Encyclopedia of Health and Medicine

224 The Urinary System
method, it requires more frequent emptying than
would the natural bladder. Likewise the catheter
reservoir, which further requires the person to
carry a catheter at all times. URINARY TRACT INFECTION
(UTI) tend to be more frequent in people who have
any form of urinary diversion, though are most
common with urostomy. Urostomy also may cause
irritation to the SKIN around the stoma. Many people
who have urostomies or catheter reservoirs feel
self-conscious about them. The urologist or hospital
can provide information about support groups
where people who have urinary diversions can
share their concerns and experiences.
See also COLOSTOMY; ILEOANAL RESERVOIR;
ILEOSTOMY; QUALITY OF LIFE; SURGERY BENEFIT AND RISK
ASSESSMENT.
urinary frequency The need to urinate more
often than normal. Urinary frequency is common
in PREGNANCY, CYSTITIS, URINARY TRACT INFECTION (UTI),
BENIGN PROSTATIC HYPERPLASIA (BPH) and PROSTATITIS
in men, and DIABETES. Urinary frequency at night
is NOCTURIA. Sometimes the cause is excessive fluid
consumption, particularly in the evening when
nocturia is a problem. The diagnostic path may
include urinalysis, assessment of any symptoms
that accompany the urinary frequency, and procedures
such as abdominal ULTRASOUND or CYSTOSCOPY
to evaluate the BLADDER and URETHRA. Treatment
targets the underlying cause. The doctor may prescribe
medications such as tolterodine or oxybutynin
to slow the bladder’s response when no
clear-cut cause emerges and symptoms persist.
See also URINARY INCONTINENCE; URINARY URGENCY.
urinary incontinence The involuntary leakage
of URINE from the URETHRA. Health experts estimate
that as many as 12 million Americans experience
some degree of urinary incontinence, which
becomes increasingly common with advancing
age. There are several types of urinary continence.
They include
• stress incontinence, in which urine leaks with
activities such as sneezing, coughing, or laughing
• urge incontinence, in which urine leakage
accompanies a sudden and overwhelming
desire to urinate
• overflow incontinence, in which the bladder
fails to send or respond to the normal NERVE signals
that direct urination and becomes overly
full, eventually leaking urine because it can
hold no more volume
Many people, particularly women past
MENOPAUSE, experience a combination of stress and
urge incontinence. This combination form of urinary
incontinence develops when the pelvic muscles
and ligaments that support the bladder
weaken and stretch. Overflow incontinence is
more common in older men who have BENIGN
PROSTATIC HYPERPLASIA (BPH). The enlarged PROSTATE
GLAND can constrict the urethra, preventing urine
from leaving the bladder. Overflow incontinence
may also develop in people who have NEUROPATHY
of DIABETES, long-standing chronic ALCOHOLISM, or
conditions of the NERVOUS SYSTEM that affect control
of involuntary functions such as MULTIPLE SCLE-
ROSIS.
The diagnostic path includes a careful history of
the urinary incontinence, BLOOD and urine tests,
and possibly diagnostic imaging procedures such
as ULTRASOUND or CYSTOSCOPY to identify any underlying
conditions that could be causing the urinary
incontinence. Treatment may be lifestyle modification,
such as altering fluid consumption habits
or emptying the bladder on a schedule. Many people,
especially women, regain continence with
KEGEL EXERCISES to strengthen and tone the pubococcygeal
MUSCLE that forms the pelvic floor.
Incontinence pads and other items help protect
clothing from leaking urine. Sometimes medications
to slow the bladder’s response, such as oxybutynin
(Ditropan), help ease urge incontinence.
In situations that do not improve the urologist
may suggest surgery to tighten pelvic muscles or
the urethral sphincter. Though finding the most
effective solution may take time, most people are
able to successfully manage urinary incontinence.
See also ENURESIS.
urinary retention The inability to completely
empty URINE from the BLADDER with URINATION.
Because urinary retention presents a risk for bacterial
URINARY TRACT INFECTION (UTI) or NEPHRITIS
(INFECTION of the KIDNEYS), it is important to find
and treat its cause. The most common cause is an