Incontinence or urinary incontinence is the inability to hold or control the flow of urine until you are able to get to a toilet. It can be an embarrassing problem and so the majority of people who suffer with incontinence will not seek help. Left untreated incontinence can cause rashes, depression, skin and kidney infections. Incontinence is not a natural part of ageing and in most cases it can be successfully treated.
Incontinence is much more common in women than in men.
The urinary tract.
Before we explain what causes incontinence it might help if we tell you what the urinary system is composed of.
The urinary system is composed of 2 kidneys, 2 ureters, a bladder and a urethra. There is also a tight muscular ring around the neck of the bladder, called the sphincter. The sphincter muscle prevents urine from flowing out and can play a role in incontinence. Urine is produced continuously day and night by the kidneys, the urine then slowly passes from the kidneys down the ureters and into the bladder. The bladder is a muscular sack in which urine is stored until it is released through the urethra. Our brain monitors how full the bladder is and eventually we begin to feel the need to empty it, usually well before it is actually full. Most of us, depending on how much we have perspired, eaten and drunk during the day, will empty our bladders 4-8 times a day.
What causes incontinence?
Incontinence can develop for a number of reasons, some causes may be temporary, for example, if urinary incontinence develops suddenly it is usually as a result of a bladder infection, such as cystitis. Sometimes incontinence can develop as a side effect of certain medications.
One cause of incontinence which isn’t temporary is when the muscles in the pelvic floor, that surround the bladder become weak. The pelvic floor muscles may become weak after childbirth or pelvic surgery. Incontinence can also develop after the menopause because of a lack of the hormone oestrogen, which causes a weakened urethra. In men, incontinence can develop as a result of prostate enlargement.
What are the different types of incontinence?
There are a number of different types of incontinence, the following are the most common forms:
If you suffer with a combination of two or more types of incontinence it is then called mixed incontinence.
What are the symptoms of incontinence?
The symptom of all types of incontinence is the leakage or loss of urine before a toilet can be reached.
How is incontinence diagnosed?
It is often possible for your doctor to diagnose the cause of incontinence from your symptoms alone. Your doctor may want to give you a physical examination to examine the vagina and pelvic structures.
Your doctor may also do a selection of tests, including a urine sample to check that you haven’t got an infection, an x-ray or an ultrasound to check the pelvic organs, kidneys and the ureters. Other tests that you might have include a urodynamics study or a cystoscopy. A urodynamics study is used to measure and test urine flow and to check how your bladder fills and empties itself. A cystoscopy is a thin telescope which is inserted into the bladder to check that it is healthy.
These tests are important so that the doctor can distinguish between which type of incontinence you have, as the treatment is different for each type.
How is incontinence treated?
If you suffer with stress incontinence the main part of treatment is exercise to strengthen the muscles supporting the bladder and the pelvic organs. These exercises are known as kegel exercises, your doctor will help explain how to do these or refer you to a physiotherapist. Special weighted cones may also be used to help train the pelvic muscles. You might have to persist with the exercises for weeks before you begin to see an improvement.
If incontinence is not improved with exercise then surgery is an option. The operation will usually involve lifting and strengthening the bladder. Your doctor will discuss all options with you.
There are many medicines available to treat urge incontinence, these drugs are aimed at reducing the activity of the bladder. Your doctor may also recommend ‘bladder training’. Bladder training is aimed at teaching the bladder not to send “I’m full” signals to the brain too early. Bladder training is carried out by learning to resist going to the toilet when you first have the urge to do so, the time you wait is then gradually increased. If the cause of your incontinence is a bladder infection you will be given drugs to treat it.
If your stress or urge incontinence symptoms have developed after the menopause, you may benefit from having oestrogen replacement therapy.
Overflow incontinence is treated by removing the cause of the obstruction.
People who suffer with functional incontinence should be helped by ensuring there is always a comode or urinal close to where they are and make sure their clothing is easy to remove. There are also a number of pads and devices which can be used to help maintain their dignity.
How can I help myself?
There are number of things you can do to help yourself, they are as follows: