Urinary incontinence is very common in women and approximately four in every ten women will suffer from some form of the condition during their lifetime and women over forty years of age are more likely to be affected.
Types of urinary incontinence
There are various types of urinary incontinence however the main two are:
- Stress incontinence, which is when the pelvic muscles are too weak to prevent urination
- Urge incontinence, which is a result of incorrect communication between the brain and the bladder.
It is thought that these two particular types of urinary incontinence are responsible for up to 90% of all cases of the condition. It is also possible for women to have both stress and urge urinary incontinence.
The main symptom of urinary incontinence is loss of bladder control that results in the unexpected passing of urine.
Stress incontinence tends to be the most common type of urinary incontinence especially amongst women who have had children or been through the menopause and occurs when the bladder is put under additional sudden pressure.
Women suffering from stress incontinence may find that urine leaks during physical activities such as:
- Heavy lifting
The amount of urine that is passed is usually small however, larger amounts, can be passed especially if the bladder is full.
Urge incontinence is caused by an unstable, or overactive bladder and is the second most common type of urinary incontinence.
Women suffering from urge incontinence may feel a very sudden need to pass large amounts of urine very quickly. Often there are only a few seconds between the need to pass urine and the actual release of urine.
The need to pass urine can be caused by a sudden change in position, the sound of running water and some women may find the need pass urine during sex.
Women that have urge incontinence may find the need to pass urine often and may need to get up several times during the night.
Very severe and continuous urinary incontinence is sometimes referred to as total incontinence.
Total incontinence usually occurs as a result of a congenital bladder disorder or following surgery or injury.
Total incontinence may cause the constant passing of large amounts of urine or women suffering from the condition may pass large amounts of urine every so often and leak small amounts in between.
Causes of stress incontinence
Stress incontinence occurs when the pelvic floor muscles have been weakened and are no longer keep the urethra closed. Sudden extra pressure on the bladder, for example laughing or sneezing, can cause urine to leak out of the urethra.
The pelvic floor muscles can be weakened by a number of different factors and include:
- Age - as women become older the muscles naturally become weaker
- Hysterectomy - can cause damage to the muscles
- Menopause - a lack of oestrogen can cause weakening of the muscles
- Obesity - obesity can cause excess stress on the bladder muscles
- Pregnancy and childbirth - this can overstretch and strain the muscles.
Causes of urge incontinence
Urge incontinence occurs when the bladder contracts early, usually before prior to being full and before getting to the toilet. It is not known exactly why this happens however, it could be due to incorrect communication between the brain and the bladder.
In most cases it is not possible to find a cause for urge incontinence and the condition may be diagnosed as 'overactive bladder syndrome' however, some specific causes of urge incontinence have been identified and include:
- Urine infections, such as cystitis
- Conditions that affect the nervous system, such as Parkinson's disease, multiple sclerosis and stroke.
Causes of total incontinence
Total incontinence occurs when the bladder is unable to store any urine and can result in either passing large amounts of urine constantly, or passing urine from time to time, with frequent leaking.
Total incontinence can be caused by:
- A bladder defect - which you were born with
- Injury to your spinal cord - as this can disrupt the nerve signals between your brain and your bladder
- A bladder fistula - this is a small, tunnel-like structure, which can develop between your bladder and a nearby area such as the vagina.
Other causes of urinary incontinence
In some cases mild urinary incontinence may be experienced and if so, may be due to one of the following:
- Drinks - such as alcohol, caffeine, citrus fruits and those containing sweeteners
- Drugs - such as diuretics and muscle relaxants
- Infections - such as cystitis and urinary tract infections
- Smoking - a smokers cough can place additional strain on the bladder and weaken the muscles
Diagnosis of urinary incontinence
Your consultant will press on your lower abdomen to feel your bladder.
He or she may feel inside the vagina while pressing on your abdomen to check if there is any abnormality in the pelvic area and they may also use a speculum. They may also check for leakage when you cough and test the sensation around the bridge between your vagina and bottom (the perineum).
A sample of mid-stream urine will probably be taken to test for infection, bladder stones or other problems and the pressure inside your bladder will be measured.
For more information, and if you have any queries about being diagnosed, speak to your consultant.
Treatment for urinary incontinence
The following can help overcome urinary incontinence:
- Giving up smoking
- Eating a high fibre diet and drinking plenty of water
- Pelvic floor exercises to strengthen the pelvic floor (link to Physiotherapy for Pelvic Floor Conditions)
- Electrical stimulation or biofeedback can help with exercise. With electrical stimulation a probe is inserted inside your vagina, carrying a safe, gentle electrical current to stimulate your muscles and help strengthen your pelvic floor. Biofeedback uses sensors to check if you are using the correct muscles when performing your pelvic floor exercises. Ask your physiotherapist for details
- Bladder training - if you have an overactive bladder or urge incontinence, training the bladder by emptying it at set intervals and gradually increasing the length of time between intervals could help
- Medication - some drugs help improve the symptoms of a weak pelvic floor, by tightening the muscles at the neck of the bladder (the urethra) to prevent leakage. Others reduce or prevent contractions in an overactive bladder, or relax the muscles so that the bladder can empty more completely.
If you have urinary incontinence caused by a weak or damaged pelvic floor and physiotherapy and medication haven’t helped, your consultant may recommend vaginal slings and tapes.
These support the entrance to the bladder (the urethra), by holding it in the correct position. The tape is inserted through very small cuts in the vagina.
The procedure is performed under local or general anaesthetic and usually takes around 40 minutes.
Other treatment options include injecting collagen or silicone into the tissues of the pelvic floor. This is injected around the neck of the bladder (the urethra) to reduce the opening and helps to reduce leakage.
For further information regarding Urinary Incontinence please contact 0161 428 3656.