Urinary incontinence, sometimes called overactive bladder, is the loss of bladder control. Incontinence affects twice as many women as men. Pregnancy, childbirth, and menopause may make urinary incontinence more likely. Urinary incontinence is not a normal part of aging, and it can be treated.
What is urinary incontinence?
Urinary incontinence is the loss of bladder control, or leaking urine. Urine is made by the kidneys and stored in the bladder. The bladder has muscles that tighten when you need to urinate. When the bladder muscles tighten, urine is forced out of your bladder through a tube called the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of your body.
Incontinence can happen when the bladder muscles suddenly tighten and the sphincter muscles are not strong enough to pinch the urethra shut. This causes a sudden, strong urge to urinate that you may not be able to control. Pressure caused by laughing, sneezing or exercising can cause you to leak urine. Urinary incontinence may also happen if there is a problem with the nerves that control the bladder muscles and urethra. Urinary incontinence can mean you leak a small amount of urine or release a lot of urine all at once
Q: What are the types of urinary incontinence that affect women?
A: The two most common types of urinary incontinence in women are:
• Stress incontinence. Stress incontinence can happen when weak pelvic floor muscles put
pressure on the bladder and urethra by making
them work harder. With stress incontinence,
everyday actions that use the pelvic floor muscles, such as coughing, sneezing, laughing, or physical activity, can cause you to leak urine.
• Urge incontinence. With urge incontinence, urine leakage usually happens after a strong, sudden urge to urinate and before you can get to a bathroom. Some women with urge incontinence can get to a bathroom in time but feel the urge to urinate more than eight times a day. They also do not urinate much once they get to the bathroom. Urge incontinence is more common in older women.
Q: Why does urinary incontinence affect more women than men?
A: Pregnancy, childbirth, and menopause may affect the urinary tract and the surrounding muscles. The pelvic floor muscles that support the bladder, urethra, uterus (womb), and bowels may become weaker or damaged. When the muscles that support the urinary tract are weak, the muscles in the urinary tract must work harder to hold urine until you are ready to urinate.
This extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage. The female urethra is also shorter than the male urethra. Any weakness or damage to the urethra in a woman is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in until you are ready to urinate.
“not all women who have given birth will develop incontinence”
Q: What causes urinary incontinence?
A: Other than pregnancy, childbirth, and menopause, causes of urinary incontinence include:
• Overweight. Having overweight puts pressure on the bladder, which can weaken the muscles over time.
• Constipation. Constipation, or straining to have a bowel movement, can put stress or pressure on the bladder and pelvic floor muscles.
• Nerve damage. Damaged nerves may send signals to the bladder at the wrong time or not at all. Childbirth and health problems such as diabetes and multiple sclerosis can cause nerve damage in the bladder, urethra, or pelvic floor muscles.
• Surgery. Any surgery that involves a woman’s reproductive organs, such as a hysterectomy, can damage the supporting pelvic floor muscles, especially if the uterus is removed.
• Certain medicines. Urinary incontinence may be a side effect of medicines such as diuretics (“water pills” used to treat heart failure, liver cirrhosis, hypertension, and certain kidney diseases). The incontinence often goes away when you stop taking the medicine.
• Caffeine. Drinks with caffeine can cause the bladder to fill quickly, which can cause you to leak urine. Limiting caffeine may help with incontinence because there is less strain on your bladder.
• Infection. Urinary tract infections and bladder infections may cause incontinence for a short time. Bladder control often returns when the infection goes away.
Types of urinary incontinence
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
This is the most common kind of urinary incontinence, especially among women who have given birth or gone through 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 the loss of urine.
- Urodynamic testing: This determines how much pressure the bladder and urinary sphincter muscle can withstand.
- Cystogram: An X-ray procedure provides 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 are 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 concerned about urinary incontinence should see a doctor, as help may be available.