Urinary Incontinence, Types And Causes

What Is Urinary Incontinence?

Urinary incontinence is the involuntary loss of urine due to any cause. Contrary to popular belief, it is not exclusively a problem of the elderly although it is much more commonly seen in old age. Millions of people in the UK have bladder problems and urinary incontinence, UI. Urinary incontinence can be improved in the vast majority of cases. Most people (the 'average') need to empty their bladders less than eight times a day, and only once at night. They have conscious control over when they pass urine. In UI, there is loss of bladder control and urine is released involuntarily or at the wrong time.

What Causes Urinary Incontinence?

There are a number of causes of urinary incontinence. Childbirth, hormonal disturbances, prostate surgery, neurological diseases and trauma are all common causes, but it should also be remembered that impaired thinking in the elderly (such as dementia), combined with medication, sleeping pills or alcohol can also cause incontinence in the absence of serious physical disease.

There Are Four Main Types Of Urinary Incontinence;

1. Stress incontinence. This is when small amounts of urine are leaked out of the bladder during exercise, coughing or sneezing. These events all increase pressure inside the abdomen, placing stress on the muscles supporting the bladder. Laughing, lifting heavy objects and sudden exercise may also cause it.

Women who have had children are prone to this type of UI due to weak pelvic floor muscles, and they have a prolapsed bladder called a cystocoele. Their weak muscles allow the front part of the bladder to bulge into the vagina, making their sphincter muscles that hold urine in the bladder less effective. Men who have had prostate gland surgery are also at risk of developing it although this may improve with time following their operation.

2. Urge incontinence (an 'unstable bladder'). This is commoner in older adults and has different symptoms. There is usually a need to urinate very frequently, including getting out of bed at night a number of times. There may be a very strong but sudden urge to pass water, which may result in people wetting themselves before they have reached the toilet. The underlying problem is due to sudden, involuntary bladder contractions.

3. Overflow incontinence. This is due to the bladder not emptying properly, and so over a period of time large amounts of urine collects and is stored in the bladder as a chronic condition. This can then cause the bladder to overflow. In men it is usually due to an enlarged prostate gland blocking the bladder opening, and is more common in men. In children, bedwetting and incontinence at school is linked to behavioural or psychological problems, rather than being a true incontinence problem.

4. Mixed incontinence. As the name suggests, this is a combination of both stress and urge incontinence. It is especially common in elderly women.


What Are The Signs And Symptoms Of Urinary Incontinence?

These depend on the type of UI. All have the same common feature however - voiding of urine at a time when that individual does not want to urinate.

Will I Have Any Tests Or Investigations?

Your doctor will probably test a sample of your urine to see whether there is ant infection present. This can be done at the surgery (a 'dipstick test') or the sample may be sent off to the local hospital laboratory for more detailed testing. If any infection is present, treatment is usually started by the GP who will also examine you.

In men this usually includes a rectal examination to assess the size of the prostate gland, and in women there is often a vaginal examination to look for any weaknesses in the vagina or pelvic muscles. If it is felt there may be problems with the bladder or kidneys, X-rays may be organized to look for these, again usually arranged by the GP.

Flow tests - detailed assessment of how well the bladder is able to hold urine - are done as an outpatient appointment and take about an hour to complete. These need to be arranged by your local hospital. Should the bladder itself need to be examined, this needs to be done by a specialist - a consultant urologist - who will perform a cystoscopy. This is done under either local or general anaesthetic, and a small fibreoptic tube is inserted into the bladder, via the urethra, to obtain a direct view of any bladder abnormalities.

What Treatment Might I Need?

There are a great many possible treatments available, and these depend upon the type of incontinence, its causes, and the health of the patient. As a general rule they fall into one of four main categories, and people may need only one or a mixture of them.

1. Pelvic muscle exercises. These improve the muscle tone of the pelvic floor in women, and so reduce urinary leakage. Exercises such as 'Kegel' exercises are performed daily for up to 50 times a day for at least 8 weeks. If you imagine trying to stop urinating in mid-flow by tensing your pelvic muscles, then you have the exercises in a nutshell. They can be done while sitting or standing and are painless. The muscle walls of the vagina may also be tightened by holding very small weights inside it for quarter of an hour each day for up to 6 weeks. Physiotherapy may also be useful, with pelvic 'faradism' or electrical stimulation in the form of mild electrical pulses stimulating pelvic muscle contractions and tightening.

2. Behavioural treatments. These include bladder retraining, where people learn to resist urinating at the first urge to do so, and gradually increase the time between having to go to the toilet. Prompt voiding of the bladder also helps to prevent urinary overflow, and routine or scheduled urination times can lead to better bladder control.

3. Medicines. Some drugs are able to relieve or control the symptoms of an unstable bladder. These are usually taken as tablets, although they do exist in the form of a nasal spray too. Common examples are oxybutynin, which helps to prevent urge incontinence by relaxing bladder sphincter muscles and oestrogen, often used in conjunction with other treatments in women suffering from UI after their menopause.

4. Surgery. If there is a blockage in the bladder, or weak muscles around it causing UI, surgery may be curative. These procedures are straightforward, performed under general anaesthetic and require several days stay in hospital afterwards. They are usually followed by pelvic exercises at home.

5. Other treatments. In the cases of UI that are unable to be cured, there are special aids that allow for a normal life. These include special pads and pants, urine collection devices, and chair and mattress protection. These greatly reduce the inconvenience and embarrassment many UI sufferers would otherwise feel.

What Course Will The Illness Follow?

This again depends on the underlying cause. Most people with UI are able to be helped to some degree, but conditions such as dementia or neurological disorders such as multiple sclerosis may mean the treatment is aimed at reducing the effects of incontinence rather than obtaining a cure.

Can I do anything to help myself?

A Great Deal! Always Remember;

1. Keep your weight down. Obesity makes incontinence more likely
2. Stop smoking. Chronic coughing predisposes to UI by putting strain on the pelvic muscles.
3. Practice pelvic floor exercises, especially after having a baby.
4. Reduce the chances of having constipation, which puts strain on bladder muscles, by eating lots of fresh fruit and vegetables.
5. Cut down the amount of tea, coffee and alcohol you are drinking, as these increase the amount of urine you pass.
6. Keep the amount of liquid you drink each day at a sensible level. Remember the golden rule of trying to drink at least eight cups of water every day.

Tell Your Doctor

1. Are you incontinent at any time, or only when you sneeze, cough or exercise?
2. Do you have any pain when you pass water?
3. Do you have problems starting passing water, or is your stream very poor? (men)
4. Have you noticed any unusual lumps or prolapses around your vagina when you strain? (women)
5. Do you ever wet yourself completely unexpectedly?

Ask Your Doctor

1. Will my symptoms get worse as I get older?
2. Do I need to see a specialist, and if so when?
3. Do I have to pay for special pads or products, and where can I get them?
4. How long will I need to wait for any surgery?
5. How do I get help to improve my bathroom facilities at home?

Useful Contacts

Association for Continence Advice
Address: Blackburn House, Redhouse Road, Seafield, Bathgate, West Lothian, EH47 7AQ
Telephone: +44 (0) 1506 811077
Website: www.aca.uk.com

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