Urinary Incontinence

Urinary incontinence is the inability to hold in urine or the involuntary leakage of urine from the bladder. It is sometimes referred to as "loss of bladder control".

It is a common medical condition that affects millions of people, especially women.

It affects women twice as much as men and is more common in older women than younger women.

Incontinence is often temporary and is usually caused by an underlying medical condition. For instance, birth defects, neurological injury, strokes, multiple sclerosis (MS) and other problems associated with aging can cause bladder control problems.

It is also quite common for women to experience urinary incontinence during pregnancy, caused by pressure on the bladder.

The Bladder and Urination

Urinary Bladder

The bladder (urinary bladder) is a muscular sac located at the base of the pelvic cavity. It collects and stores urine produced by the kidneys.

Urine enters the bladder via the ureters and is eventually expelled from the bladder via the urethra.

On the floor of the bladder, the openings of the two ureters and the urethra form a triangular area known as the trigone. This is a common area for development of bladder infections.

As the bladder begins to fill up, it expands and its wall becomes thinner. A moderately full bladder contains about 500 mL of urine but its maximum capacity is 700 to 800 mL. The sensation to urinate, however, can begin to be felt when the bladder contains about 200 mL of urine. Nerves in the bladder signal to the brain that it is time to urinate. This creates the sensation or urge to go to the bathroom.

Voluntary urination takes place when the brain tells the external urethral sphincter to relax and at the same time tells the bladder to contract. This causes urine to pass out of the bladder (and the body), via the urethra.

Good bladder control occurs when the nerves, brain and muscles associated with the bladder all work effectively and efficiently together. Essentially, you urinate when you want to (voluntarily). However, if any part of this bladder control system fails to function as it should, the result could be urinary incontinence.

Causes of Urinary Incontinence

Some common causes of incontinence in children and adults include the following:

  • Slower physical development: In children, incontinence may result, during sleep, as a result of a small bladder capacity or underdevelopment of the body's alarms that signal that the bladder is full and needs emptying. This type of incontinence usually fades as the child grows older and the bladder grows and the body's alarms become more efficient.

  • Anxiety: Some experts suggest that anxiety-causing events may contribute to bladder control problems in children. Events such as family problems or unfamiliar social situations can contribute to incontinence in children.

  • Genetics: Some inherited genes appear to contribute to incontinence in children. Consequently, if both parents were bed wetters, there is a high probability that the child will also have bladder control problems.

  • Structural problems: Incontinence can be caused by physical problems in the urinary system. For instance, nerve damage associated with birth defect can cause incontinence.

  • Nerve problems: Any disease or injury that damages the nerves can lead to bladder control problems. This includes conditions such as stroke, Parkinson disease, multiple sclerosis (MS) and chronic diabetes.

  • Infrequent emptying (voiding) of the bladder: Voluntarily holding urine for extended periods can contribute to incontinence. The bladder becomes overfilled and begins to leak urine.

  • Overactive bladder: The bladder may suddenly, and without warning, contract and force the escape of some urine. This tends to often happen as a result of urinary tract infection.

  • Prostate problems: This is exclusively a male issue, since the prostate is a male gland. It surrounds the urethra just below the bladder. An enlarged prostate may squeeze the urethra and cause the bladder to become irritated. Consequently, the bladder begins to contract even when it only contains a small amount of urine. This can lead to frequent urination and bladder control problems.

  • Pregnancy: The added pressure and weight of pregnancy may cause urinary incontinence in some women. Common causes include weakened pelvic muscles, shifting of the bladder or urethra, or damage to the bladder's control nerves.

  • Menopause: As women begin to age and go through menopause, the lack of the hormone estrogen and weakening of the bladder muscles can cause bladder control problems in women.

Different Types of Incontinence

The underlying symptom of urinary incontinence is the involuntary passing of urine. This, however, may happen in different ways, at different times and may be triggered by different events. Incontinence is thus divided into different categories, based on what and how it is triggered.

  • Urge incontinency: Patients suddenly feel the need (or urge) to urinate and, without warning, may leak some urine. This is usually caused by bladder problems (such as overactive bladder). Typically, urge incontinence occurs after drinking a small amount of water, or when hearing running water, or when touching water. Urge incontinence can also occur during sleep.

    The involuntary contraction of the bladder muscles can be caused by nerve damage or muscle damage. This is usually found in patients suffering from stroke, Parkinson disease, multiple sclerosis, or Alzheimer disease.

  • Stress incontinence: This type of incontinence is typically triggered by coughing, sneezing, laughing, or other movements that may put pressure on the bladder. Women tend to suffer from stress incontinence, which mainly results from pregnancy and menopause.

  • Functional incontinence: This affects people who are incapacitated or have problems moving, or have problems thinking or communicating. These challenges prevent patients from getting to the bathroom on time (or at all) and result in urinary incontinence.

  • Overflow incontinence: Patients whose bladder is always full frequently leak urine. A weak bladder and/ or a blocked urethra are the main causes of overflow incontinence.

Treatment of Urinary Incontinence

Treatments of bladder control problems vary and depend on the type of incontinence and the underlying causes. Not all cases of incontinence require medical intervention. For instance, incontinence caused by pregnancy is usually resolved once the term of the pregnancy is completed.

In other cases, some simple exercises to strengthen the pelvic floor muscles and sphincter muscles can resolve some bladder control problems. For example, if you imagine that you are trying to stop yourself from passing gas and squeeze the muscles you would use, this helps to strengthen the pelvic muscles. (There is normally a pulling sensation or feeling, when those muscles are squeezed or tightened.)

Other simple non-medical treatments may simply require limiting fluid intake at certain times of the day, or planning regular trips to the bathroom can help with some cases of urinary incontinence.

Other treatment options include (but are not limited to) the following:

  • Medications: Medicines can be used to treat various bladder control problems. For instance, some medicines help to block abnormal nerve signals that cause the bladder to contact involuntarily. Others help to relax the bladder, while others slow down the production of urine. Also, some medicines help to tighten muscles at the neck of the bladder and the urethra, preventing leakage.

    In the case of some men, if urinary incontinence is caused by an enlarged prostate, medicines can be used to shrink the prostate.

    All medicines for treating bladder control problems should be prescribed by a qualified medical practitioner. You should also ask your doctor about any possible harmful side effects of medicines prescribed.

  • Implants can be injected into tissues around the urethra to add bulk and help close the urethra. Collagen and fat from the patient's body are normally used as implants.

  • Brief doses of electrical stimulation can help to strengthen the muscles in the lower pelvis. Electrical stimulation has a similar effect as exercising the pelvic muscles.

  • Catheters can also be used to treat urinary incontinence (particularly overflow incontinence) by helping to completely empty the bladder. A catheter is a tube that is inserted through the urethra into the bladder to drain urine. In some cases it is attached to a bag (that is attached to the leg) to collect the urine.

    Patients who use catheters on a long-term basis should be careful of possible urinary tract infection.

  • If other treatment options fail to resolve incontinence, a doctor may recommend surgery. Surgical procedures can be used to help pull the bladder up to its normal position, or to implant an artificial sphincter. An artificial sphincter is a circular device that keeps the urethra closed until the patient is ready to urinate.

Bladder control problems are quite common and can sometimes be embarrassing. This however, should not be a hindrance to seeking prompt treatment. If you develop symptoms of urinary incontinence (involuntarily leak urine), you should consult your physician to find out the cause and determine the appropriate treatment. In many cases, urinary incontinence is temporary and can be cured by appropriate treatment.