What causes urinary incontinence? Who might be affected? What can we do to manage or prevent it?
What is urinary incontinence? This is the unintentional passing of urine. In some cases, it may result in a total loss of the bladder’s contents or it may just cause minor leakage.
Some people may think it is just an inevitable part of ageing. However it can often be prevented (for instance through pelvic floor exercises – as explained below) and sometimes be treated. So don’t ignore the warning signs.
How does the bladder normally work? The bladder collects the urine (waste products of blood) from the kidneys and stores it until it is full, supported by muscles of the pelvic floor. When the bladder is full a signal is sent to the brain that causes the urge to pass urine. In return, signals sent from the brain to muscles of the pelvic floor instruct them to relax and push the urine out.
Who might be affected by incontinence?
Incontinence is a more widespread condition than often realised. NHS Choices estimates that 3-6 million people in the UK are affected. Worldwide some 400 million people are believed to be affected.
Incontinence can affect both men and women but bladder incontinence is more common in women than men. This is possibly due to over stretching pelvic muscles during childbirth.
In both sexes, though, the risk increases with age.
Incontinence, though mainly an important hygiene issue, can affect quality of life and confidence in those who experience this condition.
Stress incontinence and Urge incontinence account for around 90% of cases in women.
Stress incontinence is triggered by physical activity or exertion – like coughing, lifting something heavy or exercise. It occurs when the muscles and other tissues that support the bladder (pelvic floor muscles) and the muscles that regulate the release of urine (urinary sphincter) weaken.
Urge incontinence occurs when you have an urgent desire to pass urine and sometimes urine leaks before you have time to get to the toilet. With urge incontinence, you leak urine because the bladder muscles squeeze, or contract, at the wrong times. It is usually due to an overactive bladder. This can be caused by a range of different factors, including bladder inflammation, bladder stones, infection, an enlarged prostate, brain or nerve problems (such as MS or a stroke). However, in most cases there is no obvious cause. And in people with an overactive bladder, urgency and frequency can occur without any resulting incontinence.
Other factors increasing the risk of urinary incontinence include: food and drink with a diuretic effect (like alcohol, caffeine, carbonated drinks, spicy or acidic food); smoking; being overweight; constipation; and not drinking enough water.
For women hormonal changes after the menopause (and for men an enlarged prostate) are among the reasons for the higher occurrence of incontinence in elderly people.
Can we preventing urinary incontinence?
Where risk factors are avoidable then this is a useful first step i.e. avoid food and drink with a diuretic effect, maintain a healthy weight, don’t smoke and drink enough water.
Exercises to strengthen pelvic muscles damaged during childbirth or due to some other cause and bladder training are also recommended.
All women who have been through childbirth should practise pelvic muscle exercises regularly as part of their daily exercise routine.
What to do if you experience incontinence? Talk to your doctor, as in some cases the cause of incontinence can be treated and further episodes of this condition can be prevented.
There are also certain medications which can be used to treat urinary incontinence for a time. In contrast, in bowel incontinence, surgery seems to be the main remedy to overcome this disability in medically intractable cases.
Conclusions
- Urinary incontinence affects millions of people.
- Stress incontinence and urge incontinence are the most common - they affect women more than men but both sexes as they get older.
- Some risks can be avoided – by not smoking, maintaining a healthy weight, avoiding diuretic food and drink etc.
- Exercise to strengthen pelvic muscles and bladder training are both recommended.
- If problems persist, see your doctor.
Reviewed and updated by Kayhan Nouri-Aria January 2016. Next review date December 2020.