What is urinary incontinence?
Urinary incontinence is a common problem.
Urinary incontinence is when a person cannot prevent urine from leaking out.
It can be due to stress factors, such as coughing, it can happen during and after pregnancy, and it is more common with conditions such as obesity.
The chances of it happening increase with age.
Bladder control and pelvic floor, or Kegel, exercises can help prevent or reduce it.
Treatment will depend on several factors, such as the type of incontinence, the patient’s age, general health, and their mental state.
Pelvic floor exercises, also known as Kegel exercises, help strengthen the urinary sphincter and pelvic floor muscles – the muscles that help control urination.
• Delaying the event: The aim is to control urge. The patient learns how to delay urination whenever there is an urge to do so.
• Double voiding: This involves urinating, then waiting for a couple of minutes, then urinating again.
• Toilet timetable: The person schedules bathroom at set times during the day, for example, every 2 hours.
Bladder training helps the patient gradually regain control over their bladder.
Medications for urinary incontinence
If medications are used, this is usually in combination with other techniques or exercises.
The following medications are prescribed to treat urinary incontinence:
• Anticholinergics calm overactive bladders and may help patients with urge incontinence.
• Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
• Imipramine (Tofranil) is a tricyclic antidepressant.
The following medical devices are designed for females.
• Urethral inserts: A woman inserts the device before activity and takes it out when she wants to urinate.
• Pessary: A rigid ring inserted into the vagina and worn all day. It helps hold the bladder up and prevent leakage.
• Radiofrequency therapy: Tissue in the lower urinary tract is heated. When it heals, it is usually firmer, often resulting in better urinary control.
• Botox (botulinum toxin type A): Injected into the bladder muscle, this can help those with an overactive bladder.
• Bulking agents: Injected into tissue around the urethra, these help keep the urethra closed.
• Sacral nerve stimulator: This is implanted under the skin of the buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping bladder control.
Surgery is an option if other therapies do not work. Women who plan to have children should discuss surgical options with a doctor before making the decision.
• Sling procedures: A mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out.
• Colposuspension: Lifting the bladder neck can help relieve stress incontinence.
• Artificial sphincter: An artificial sphincter, or valve, may be inserted to control the flow of urine from the bladder into the urethra.
Urinary Catheter: A tube that goes from the bladder, through the urethra, out of the body into a bag which collects urine.
Absorbent pads: A wide range of absorbent pads is available to purchase at pharmacies and supermarkets, as well as online.
The causes and the type of incontinence are closely linked.
• pregnancy and childbirth
• menopause, as falling estrogen can make the muscles weaker
• hysterectomy and some other surgical procedures
The following causes of urge incontinence have been identified:
• cystitis, an inflammation of the lining of the bladder
• neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson’s disease
• enlarged prostate, which can cause the bladder to drop, and the urethra to become irritated
This happens when there is an obstruction or blockage to the bladder. The following may cause an obstruction:
• an enlarged prostate gland
• a tumor pressing against the bladder
• urinary stones
• urinary incontinence surgery which went too far
This can result from:
• an anatomical defect present from birth
• a spinal cord injury that impairs the nerve signals between the brain and the bladder
• a fistula, when a tube or channel develops between the bladder and a nearby area, usually the vagina
• some medications, especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants
• urinary tract infections (UTIs)
The type of urinary incontinence is normally linked to the cause.
• Stress incontinence: Urine leaks out while coughing, laughing, or doing some activity, such as running or jumping
• Urge incontinence: There is a sudden and intense urge to urinate, and urine leaks at the same time or just after.
• Overflow incontinence: The inability to empty the bladder completely can result in leaking
• Total incontinence: The bladder cannot store urine
• Functional incontinence: Urine escapes because a person cannot reach the bathroom in time, possibly due to a mobility issue.
• Mixed incontinence: A combination of types
The main symptom is the unintentional release (leakage) of urine. When and how this occurs will depend on the type of urinary incontinence.
This is the most common kind of urinary incontinence, especially among women who have given birth or gone through the menopause.
In this case “stress” refers to physical pressure, rather than mental stress. When the bladder and muscles involved in urinary control are placed under sudden extra pressure, the person may urinate involuntarily.
The following actions may trigger stress incontinence:
• coughing, sneezing, or laughing
• heavy lifting
Also known as reflex incontinence or “overactive bladder,” this is the second most common type of urinary incontinence. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes an urge to urinate that cannot be stopped.
When the urge to urinate comes, the person has a very short time before the urine is released, regardless of what they try to do.
The urge to urinate may be caused by:
• a sudden change in position
• the sound of running water
• sex, especially during orgasm
Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.
This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. An enlarged prostate gland can obstruct the bladder.
The bladder cannot hold as much urine as the body is making, or the bladder cannot empty completely, causing small amounts of urinary leakage.
Often, patients will need to urinate frequently, and they may experience “dribbling” or a constant dripping of urine from the urethra.
There will be symptoms of both stress and urge incontinence.
With functional incontinence, the person knows there is a need to urinate, but cannot make it to the bathroom in time due to a mobility problem.
Common causes of functional incontinence include:
• poor eyesight or mobility
• poor dexterity, making it hard to cannot unbutton the pants
• depression, anxiety, or anger can lead to an unwillingness to use the bathroom
Functional incontinence is more prevalent among elderly people and is common in nursing homes.
This either means that the person leaks urine continuously, or has periodic uncontrollable leaking of large amounts of urine.
The patient may have a congenital problem (born with a defect), there may be an injury to the spinal cord or urinary system, or there may be a hole (fistula) between the bladder and, for example, the vagina.
The following are risk factors linked to urinary incontinence:
• Obesity: This puts extra pressure on the bladder and surrounding muscles. It weakens the muscles, making leakage more likely when the person sneezes or coughs.
• Smoking: This can lead to a chronic cough, which may result in episodes of incontinence.
• Gender: Women have a higher chance of experiencing stress incontinence than men, especially if they have had children.
• Old age: The muscles in the bladder and urethra weaken with age.
• Some diseases and conditions: Diabetes, kidney disease, spinal cord injury, and neurologic diseases, for example, a stroke, increase the risk.
• Prostate disease: Incontinence may present after prostate surgery or radiation therapy.
Ways to diagnose urinary incontinence include:
• A bladder diary: The person records how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
• Physical exam: The doctor may examine the vagina and check the strength of the pelvic floor muscles. They may examine the rectum of a male patient, to determine whether the prostate gland is enlarged.
• Urinalysis: Tests are carried out for signs of infection and abnormalities.
• Blood test: This can assess kidney function.
• Postvoid residual (PVR) measurement: This assesses how much urine is left in the bladder after urinating.
• Pelvic ultrasound: Provides an image and may help detect any abnormalities.
• Stress test: The patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
• Urodynamic testing: This determines how much pressure the bladder and urinary sphincter muscle can withstand.
• Cystogram: An X-ray procedure provide an image of the bladder.
• Cystoscopy: A thin tube with a lens at the end is inserted into the urethra. The doctor can view any abnormalities in the urinary tract.
The inability to retain urine can sometimes lead to discomfort, embarrassment, and sometimes other physical problems.
• Skin problems – a person with urinary incontinence is more likely to have skin sores, rashes, and infections because the skin is wet or damp most of the time. This is bad for wound healing and also promotes fungal infections.
• Urinary tract infections – long-term use of a urinary catheter significantly increases the risk of infection.
• Prolapse – part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. This is usually caused by weakened pelvic floor muscles.
Embarrassment can cause people to withdraw socially, and this can lead to depression. Anyone who is concerned about urinary incontinence should see a doctor, as help may be available