Urinary incontinence is more common than you might think. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 33% of men and 50% of women will experience some form of urine leakage during their lifetime.
What is Urinary Incontinence?
Urinary incontinence is any involuntary loss of bladder control. When your bladder functions normally, specific nerves send messages from the brain to muscles in the bladder and urethra about when to tense up and relax. This allows you to control when urine is released.
When you have incontinence, you no longer have complete bladder control. This can range from occasionally leaking urine when you cough or sneeze to having a sudden and strong urge to urinate that you don’t get to a toilet in time.
Types of Incontinence
There are several common types of incontinence:
- Stress incontinence is the most common form of urinary incontinence. It occurs when you leak due to increased pressure on your pelvic floor muscles. This can be caused by doing simple actions like coughing or sneezing.
- When you have a sudden and strong urge to urinate but can’t make it to the toilet in time, you have urge incontinence. It is also known as an overactive bladder.
- Many people also experience what is called overflow incontinence. This is when the bladder muscles cannot push out all of the urine and/or there is a blockage (commonly an enlarged prostate), causing a build-up of more urine than it can hold. Often people will leak urine throughout the day, and when they go, the flow of urine is typically relatively weak.
- Mixed incontinence occurs when you have symptoms of both stress and urge incontinence.
- Functional incontinence is when someone either physically can’t get to the toilet and/or they don’t care to go to the toilet such as with dementia.
Causes of Urinary Incontinence
There are several reasons why you may develop urinary incontinence:
Pregnancy and childbirth
Bladder incontinence commonly occurs during pregnancy, but vaginal delivery is one of the leading causes of incontinence in women. As the baby grows in the mother’s womb, the pressure on the pelvic floor increases. It can also mean that there is increased pressure on the bladder giving the sensation of constantly needing to go.
Trauma and nerve damage to the pelvic floor are also common during vaginal delivery as the tissues become stretched and even torn. Some women even lose feeling in their pelvic floor muscles after delivery. This may lead to weakening of the pelvic floor connective tissue and muscles, often leading to incontinence.
Neurologic conditions
Conditions that can affect the nerves, and ultimately the communication between the brain and the bladder, can result in urinary incontinence: stroke, spinal cord disease or injury, multiple sclerosis, Parkinson’s disease, and other conditions.
Pelvic surgery
Surgery involving the pelvic organs, including the bladder, can result in urinary incontinence as nerves and muscles can be affected by surgery. Colon surgery, hysterectomy, and other surgeries in the pelvis may result in urinary incontinence.
Issues that might develop as a result of incontinence
Often, patients with incontinence will develop skin problems caused by the excess moisture in the affected areas due to leakage similar to a baby’s diaper rash. This may lead to red or peeling skin and yeast infections.
Aside from the physical issues, many incontinence patients might experience fear, anger, and anxiety about their condition. Patients will often limit their social interactions due to the fear of not having complete bladder control. Worries about leakage can also cause problems with having sex.
Treatments for Incontinence
Some people may experience only occasional, mild bouts of incontinence. These people might choose to manage these symptoms on their own. However, the incontinence may become so frequent or severe that it affects everyday activities or causes distress. In that case, a doctor, who can recommend a treatment plan should be consulted.
Lifestyle Changes
Many people think that if they drink less, they will need to go less–and that is true. However, drinking a lot less is not a good treatment plan as dehydration can cause other problems.
Cutting back on certain drinks like alcohol, carbonated drinks, and caffeinated drinks like coffee and tea will improve your symptoms more than just drinking less overall as these are bladder irritants.
Incontinence symptoms can also be helped by losing weight.
Pelvic Floor Muscle Strengthening
Your doctor may recommend pelvic floor muscle exercises (Kegel exercises) to help strengthen your pelvic floor. This may improve muscle strength and control by tightening the muscles that control your passing of urine. You might do this on your own or with the help of a pelvic floor physical therapist.
Timed voiding
Training yourself to empty your bladder at timed intervals can help avoid incontinence. If someone can comfortably go two hours without incontinence, then urinating every two hours even without an urge to urinate can help prevent incontinence.
Bladder Training
Bladder training is good for incontinence associated with frequent and urgent urination. This involves gradually increasing the time between urination. For example, for one week someone might postpone urination just five minutes each time they need to urinate for one week. In six weeks they should then be able to postpone urination 30 minutes. The concept is gradually increasing the functional capacity of the bladder–think about it like yoga for the bladder.
Medication
Medications are typically only prescribed for overactive bladder and urge incontinence. They are basically bladder muscle relaxants so that the bladder isn’t “overactive.” Botox is sometimes injected into the bladder muscle for overactive bladder that isn’t treated adequately with medication or someone can’t take overactive bladder medication.
Surgery
Surgery may be an option for incontinence if other treatment methods do not work. Surgical solutions will be based on the type of incontinence you are experiencing. For stress incontinence, your doctor may perform a urethral bulking agent or sling, which is a “filler” for the urethra or procedure to support the urethra, respectively. An artificial sphincter may be inserted to control the flow of urine from the bladder to the urethra in more severe cases, although this is mainly performed in men. For urge incontinence, there are treatments aimed at the nerves that include something like acupuncture and a “bladder pacemaker”.
Whatever the reason you are having urinary incontinence, there is usually a solution that can improve your quality of life.