Urinary incontinence

What is urinary incontinence?

Urinary incontinence is the accidental loss of bladder control that results in urine leakage. It is more common in women, but can also occur in men. It can be variable in its severity and potentially embarrassing.

Signs and symptoms

Signs and symptoms associated with urinary incontinence can include:

• Leakage of urine caused by coughing, sneezing or exercising;
• Leakage of urine before reaching the toilet;
• Frequent urination or urgent need to urinate;
• Poor urine flow;
• Straining to empty the bladder;
• The feeling of an unemptied bladder;
• Getting up to urinate two or more times per night, and;
• Bedwetting.

Causes

There are many causes of urinary incontinence. Some can be temporary, while others are longer-lasting physical changes that may affect only males or females.

Temporary urinary incontinence

Temporary urinary incontinence can be caused by diuretics, such as caffeine, alcohol, soft drinks, spicy food, citrus fruits and blood pressure medications. Diuretics increase the amount of urine produced, which places strain on the bladder to store more urine. If this capacity is exceeded, then urinary incontinence may develop. By avoiding such diuretics, urinary incontinence may be reversed.

A urinary tract infection can cause bladder irritations, strong urges to urinate and incontinence.

Constipation can put increased pressure on nerves that control your bladder, also leading to an increased need to urinate.

Physical changes causing urinary incontinence

In some people, the bladder muscle and/or the pelvic floor muscles that support the bladder can weaken over time and contribute to urinary incontinence. In women, events including pregnancy, childbirth, menopause and hysterectomy can cause urinary incontinence. In men, conditions including an enlarged prostate gland or prostate cancer can cause urinary incontinence.

Some neurological conditions including stroke, Parkinson's disease, multiple sclerosis and brain tumors can affect nerve signals that control the bladder and lead to urinary incontinence.

Types

There are multiple types of urinary incontinence. These include:

Stress incontinence

Stress incontinence is the most common form of urinary incontinence and can occur from coughing, sneezing, laughing, or lifting a heavy object. This commonly affects women who have given birth or have experienced menopause. It is caused by weak bladder and/or pelvic floor muscles.

Urge incontinence

Urge incontinence, also known as an overactive bladder, occurs when the bladder muscle becomes too active, leading to a strong urge to pass urine. It can be due to a urinary tract infection, some neurological conditions or commonly, the cause is unclear.

Overflow incontinence

Overflow incontinence involves a slow dribble of urine from the bladder. This occurs when the feeling of a full bladder is reduced, leading to a build-up of urine. The bladder then spontaneously empties once it has reached full capacity.

Functional incontinence

Functional incontinence occurs when a person cannot get to the toilet in time due to a physical or intellectual disability, or memory impairment.

Different types of urinary incontinence in women. 

Different types of urinary incontinence in men. 

Methods for diagnosis

To diagnose urinary incontinence, your doctor will give you a physical examination and ask about the frequency and timing of your urinary incontinence. A urine sample may be collected to identify any infection, blood or other abnormalities. A bladder diary can also be used to keep track of instances of urges and incontinence.

Another test called post-void residual measurement involves using an ultrasound or catheter to measure the amount of urine remaining in your bladder after urinating. This can identify if your bladder is not emptying correctly. Your doctor may recommend urodynamic studies, which are more invasive tests to measure the flow and pressure of urine during voiding.

Types of treatment

Depending on the type of urinary incontinence, various treatments can be used. These can include:

Behavioral techniques

Behavioral techniques involve training your bladder to hold off when you have the urge to urinate, creating scheduled toilet visits or 'double-voiding', a process in which you urinate twice within 10 minutes to ensure all urine is expelled.

Pelvic floor exercises

Pelvic floor exercises, also known as Kegel exercises, help strengthen the pelvic floor muscles. These are the muscles used to stop the flow of urine while urinating. When the bladder is empty, contract the pelvic floor muscles, hold for 10 seconds and then release. Repeat this process 10 times and perform three times each day.

Medications

Medications are commonly used to treat urinary incontinence. Medications, such as oxybutynin, can be helpful for urge incontinence. In women, estrogen cream can also be applied to rejuvenate and strengthen vaginal tissues. Other medications, including tamsulosin, can be used in men to relax the muscle fibers of the prostate gland and bladder, to make bladder emptying easier.

Absorbent pads and catheters

Absorbent pads are used to absorb any residual leaking of urine. They are very thin and can be worn under clothing. Men can also wear an absorbent padding that fits onto the end of the penis.

Very rarely, a catheter can be used if the bladder does not empty properly. This is a small tube that is inserted into the urethra to drain the bladder into an external bag.

Surgery

Urinary incontinence can also be treated by various surgical procedures. However, as there is the potential for complications, surgery is generally reserved for cases that do not respond to other treatments.

Sling procedure

In women, this procedure involves creating a sling using body tissue or synthetic material to support the bladder and related structures. This can help to keep the urethra closed during coughing and sneezing.

Prolapse surgery

In some cases, the bladder can prolapse (bulge or protrude) into the front wall of the vagina causing urinary incontinence. This can be corrected with prolapse surgery.

Prostate surgery

Transurethral resection of the prostate (TURP) may be performed to relieve blockage in an enlarged prostate gland. A central core of the prostate is removed to allow for easier urination. Unfortunately, although symptoms can improve with this procedure, it can also have a number of troublesome side effects including erectile dysfunction and urinary incontinence.

Artificial urinary sphincter

This involves inserting a fluid-filled ring around the opening of the bladder to prevent accidental urination. To urinate, the ring can be deflated by pressing a valve under the skin. This is a helpful treatment for men with an enlarged prostate or prostate cancer-related incontinence.

Potential complications

Complications associated with urinary incontinence can include an increased risk of urinary tract infections, skin rashes due to consistently wet skin, and impacts on personal life.

Prognosis

If you are experiencing urinary incontinence, there are many treatment and management options available. To treat the condition, you may be able to train your bladder using behavioral techniques, or strengthen your pelvic floor muscles to better control urination. In other cases, medications or surgery may be required. For urinary incontinence management, pads can be worn under clothing to absorb any uncontrollable leakage.

Prevention

Depending on the type of urinary incontinence, it may be possible to help prevent the leakage of urine by maintaining a healthy body weight and healthy diet. Limiting caffeine and soft drinks may help reduce urinary incontinence. Strengthening your pelvic floor muscles by performing pelvic floor exercises can also help prevent urinary incontinence.