What is urinary incontinence?
Urinary incontinence is an inability to hold your urine until you get to a toilet. It is often temporary, and it always results from an underlying medical condition.
Women experience incontinence twice as often as men. Pregnancy, childbirth, menopause and the structure of the female urinary tract account for this difference. It's most common in women over 50 years old, but both women and men can become incontinent from strokes, diabetes, multiple sclerosis and physical problems associated with old age i.e.
arthritis.
Older women, more often than younger women, experience incontinence, but incontinence is not a condition associated with old age. Incontinence is treatable and often curable at all ages.
If you experience incontinence you may feel embarrassed, which you will need to overcome to see your DOCTOR – which is very important as you may need treatment for an underlying medical condition. Remember that the loss of bladder control can be treated and if you hide your incontinence, you risk getting rashes, sores, skin and urinary tract infections. Also, you may find yourself avoiding friends and family from fear and embarrassment.
What causes urinary incontinence?
Incontinence in women usually occurs due to problems associated with the muscles, which help you hold or release urine (See diagram). The body stores urine in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body, the urethra is shorter in females and can lead to infections quite easily.
During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body (see diagram). Incontinence will occur if this process becomes unco-ordinated and your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
Is urinary incontinence just part of growing old?
No, but changes in your body as you age can reduce how much urine your bladder can hold. Ageing can make your stream of urine weaker and cause you to feel the urge to urinate more often. This doesn't mean you'll have urinary incontinence just because you're ageing. Treatment can control incontinence or stop it completely.
Are there different types of incontinence?
There are four types of incontinence:
If coughing, laughing, sneezing, or other movements that puts pressure on your bladder causes you a small leakage or causes a large amount of urine to spill out, you may have stress incontinence. Often physical changes resulting from pregnancy, childbirth and menopause cause stress incontinence. It is the most common form of incontinence in women and the good news is that incontinence is treatable. In women stress incontinence can become happen more frequently a week before a menstrual period. At that time, lowered oestrogen levels might lead to lower muscular pressure around the urethra, increasing the chances of leakage. The incidence of stress incontinence is more common after the menopause.
If you leak urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions. Medical professionals describe such a bladder as "unstable", "spastic" or "overactive". Your Doctor might call your condition "reflex incontinence" if it results from overactive nerves controlling the bladder. Urge incontinence occurs because of damage to the nerves controlling the bladder. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumours and injuries, including injury that occurs during surgery can harm the bladder nerves or muscles.
People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer's disease, for example, may not recognise the fact they have a full bladder and may not reach the toilet in time. A person in a wheelchair may be blocked from getting to a toilet in time.
If your bladder is always full and it continually leaks urine, you have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to a weak bladder. Overflow incontinence is uncommon in women.
Other types of incontinence
Stress and urge incontinence can occur together in women. This type of incontinence can be called "mixed incontinence".
"Transient incontinence" is a type of temporary incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility and stool impaction (severe constipation), which can push against the urinary tract and obstruct the urine flow
.
How is incontinence diagnosed?
The first step is to see a DOCTOR who may refer you to an Urologist or Gynaecologist. To diagnose the problem, your DOCTOR will first ask about the nature and severity of the problem and about other medical conditions that you may have had in the past.
Your DOCTOR will do a physical examination to see if there are any underlying medical conditions causing incontinence, such as a tumour that is blocking the urinary tract, constipation and poor reflexes or sensations, which may be from nerve damage.
Your DOCTOR may also recommend:
Stress test
You relax, then cough vigorously as the DOCTOR watches for loss of urine.
Urine test
Urine is tested for evidence of infection, urinary stones, or other contributing causes.
Blood tests
Blood is taken and sent to a laboratory. This is examined for substances related to causes of incontinence.
Ultrasound
Sound waves are used to "see" the kidneys, urethras, bladder and urethra.
Cystoscopy
A thin tube with a tiny camera is inserted into the urethra and used to see the urethra and bladder (this test is only done by the Urologist in hospital or day centre).
Urodynamics
Various techniques measure pressure in the bladder and the flow of urine.
Your DOCTOR may ask you to keep a diary and record when you pass urine for a day or more, up to a week. This diary may be used for one day or one week, it will give you a clear picture of when you need to use the toilet – which can help you plan a trip to the toilet in time, before leakage occurs.
How is incontinence treated?
Depending upon the cause of your incontinence your GP or Consultant may prescribe one or more of the following:
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage.
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis, these electrical impulses can be similar to the same type you see advertised on T.V. to strengthen tummy muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles.
Biofeedback uses measuring devices to help you become aware of your body's timing in terms of needing to use the toilet. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
- Timed voiding or bladder training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning, known as bladder training can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.
Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra preventing leakage and some, especially hormones such as oestrogen, are believed to cause muscles involved in urination to function normally.
Some of these medications can produce harmful side effects if used for long periods of time. In particular, oestrogen therapy has been associated with an increased risk of breast cancer and endometrial cancer. Your GP will talk about the risks and benefits of long-term use of medications.
A pessary is a stiff ring that is inserted by a GP into the vagina, where it presses against the wall of the vagina and nearby urethra. The pressure helps reposition the urethra, leading to a reduced ‘stress' leakage.
Implants are substances injected into flesh around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence.
DOCTORS usually suggest surgery to alleviate incontinence only after other treatments have failed. Many surgical options have high rates of success
.
Stress incontinence in most cases result from the bladder dropping down towards the vagina. Therefore, surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attaching it to a muscle, ligament, or bone.
For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. As fluid fills and expands the sac, the artificial sphincter squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass.
If you are incontinent because your bladder never empties completely (overflow incontinence), your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used temporarily or on a constant basis, in which case the tube connects to a bag that you can attach to your leg.
Many women use pads to manage incontinence that catch slight leakages during activities such as exercising. Also, you can reduce incontinence by restricting certain liquids, such as coffee, tea and alcohol as caffeine and other chemicals can cause urge incontinence.
How long does urinary incontinence last for?
Urinary incontinence may not last for very long depending on the underlying problem and the treatment received. If it's related to muscle weakness, pelvic injury or nerve problems it may be a long-term problem.
What is the prevention?
- Doing Kegel exercises.
- Keeping weight down.
- Quitting smoking.
Points To Remember
- Urinary incontinence is common especially in women.
- All types of urinary incontinence can be treated.
- Incontinence can be treated at all ages.
Written by Medpages Editorial Team
Last Editorial Review: 19/1/2010
