It is estimated that over 12 million Americans have urinary incontinence. Incontinence affects all ages, both sexes, and people of every social and economic level. It is also estimated that 15 to 30 percent of people over the age of 60 who live at home have incontinence. Women are twice as likely as men to have this condition. In addition, at least half of the 1.5 million Americans who reside in nursing homes are incontinent.
The exact number of people with incontinence is not known, but the total number of people affected may be far greater than current estimates. Incontinence is a symptom that can be caused by a wide variety of conditions. Some of these causes, such as urinary tract or vaginal infections, medicine effects, or constipation, may be temporary.
Other causes can be longer-lasting, even permanent. These include such conditions as an overactive bladder muscle, weakness of the muscles holding the bladder in place, weakness of the sphincter muscles surrounding the urethra, birth defects, an enlarged prostrate, spinal cord injuries, surgery, or diseases involving the nerves and/or muscles (multiple sclerosis, muscular dystrophy, polio, and stroke). In some cases, more than one factor causes incontinence in a single individual.
For millions of Americans, incontinence is not just a medical problem. It is a problem that also affects their emotional, psychological, and social well-being. Many people are afraid to participate in normal daily activities that might take them too far from a toilet. So it is particularly important to note that the great majority of incontinence causes can be treated successfully.

How Do the Types of Incontinence Differ?
Incontinence is classified by the symptoms or circumstances occurring at the time of the urine leakage.

Stress incontinence may be due to poor bladder support by the pelvic muscles or to a weak or damaged sphincter. This condition allows urine to leak when you do anything that strains or stresses the abdomen, such as coughing, sneezing, laughing, or even walking.

Urge incontinence results when an overactive bladder contracts without your wanting it to do so. You may feel as if you can't wait to reach a toilet. A bladder can become overactive because of infection that irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. In other cases, the cause may be unclear.

Overflow incontinence occurs when the bladder is allowed to become so full that it simply overflows. This happens when bladder weakness or a blocked urethra prevents normal emptying. An enlarged prostate can result in such blockage. For this reason, overflow incontinence is more common in men than in women. Bladder weakness can develop in both men and women, but it happens most often in people with diabetes, heavy alcohol users, and others with decreased nerve function.

Environmental incontinence (sometimes called functional incontinence) occurs when people cannot get to the toilet or get a bedpan when they need it. The urinary system may work well, but physical or mental disabilities or other circumstances prevent normal toilet usage.

Nocturnal enuresis is incontinence that occurs during sleep.

When individuals have two or more types of incontinence, the causes of each must be considered in planning appropriate treatment.

Is There Help for a Person Who Leaks Urine?
Yes. Many types of treatment are available for incontinence. A qualified specialist can recommend the treatment that is best for you.

Behavioral therapy. Special exercises and training programs are effective in improving bladder control. Exercises to strengthen the sphincter muscles must be done correctly and faithfully to regain and maintain continence. Bladder retraining (gradually prolonging the time between visits to the toilet), along with reasonable fluid intake, has helped many people with incontinence. Several types of health-care providers are able to offer assistance with this treatment.

Medicine. Medicines can be prescribed to relax the bladder or tighten the sphincter muscles. Certain medications taken for other conditions can affect your bladder control. Review your medication with your health-care professional.

Surgery. Several operations for incontinence exist. In men, an operation may be required to relieve the blockage caused by an enlarged prostate. In women, an operation may be required to restore the support of the pelvic floor muscles or to reconstruct or compress the sphincter. An artificial urinary sphincter is another surgical treatment for people whose sphincter muscle is absent or has been severely damaged and whose problem has not responded to simpler treatments.

Other options. Certain materials can be injected around the urethra to add bulk to that area. These serve to compress the urethra and thereby increase resistance to urine flow.

Absorbent products and devices. For people who are currently participating in a treatment program or whose incontinence cannot be cured, many absorbent products and devices are available to wear. There are also devices, called pessaries, worn internally by women to support the bladder and improve control.

Many people are being helped every day. No matter how serious the problem, incontinence is a medical condition that can be treated. Each year, tens of thousands of people find the solution that works best for them. A number of organizations and associations provide information about diagnosis, treatment, and management of urinary incontinence (see "Continence Resources" below).

Reprinted with permission from The Bladder Health Council, a council of American Foundation For Urologic Disease. For additional information about incontinence, call 800-242-2383.

Some Possible Causes of Incontinence

• Urinary tract or vaginal infections
• Effects of medicine
• Constipation
• Weakness of certain muscles
• Blocked urethra due to an enlarged prostate
• Diseases and disorders involving nerves and/or muscles
• Some types of surgery

Strengthening Pelvic Muscles with Kegel Exercises
There are two types of exercises you need to do. Doing both types of exercises is the best way to help improve your bladder control.

The first exercise works on the holding ability of the muscles (building a strong dam to hold back the urine). It is done by slowly tightening, lifting and drawing in the pelvic floor muscles and holding them to a count of five. At first you will probably notice that the muscles do not want to stay contracted or tightened very long. If you feel the contraction letting go, just retighten the muscles. In fact, in the beginning, you may be able to hold the contraction for 1 to 2 seconds. Concentrate on lifting the muscles and holding the contraction while progressing slowly over a period of weeks to a goal of 10-second holds. Rest for 10 seconds between each contraction.

The second type of exercise is a quick contraction. The muscles are quickly tightened, lifted up and let go. This works the muscles that quickly shut off the flow of urine (like a faucet) to help prevent accidents. Now you are ready to begin your exercise program. Remember:
° It is important to exercise only the muscles of your pelvic floor (between your pubic bone and tailbone). Do not tense or contract the legs, buttocks or your belly as you do these exercises.

° Holding your breath makes it difficult for the muscles to work correctly. You should contract the pelvic floor muscles as you exhale, then continue to breathe normally as you do the exercises.

° Relax the body before and after the exercises.

° In the beginning, it is best to do the exercises lying down so that there is little stress on the muscles. Bend your knees or elevate your legs on a pillow or stool so you are comfortable and your legs are relaxed.

Exercise Schedule
Start with a set of 10 repetitions of each type of exercise and do them two to three times per day. It is recommended that you try to do a total of 30 to 80 repetitions per day.
Your bladder and bowel control can begin to improve in three to four weeks. However, some people take three to six months to see a major improvement.

By Kathe Wallace, P.T. and Jane Frahm, P.T. Reprinted with permission from the National Association for Continence.

CONTINENCE RESOURCES
Bladder Health Council (of the American Foundation for Urologic Disease). 800-242-2383. Sponsors annual Bladder Health Week, which focuses on Interstitial Cystitis (IC) this year, October 26-31, 1997. Call for information about IC or for the free brochure, "Answers to Your Questions About Urinary Incontinence."

Caring Products International Inc. 800-FEEL DRY. Developer of Rejoice®, a paper-thin disposable liner used in a cotton pant that is washer- and dryer-safe. Call for a free sample and a copy of the booklet, "How to Help a Family Member Who Has a Bladder Control Problem."

Continence Restored, Inc. For a free copy of a general informational article on incontinence, send a #10 SASE to: Continence Restored, Inc., 407 Strawberry Hill Ave., Stamford, CT 06902.

National Association for Continence. 800-BLADDER. Offers books, audio-visuals, and brochures about causes and treatments of incontinence. Call for a list of available products and a free sample of their quarterly newsletter "Quality Care."

National Kidney and Urologic Diseases Information Clearinghouse (for the National Institutes of Health). 800-891-5388. Conducting a public health awareness campaign aimed at women called "Let¹s Talk About Bladder Control for Women." Call to request free booklets on bladder control, or locate materials online at http://www.niddk.nih.gov.

National Kidney Foundation. 800-622-9010. Call for a free copy of the brochure "Treating Urinary Incontinence."

The Simon Foundation for Continence. 800-23-SIMON. Call for a free information packet which includes a list of resources, membership card, and a sample of the newsletter, The Informer.