Urinary incontinence is the involuntary leakage of urine; in simple terms, to wee when you don’t intend to. It is the inability to hold urine in the bladder because voluntary control over the urinary sphincter is either lost or weakened. — Medical News Today Urinary incontinence is a much more common problem than most people realise. In the United Kingdom it is estimated that at any one time at least three million people —5% of the total population — suffer from urinary incontinence. The US Department of Health and Human Services estimates that approximately 13 million Americans suffer from urinary incontinence.
Urinary incontinence is more common among women than men. 10% to 30% of American women/girls aged 15-64 years are thought to suffer from it, compared to between 1,5% and 5% of men. What are the signs and symptoms of urinary incontinence?
The main symptom is the release (leakage) of urine when you don’t want to. When and how this occurs will depend on the type of urinary incontinence.
Stress incontinence — this is the most common kind of urinary incontinence, especially among women who have given birth or have 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.
Urge incontinence (effort incontinence)— also known as reflex incontinence. This is the second most common type of urinary incontinence. The bladder is either unstable or overactive. There is a sudden, involuntary contraction of the muscular wall of the bladder (detrusor muscles) that causes urinary urgency — an urge to urinate that cannot be stopped. There is an involuntary loss of urine for no apparent reason while suddenly feeling the need or urge to urinate.
The urge to urinate may be caused by: lA sudden change in position, lThe sound of running water (for some people), lSex (especially during orgasm)
People with urge incontinence tend to have to pass urine frequently; sometimes having to get up to go to the toilet during the night.
Overflow incontinence — this type of urinary incontinence is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. The enlarged prostate gland obstructs the bladder; the person often only manages to urinate in small trickles and has to go frequently. He may feel that his bladder is never really completely emptied, even after trying hard.
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Mixed incontinence — if a patient experiences both stress and urge incontinence he/she has mixed incontinence.
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. If a person has a disability they may not be able to get their pants down in time; this would be an example of functional incontinence. The amount of urine lost may be large. Common causes of functional incontinence include: Confusion, dementia, poor eyesight, poor mobility, poor dexterity (cannot unbutton pants in time) and depression, anxiety or anger (unwilling to go to the toilet). Gross total incontinence — this either means the person leaks urine continuously all day and night, or has periodic uncontrollable leaking of large amounts of urine. The bladder is unable to store urine. The patient may have a congenital problem (was born with a defect), there may be an injury to the spinal cord, and injury to the urinary system, or there may be a fistula between the bladder and, for example the vagina.
What are the risk factors of urinary incontinence?
Obesity — obese people have increased pressure on their bladder and surrounding muscles, compared to people of normal weight. This weakens the muscles and makes it more likely that a leak occurs when the person sneezes or coughs.
Smoking — regular smokers are more likely to develop a chronic cough, which may result in episodes of incontinence. A chronic cough places undue stress on the urinary sphincter, leading to stress incontinence. A regular smoker is also more susceptible to having an overactive bladder.
Gender — women have a significantly higher chance of experiencing stress incontinence than men. Certain aspects of a female’s life, such as childbirth and menopause make incontinence more likely. A man’s risk is higher if he has prostate gland problems.
Old age — the muscles in the bladder and urethra weaken during old age. This means the bladder cannot hold as much liquid as before, raising the risk of involuntary leakage.
Some diseases and conditions — people with diabetes and some kidney diseases are more likely to suffer from urinary incontinence.
Coffee (caffeine) — men who drink approximately two cups of coffee each day are much more likely to suffer from urinary incontinence than males of the same age who drink less or no coffee at all, researchers from the University of Alabama at Birmingham wrote in The Journal of Urology (January 2nd, 2013 issue).
Causes of urinary incontinence Causes of stress incontinence When the pelvic floor muscles are weakened and cannot keep the urethra completely closed, stress incontinence occurs. Sudden pressure on the bladder may cause urine to leak out of the urethra. A cough or sneeze can trigger it. The following can cause the pelvic floor muscles to lose some of their strength: Pregnancy, childbirth (labour), menopause — when oestrogen levels drop the muscles may get weaker, a hysterectomy — surgical removal of the uterus, some other surgical procedures, age and obesity.
Causes of urge incontinence Urge incontinence happens when the person’s bladder contracts prematurely, usually before it is full. The sufferer typically cannot get to a toilet in time. Experts believe it is caused by something going wrong with the signalling system between the brain and the bladder, but they are not really sure. The following causes of urge incontinence have been identified:
Cystitis — inflammation of the lining of the bladder. It usually occurs when the normally sterile urethra and bladder are infected by bacteria and become irritated and inflamed.
CNS (central nervous system) problems — examples are multiple sclerosis, stroke and Parkinson’s disease.
An enlarged prostate — the bladder may drop and the urethra could become irritated.
Causes of overflow incontinence
This happens when there is an obstruction or blockage to the bladder. The patient may not be able to empty the bladder completely after urination, pressure builds up behind the obstruction, causing leakages. The following may cause an obstruction: an enlarged prostate gland, a tumour pressing against the bladder, urinary stones, constipation and urinary incontinence surgery which went too far.
Causes of total incontinence
The following can cause total incontinence: an anatomical defect the person has had from birth, a spinal cord injury which messes up the nerve signals between the brain and the bladder, a fistula — a tube develops between the bladder and a nearby area, most typically the vagina.
The following may also sometimes cause urinary incontinence:
Some medications — especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants.
Alcohol — if a person drinks a large quantity of alcohol the bladder and the muscles around it will relax, plus the individual may become less aware of when it is time to urinate.
Other drinks and foods — some sodas, tea, coffee, artificial sweeteners, corn syrup can aggravate the bladder and trigger episodes of incontinence. For some people, incontinence may be triggered by foods with certain spices, sugar, acid (citrus and tomatoes).
Urinary tract infection — this can irritate the bladder, triggering strong urges to urinate which may sometimes result in episodes of incontinence. Dehydration — if a person becomes dehydrated the urine can become highly concentrated — the concentrated salts can irritate the bladder and cause incontinence.
