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 SKINaround the stoma. Many peo-
ple 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) andPROSTATITIS
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 proce-
dures such as abdominal ULTRASOUNDor CYSTOSCOPY
to evaluate the BLADDERand URETHRA. Treatment
targets the underlying cause. The doctor may pre-
scribe medications such as tolterodine or oxybu-
tynin 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 URINEfrom 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 laugh-
ing - 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 NERVEsig-
nals that direct urination and becomes overly
full, eventually leaking urine because it can
hold no more volume
- overflow incontinence, in which the bladder
Many people, particularly women past
MENOPAUSE, experience a combination of stress and
urge incontinence. This combination form of uri-
nary incontinence develops when the pelvic mus-
cles 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
GLANDcan 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 SYSTEMthat affect con-
trol of involuntary functions such asMULTIPLE SCLE-
ROSIS.
The diagnostic path includes a careful history of
the urinary incontinence, BLOODand urine tests,
and possibly diagnostic imaging procedures such
as ULTRASOUNDor CYSTOSCOPYto identify any under-
lying conditions that could be causing the urinary
incontinence. Treatment may be lifestyle modifi-
cation, such as altering fluid consumption habits
or emptying the bladder on a schedule. Many peo-
ple, especially women, regain continence with
KEGEL EXERCISESto strengthen and tone the pubo-
coccygeal MUSCLE that forms the pelvic floor.
Incontinence pads and other items help protect
clothing from leaking urine. Sometimes medica-
tions to slow the bladder’s response, such as oxy-
butynin (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 bac-
terial URINARY TRACT INFECTION (UTI) or NEPHRITIS
(INFECTIONof the KIDNEYS), it is important to find
and treat its cause. The most common cause is an224 The Urinary System