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Urinary Incontinence

What is urinary incontinence (UI)?

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

What are the types of urinary incontinence (UI)?

There are several different types of UI. Each type has different symptoms and causes:

  • Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
  • Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
  • Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
  • Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
  • Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
  • Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
  • Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
    • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
    • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.
Who is at risk for urinary incontinence (UI)?

In adults, you are at higher risk of developing UI if you:

  • Are female, especially after going through pregnancy, childbirth, and/or menopause
  • Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
  • Are a man with prostate problems
  • Have certain health problems, such as diabetes, obesity, or long-lasting constipation
  • Are a smoker
  • Have a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children.

How is urinary incontinence (UI) diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
  • A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
  • Urine and/or blood tests
  • Bladder function tests
  • Imaging tests
What are the treatments for urinary incontinence (UI)?

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including:

  • Lifestyle changes to reduce leaks:
    • Drinking the right amount of liquid at the right time
    • Being physically active
    • Staying at a healthy weigh
    • Avoiding constipation
    • Not smoking
  • Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
  • Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as:

  • Medicines, which can be used to
    • Relax the bladder muscles, to help prevent bladder spasms
    • Block nerve signals that cause urinary frequency and urgency
    • In men, shrink the prostate and improve urine flow
  • Medical devices, including
    • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
    • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
  • Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
  • Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
  • Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Urine and Urination

Your kidneys make urine by filtering wastes and extra water from your blood. The waste is called urea. Your blood carries it to the kidneys. From the kidneys, urine travels down two thin tubes called ureters to the bladder. The bladder stores urine until you are ready to urinate. It swells into a round shape when it is full and gets smaller when empty. If your urinary system is healthy, your bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2 to 5 hours.

You may have problems with urination if you have:

  • Kidney failure
  • Urinary tract infections
  • An enlarged prostate
  • Bladder control problems like incontinence, overactive bladder, or interstitial cystitis
  • A blockage that prevents you from emptying your bladder

Some conditions may also cause you to have blood or protein in your urine. If you have a urinary problem, see your health care provider. Urinalysis and other urine tests can help to diagnose the problem. Treatment depends on the cause.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Usher Syndrome

Usher syndrome is an inherited disease that causes serious hearing loss and retinitis pigmentosa, an eye disorder that causes your vision to get worse over time. It is the most common condition that affects both hearing and vision.

There are three types of Usher syndrome:

  • People with type I are deaf from birth and have severe balance problems from a young age. Vision problems usually start by age 10 and lead to blindness.
  • People with type II have moderate to severe hearing loss and normal balance. Vision problems start in the early teens and get worse more slowly than in type I.
  • People with type III are born with normal hearing and near-normal balance but develop vision problems and then hearing loss.

There is no cure. Tools such as hearing aids or cochlear implants can help some people. Training such as Braille instruction, low-vision services, or auditory training can also help.

NIH: National Institute on Deafness and Other Communication Disorders

Vaccine Safety

What are vaccines?

Vaccines play an important role in keeping us healthy. They protect us from serious and sometimes deadly diseases. Vaccines are injections (shots), liquids, pills, or nasal sprays that you take to teach your body's immune system to recognize and defend against harmful germs. The germs could be viruses or bacteria.

Some types of vaccines contain germs that cause disease. But the germs have been killed or weakened enough that they won't make you sick. Some vaccines only contain a part of a germ. Other types of vaccines include instructions for your cells to make a protein of the germ.

These different vaccine types all spark an immune response, which helps your body fight off the germs. Your immune system will also remember the germ and attack it if that germ ever invades again. This protection against a certain disease is called immunity.

These diseases can be very serious. Because of this, getting immunity from a vaccine is safer than getting immunity by being sick with the disease. And for a few vaccines, getting vaccinated can actually give you a better immune response than getting the disease would.

Do vaccines cause side effects?

As with medicines, any vaccine can cause side effects. Most of the time the side effects are minor, such as a sore arm, fatigue, or mild fever. They usually go away within a few days. These common side effects are often a sign that your body is starting to build immunity against a disease.

Serious side effects from vaccines can happen, but they are very rare. These side effects could include a severe allergic reaction. Other possible side effects are different for each vaccine. Talk with your health care provider if you're concerned about your health after getting vaccinated.

Some people worry that childhood vaccines could cause autism spectrum disorder (ASD). But many scientific studies have looked at this and have found no link between vaccines and ASD.

How are vaccines tested for safety?

Every vaccine that is approved in the United States goes through extensive safety testing. It starts with testing and evaluation of the vaccine before it's approved by the Food and Drug Administration (FDA). This process can often take several years.:

  • First, the vaccine is tested in labs. Based on those tests, the FDA decides whether to test the vaccine with people.
  • Testing with people is done through clinical trials. In these trials, the vaccines are tested on volunteers. Clinical trials usually start with 20 to 100 volunteers, but eventually include thousands of volunteers.
  • The clinical trials have three phases. The trials are looking for the answer to important questions such as
    • Is the vaccine safe?
    • What dose (amount) works best?
    • How does the immune system react to it?
    • How effective is it?
  • During the process, the FDA works closely with the company who makes the vaccine to evaluate the vaccine's safety and effectiveness. If the vaccine is found to be safe and effective, it will be approved and licensed by the FDA.
  • After a vaccine is licensed, experts may consider adding it to the recommended vaccine, or immunization, schedule. This schedule is from the Centers for Disease Control and Prevention (CDC). It lists which vaccines are recommended for different groups of people. They list which age groups should get which vaccines, how many doses they need, and when they should get them.

Testing and monitoring continue after the vaccine is approved:

  • The company making the vaccines tests every batch of vaccines for quality and safety. The FDA reviews the results of these tests. It also inspects the factories where the vaccine is made. These checks help make sure the vaccines meet standards for quality and safety.
  • The FDA, CDC, and other federal agencies continue to monitor its safety, to watch for possible side effects. They have systems to track any safety issues with the vaccines.

These high safety standards and testing help to make sure that vaccines in the United States are safe. Vaccines help protect against serious, even deadly, diseases. They not only protect you, but also help to keep these diseases from spreading to others.

Vaccines

What are vaccines?

Vaccines are injections (shots), liquids, pills, or nasal sprays that you take to teach your body's immune system to recognize and defend against harmful germs. For example, there are vaccines to protect against diseases caused by:

  • Viruses, like the ones that cause the flu and COVID-19
  • Bacteria, including tetanus, diphtheria, and pertussis
What are the types of vaccines?

There are several types of vaccines:

  • Live-attenuated vaccines use a weakened form of the germ.
  • Inactivated vaccines use a killed version of the germ.
  • Subunit, recombinant, polysaccharide, and conjugate vaccines use only specific pieces of the germ, such as its protein, sugar, or casing.
  • Toxoid vaccines that use a toxin (harmful product) made by the germ.
  • mRNA vaccines use messenger RNA, which gives your cells instructions for how to make a protein (or piece of a protein) of the germ.
  • Viral vector vaccines use genetic material, which gives your cells instructions for making a protein of the germ. These vaccines also contain a different, harmless virus that helps get the genetic material into your cells.

Vaccines work in different ways, but they all spark an immune response. The immune response is the way your body defends itself against substances it sees as foreign or harmful. These substances include germs that can cause disease.

What happens in an immune response?

There are different steps in the immune response:

  • When a germ invades, your body sees it as foreign.
  • Your immune system helps your body fight off the germ.
  • Your immune system also remembers the germ. It will attack the germ if it ever invades again. This "memory" protects you against the disease that the germ causes. This type of protection is called immunity.
What are immunization and vaccination?

Immunization is the process of becoming protected against a disease. But it can also mean the same thing as vaccination, which is getting a vaccine to become protected against a disease.

Why are vaccines important?

Vaccines are important because they protect you against many diseases. These diseases can be very serious. So getting immunity from a vaccine is safer than getting immunity by being sick with the disease. And for a few vaccines, getting vaccinated can actually give you a better immune response than getting the disease would.

But vaccines don't just protect you. They also protect the people around you through community immunity.

What is community immunity?

Community immunity, or herd immunity, is the idea that vaccines can help keep communities healthy.

Normally, germs can travel quickly through a community and make a lot of people sick. If enough people get sick, it can lead to an outbreak. But when enough people are vaccinated against a certain disease, it's harder for that disease to spread to others. This type of protection means that the entire community is less likely to get the disease.

Community immunity is especially important for people who can't get certain vaccines. For example, they may not be able to get a vaccine because they have weakened immune systems. Others may be allergic to certain vaccine ingredients. And newborn babies are too young to get some vaccines. Community immunity can help to protect them all.

Are vaccines safe?

Vaccines are safe. They must go through extensive safety testing and evaluation before they are approved in the United States.

What is a vaccine schedule?

A vaccine, or immunization, schedule lists which vaccines are recommended for different groups of people. It includes who should get the vaccines, how many doses they need, and when they should get them. In the United States, the Centers for Disease Control and Prevention (CDC) publishes the vaccine schedule.

It's important for both children and adults to get their vaccines according to the schedule. Following the schedule allows them to get protection from the diseases at exactly the right time.