An estimated 12 million Americans have urinary incontinence. Urinary incontinence increases with age; women are twice as likely as men to have problems with bladder control. Approximately 15 to 30 percent of people over the age of 60 who live at home have incontinence and about half (1.5 million) of those who live in nursing homes are incontinent. Urinary incontinence can range from minor leaking to uncontrollable wetting. People with incontinence often try to hide the problem because of their embarrassment. Only about 1 in 5 people with incontinence seek help for this condition. However, 80 percent of those who do seek treatment for uinary incontinence report a cure or improvement in their condition.

Control over urinary continence can also be affected by other factors. For example, conditions such as stroke or Alzheimer's disease can affect the ability to recognize and interpret urinary urge. A number of drugs affect the ability to maintain continence or make incontinence worse. Adults who are on diuretics (e.g., water pills such as Lasix) may have difficulty controlling their bladder. Often chronic conditions can contribute to incontinence (i.e., diabetes, urinary tract infections). There are four types of incontinence which may co-occur in any individual. Determining the type of incontinence is key to appropriate intervention.

• Stress incontinence is the most common type of bladder control problem. Pressure from coughing, sneezing, laughing or lifting causes increased pressur on the bladder which results in leakage of urine through the weakened muscle. It is usually the result of pelvic muscles that have been weakened pregnancy, childbirth, being overweight. or other factors. Bladder control problems associated with weak pelvic muscles can be prevented or treated by strengthening these muscles with Kegel exercises. Kegel exercises should be done three times a day for 5 minutes to maintain pelvic fitness and badder control. The muscles involved are the same ones you use when you try to stop the flow of urine when you are sitting on the toilet.
  
  
• Urge incontinence happens when you can't hold your urine long enough to reach the bathroom. It is common in individuals who have conditions such as a stroke, dementia, Parkinson's Disease, diabetes, or multiple sclerosis, but it occurs in healthy persons also.
  
  
• Overflow incontinence occurs when a bladder is always full and small amounts of urine overflow or leak. Older men experience this type of incontinence when an enlarged prostate blocks the urine flow from the bladder. Other causes of overflow include urinary stones and cancer.
  
  
• Functional incontinence results when a disabling conditions such as arthritis makes it difficult for the person to reach the bathroom even though they have normal urine control. Functional incontinence can be managed by modifying the environment. For example, a commode might be placed nearby if the older adult has difficulty walking across the room.

People with incontinence often withdraw from social life and try to hide this problem. However, there are several possibilities for treatment which are particularly effective for stress and urge incontinence:

• behavioral techniques such as bladder training programs that focus on scheduled urination
• pelvic muscle exercises
• biofeedback

Medications can treat incontinence but must be carefully supervised by a doctor due to side effects such as a dry mouth, eye problems, and buildup of urine. Surgery can improve or cure a structural problem causing incontinence such as an abnormally positioned bladder or blockage due to an enlarged prostate. If left untreated, incontinence can increase the changes of skin irritation and infection and raise the risk of developing pressure ulcers. If incontinence cannot be cured than it can be managed by:

• using specially designed absorbent under-clothing to stay dry and control odor
• short term catheterization (inserting a flexible tube into the urethra and collecting the urine into a container.