Urinary Incontinence
Urinary incontinence is common. Women are affected much more commonly than men. There are different causes. Many cases are treatable, particularly for stress and urge incontinence which are the two common types of incontinence.
What is urinary incontinence?
If you have urinary incontinence it means that you pass urine when you do not mean to (an involuntary leakage of urine). It can range from a small ‘dribble’ now and then, to large floods of urine. Incontinence may cause you distress as well as being a hygiene problem.
Understanding urine and the bladder
The kidneys make urine all the time. A trickle of urine is constantly passing to the bladder down the ureters (the tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat.
The bladder is made of muscle and stores the urine. It expands like a balloon as it fills with urine. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles beneath the bladder that sweep around the urethra (the pelvic floor muscles).
When a certain amount of urine is in the bladder, you become aware that the bladder is getting full. When you go to the toilet to pass urine, the bladder muscle contracts (squeezes), and the urethra and pelvic floor muscles relax.
Complex nerve messages are sent between the brain, the bladder, and the pelvic floor muscles. These tell you how full your bladder is, and tell the right muscles to contract or relax at the right time.
How common is urinary incontinence?
Urinary incontinence is common, especially in women. It can occur at any age, but it is more likely to develop the older you become. As many as 1 in 5 women over the age of 40 have some degree of urinary incontinence.
The number of people affected may be even higher as many people don’t tell anyone about their problem. One reason why some people do not tell their doctor about incontinence is due to embarrassment. Some people also wrongly think that incontinence is a normal part of ageing or that nothing can be done about it. This is wrong as it can be treated in many cases.
What are the causes of urinary incontinence?
There are different types of urinary incontinence.
- Stress incontinence is the most common type. It occurs when the pressure in the bladder becomes too great for the bladder outlet to withstand. It usually occurs because the pelvic floor muscles which support the bladder outlet are weakened. Urine tends to leak most when you cough, laugh, or when you exercise (such as when you jump or run). In these situations there is a sudden extra pressure (’stress’) inside the abdomen and on the bladder. Small amounts of urine may leak, but sometimes it may be quite a lot and cause embarrassment. The common reason for the pelvic floor muscles to become weakened is childbirth. Stress incontinence is common in women who have had several children. It is also more common with increasing age and with obesity.
- Urge incontinence (unstable or overactive bladder) is the second commonest cause. This is when you get an urgent desire to pass urine. Sometimes urine leaks before you have time to get to the toilet. The bladder muscle contracts too early and the normal control is reduced. In most cases, the cause of urge incontinence is not known. This is called idiopathic urge incontinence. It seems that the bladder muscle gives wrong messages to the brain, and the bladder may feel fuller than it actually is. Sometimes urge incontinence can occur because of problems with the brain or nerves. For example, it can occur after a stroke, in some people with Parkinson’s disease, in some people with multiple sclerosis or in some people with spinal cord damage or other brain disorders.
- Mixed incontinence. Some people have a combination of stress and urge incontinence.
Most cases of urinary incontinence are due to the above causes. Other causes are less common. They include:
- Overflow incontinence. This is when there is an obstruction to the outflow of urine. The obstruction prevents the normal emptying of the bladder. A pool of urine constantly remains in the bladder that cannot empty properly. However, pressure builds up behind the obstruction. The normal bladder emptying mechanism becomes faulty and urine may leak past the blockage from time to time. An enlarged prostate gland in men is the common cause of this. Treatment depends on the cause. For example, removal of the prostate (prostatectomy) if an enlarged prostate is the cause.
- Bedwetting (enuresis) occurs in many children, but some adults are affected.
What can be done?
Urinary incontinence can usually be improved, and can be cured in many cases. Each type of urinary incontinence is treated differently.
It is important to know which type of incontinence you have. Tell your doctor if you leak urine on a regular basis. He or she will be able to assess your symptoms, examine you, and may do some simple tests to try to clarify the cause. You may also be asked to keep a diary for a few days to assess how often you go to the toilet, how much urine you pass each time, and how often you leak urine. Sometimes a referral to a specialist is needed to clarify the type of incontinence. The sorts of tests that may be done by your doctor to clarify the cause include the following:
Urinalysis. This is a simple ‘dipstick’ test to check for infection, blood or protein in urine.
Residual urine. This test finds out if any urine is left in your bladder, and how much urine is left, after you have gone to the toilet. The amount of urine is usually measured using an ultrasound scan which can look at your bladder and measure the amount of urine in it. Sometimes, another method is used: a doctor or nurse may pass a thin catheter (a thin soft tube) into the bladder via the urethra. Urine then drains out to be measured.
Vaginal and anal examination. A doctor or nurse may insert a gloved finger into the vagina and rectum (back passage). This can assess the strength and tone of the pelvic floor muscles. For men, the rectal examination can also assess the size of the prostate gland. For women, the doctor or nurse may also look for signs of pelvic organ prolapse during the vaginal examination. They may use an instrument called a speculum to help them with this.
Urodynamics. These are tests of urine flow that are sometimes done in a hospital unit if the cause of the problem is not clear. They may also be carried out in some cases where surgery is considered to treat the problem.
Treatment
Treatment depends on the type of incontinence. For example: pelvic floor muscle exercises may cure stress incontinence; bladder training may cure urge incontinence; an alarm system may cure enuresis; medicines are sometimes used to help stop urge and stress incontinence, and also to stop enuresis. Other types of incontinence are less common and treatments vary, depending on the cause.
Lifestyle changes may also help some types of incontinence. These can include changing how much liquid you drink (increasing the amount if you drink too little or decreasing the amount if you drink too much) and also losing weight if you are overweight.
Your doctor may advise on treatment or refer you to a continence advisor for advice on such things as pelvic floor exercises or bladder training. This is because some mild cases get better on their own, over time, without treatment. Sometimes a specialist needs to be involved in more difficult cases. Surgery is sometimes used to treat incontinence, especially stress incontinence.
