or permanently) to allow urine to drain from the bladder and prevent urinary retention and overflow incontinence from occurring.
■ Reflex incontinence occurs when there is damage to the nerves that enable the person to control urination. The bladder fi lls, but the person does not feel the urge to urinate. When the bladder is completely full, it empties reflexively (that is, automatically). Some people with certain disorders of the nervous system, such as paralysis from a spinal cord injury, will catheterize themselves
with a straight catheter on a regular basis to prevent reflex urinary incontinence.

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