Seven Things to Know About Urinary Incontinence

Urinary incontinence is a common problem where the individual loses some or all control of their bladder. Anyone can experience minor urine leaks. Urinary incontinence occurs when these leaks are moderate to severe and frequent.

Here are seven things to know about this problem:

1) There are several types of incontinence.

“There are many,” says Consultant Urologist Dr Elon Thompson, “but the two most common types are stress incontinence and urge incontinence.”

Stress incontinence can occur when the pelvic floor muscles and/or sphincter weaken, resulting in urine leaks when pressure is placed on the bladder (e.g. from coughing, laughing, or heavy lifting).

Urge incontinence refers to a sudden, intense need to urinate that cannot wait. It is caused by the bladder muscle contracting at the wrong time, i.e. even when the bladder is not full.

Other types include:

• Functional incontinence, where the patient is unable to use the toilet in time because of some impairment, like cerebral palsy or arthritis.

Dr Thompson: “With functional incontinence, the urinary tract is in working order, but the patient just takes too long to reach the toilet because, for example, they have to use a walker or forget where the bathroom is, as can happen with Alzheimer's or dementia.”

• Overflow incontinence, where the patient constantly leaks dribbles of urine as the bladder doesn't empty completely.

• Mixed incontinence, where the patient is dealing with more than one type of incontinence.

2) It isn’t the same as an overactive bladder (OAB).

Despite sometimes being used interchangeably, OAB is a condition where you experience frequent, sudden urges to urinate with or without urine leaks. Nocturia, where the patient regularly has to get up to urinate during the night, is a symptom of OAB.

“With OAB, the person can experience urge incontinence,” Dr Thompson explains, “so you really feel like you need to pee and are rushing to the bathroom, but before you can make it, you wet yourself.”

Certain behavioural changes can help ease symptoms of OAB, like scheduling regular trips to the bathroom versus waiting until there is an urge or reducing your liquid intake.

3) It isn’t an illness.

Instead, urinary incontinence is typically a result of another condition, like overactive bladder, or a side effect of some medications, like those for high blood pressure.

For example, uncontrolled type 2 diabetes is a common cause of urinary incontinence. Excessive blood sugar levels can cause nerve damage to the urinary tract, resulting in urge incontinence. Other illnesses that can result in urinary incontinence are bladder infections (a type of urinary tract infection), kidney stones, and any illness that causes the prostate to swell in size.

4) It’s very common in pregnancy and after birth.

This is for a number of reasons. For example, as the bladder sits right under the uterus during pregnancy, the growing foetus can put pressure on the bladder resulting in urge incontinence.

Pregnancy also causes an increase in the reproductive hormone relaxin. “Relaxin loosens the joints, ligaments and pelvic muscles to help the body to stretch during labour so that mummy can push the baby out,” Consultant Obstetrician Gynaecologist Professor Horace Fletcher explains. This occurs even if a caesarean section is performed. However, these weakened pelvic muscles can cause the sphincter to fail, allowing urine to leak out of the bladder.

After birth, the pelvic floor can take some time to regain strength. However, “it is usually not permanent,” Professor Fletcher says. “In mild cases, you can treat it with Kegel exercises and other pelvic floor exercises. Kegel exercises are a special set of exercises to improve mild prolapse and incontinence."

In more advanced cases, e.g. uterine prolapse, where the uterus falls into the vagina, surgery may be required.

5) It's more common for women, in general.

Especially older women. "The bladder is

supported by the muscles and the ligaments," Professor Fletcher explains. "And as you get older, your muscles get weaker." This applies even if you've never had children.

As noted above, during childbirth, the ligaments stretch. They don't always go back to how they were. "In younger women, the muscles compensate for this, but after menopause, these start to get weak, leading to incontinence." Kegels have no impact on damaged ligaments in the pelvis.

6) It can be overlooked in men.

While women are more likely to experience urinary incontinence, poor health-seeking behaviour on the part of men means it is often not addressed for them. “They don’t want to mention it because, for example, they are embarrassed.” Dr Thompson says. “But that means it is never addressed.”

Prostate issues, like enlarged prostate or removal of the prostate due to cancer, are the most common cause of urinary incontinence in men, so getting older is a risk factor for men. However, younger men can also develop urinary incontinence if they suffer from issues like obesity, as being overweight can put extra pressure on the bladder.

7) It is treatable.

"The treatment options for incontinence are based on the type of incontinence," explains Dr Thompson."These range from behavioural modification to surgical intervention."

For example, as mentioned above, incontinence caused by a weakened pelvic floor may be mitigated with Kegel exercises. Other treatment options could be to reduce liquid intake, lose weight or, again, as said above, surgery. What is common across all incontinence types is you need to open up to a doctor about your problem.

Dr Thompson: "A consultation to ascertain the root cause is necessary. Once that is determined, we can decide on the best treatment option for you."