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.
Urinary incontinence is a much more common problem than most people realize. In the United Kingdom it is estimated that at any one time at least 3 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. Over half of all nursing home residents are thought to be affected by urinary incontinence. The Department of Health, UK, estimates that 20% of all women over the age of 40 are affected by urinary incontinence.
The Latin word continentem (nom. continens) means "to hold together", while incontinentem (nom. Incontinens) means "not holding together". The English word incontinent meaning unable to control bowels or bladder was probably first used in 1828.
Fecal incontinence means the inability to control one's bowel movements. This article focuses just on urinary incontinence.
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.
Approximately 13 million Americans suffer from urinary 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.
The following actions may trigger stress incontinence:
- A sudden cough
- Heavy lifting
The amount of urine that leaks out unwillingly depends on how full the bladder is and how affected the muscles are.
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.
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 (for some people)
- Sex (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.
Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.
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.
Put simply, overflow incontinence is an inability to empty the bladder, the patient frequently dribbles urine. Some patients constantly dribble urine (as opposed to frequently).
If a patient experiences both stress and urge incontinence he/she has mixed 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. 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:
- Poor eyesight
- Poor mobility
- Poor dexterity (cannot unbutton pants in time)
- Depression, anxiety or anger (unwilling to go to the toilet).
People with functional incontinence may have difficulties in thinking, moving or communicating - these difficulties may prevent them from reaching a toilet.
Functional incontinence is more prevalent among elderly people, and is common in nursing homes.
Functional incontinence may occur when there is nothing physically wrong with the person. If you are on a long trip and dying to urinate but there are not toilets nearby.
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.
Risk factors of urinary incontinence
A risk factor is something that increases your chances of developing a condition or disease. For example, being obese raises the risk of developing diabetes type 2; therefore, obesity is a risk factor for diabetes type 2.
The following are risk factors linked to urinary incontinence:
- Being obese - 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 (coughing a lot over the long term) 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. This does not mean that people will necessarily become incontinent when they are old; it just means the risk is higher.
- 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 may be 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
We will divide the causes up between stress incontinence, urge incontinence, overflow incontinence and total 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:
- Childbirth (labor).
- Menopause - when estrogen levels drop the muscles may get weaker.
- A hysterectomy - surgical removal of the uterus (womb).
- Some other surgical procedures.
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 signaling system between the brain and the bladder, but they are not really sure.
Most cases of urge incontinence are diagnosed as overactive bladder syndrome because no specific cause was found. 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. Cystitis is fairly common and can affect both men and women of all ages - it is more common in women.
- 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 tumor pressing against the bladder.
- Urinary stones.
- Urinary incontinence surgery which went too far.
Causes of total incontinence
This occurs when the bladder cannot hold any urine and the patient either leaks all the time or frequently. 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 (channel) 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. Alcohol is also a diuretic and a bladder stimulant. In general, any amount of alcohol will relax the muscles linked to urinary control to a certain extent.
- Other drinks and foods - some sodas (carbonated drinks), 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). Caffeine is a diuretic and a bladder stimulant.
- 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.
On the next page we look at the diagnosis of urinary incontinence and the available treatments for the condition.