Urinary incontinence

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Urinary incontinence – how it manifests itself and what you can do about it.

Urinary incontinence

The term urinary incontinence (also: bladder weakness) refers to a leakage of urine between voidings. Normally, urine accumulates in the urinary bladder and is discharged on the toilet in a controlled manner. The ability to control the discharge of urine is referred to as continence. It develops in infancy – babies are not able to control it yet.

Urinary incontinence can develop at any age, but older people are more often affected by urinary incontinence (women approx. twice as often as men of the same age). In Austria, about 1 million people have different types of urinary incontinence. Most people affected do not speak openly about their urinary incontinence although urinary incontinence can be treated very well in most cases. Even if the impairment caused by urinary incontinence cannot be eliminated completely in individual cases, urinary incontinence can be mitigated considerably by means of suitable treatment.

What are the causes of urinary incontinence?

The function of the bladder is very complex: The nervous system, the muscles of wall, the neck of the bladder and along the urethra, the urethra itself as well as the muscles, nerves and connective tissue of the pelvic floor are parts of it. When this interaction is impaired, that may result in urinary incontinence. The underlying bladder dysfunction can manifest itself either in the form of a storage or voiding dysfunction. There is a variety of causes for that:

  • Weakness of the muscles contributing to the bladder function
  • Damage to or disorders of the nervous system
  • Connective tissue weakness
  • Mechanical and functional discharge deficiencies below the bladder
  • Disorders and malformations of the urinary tract
  • Hormonal changes or disturbances, for example oestrogen deficiency during menopause
  • Injuries, damage caused by surgery or other medical interventions

Certain factors can contribute to the development of urinary incontinence:

  • Age: During menopause, the oestrogen levels drop, the tone of the connective tissue decreases, the bladder descends. Men often experience benign prostatic enlargement.
  • Sex: Women are more often affected by urinary incontinence. Their connective tissue is softer and their pelvic floor less stable and larger. In addition, pregnancy and giving birth put a strain on women's muscles, connective tissue and pelvic floor.
  • Overweight
  • Drinking and micturition habits (micturition = voiding of the urinary bladder): Many people fail to drink enough, they put off going to the toilet or go preventively even if the bladder is not full enough yet. Both can contribute to urinary incontinence because the bladder forgets to fill or empty completely.
  • Psychological factors: Partnership problems are linked with urinary incontinence. However, the precise connection is still unclear.
  • Physical strain: Some sports strengthen the pelvic floor muscles, others have a rather detrimental effect. That includes weight lifting, among others. Persistent coughing can also contribute to urinary incontinence.
  • Nervous system disorders: Cerebral vascular accidents, dementia, Parkinson's disease and other diseases which damage the nervous system (diabetes) as well as recurrent urinary tract infections increase the risk of urinary incontinence.
  • Surgical procedures and pharmaceuticals: for example, hysterectomy, diuretics taken for hypertension or cardiac insufficiency can contribute to urinary incontinence.
  • Disposition: increased urinary incontinence risk when urinary incontinence runs in the family
  • Diseases: Prostate cancer, bladder stones or tumours can encourage urinary incontinence.

What types of urinary incontinence are there?

There are different types of urinary incontinence which have different symptoms and occur with different frequencies in people of different ages. The most frequent types of urinary incontinence are:

Stress incontinence

With stress incontinence, a sudden increase in pressure in the abdomen – e.g. when laughing, coughing, sneezing or lifting loads – results in urinary incontinence.

Hyperactive bladder / urge incontinence

A hyperactive bladder (also: irritable bladder) manifests itself by a sudden, repeated desire to void the bladder which is hard to suppress, during the day or the night, with our without urine discharge (wet or dry hyperactive bladder). There is a variety of possible causes for urge incontinence. Stress and urge incontinence can also be combined (mixed incontinence).

Overflow incontinence

Overflow incontinence is characterised in that small volumes of urine are discharged uncontrollably again and again from an overfull bladder that cannot be voided.

Remedies for urinary incontinence

Urinary incontinence can be very stressful. It is not only a physical problem, but also causes emotional distress and impairs your self-esteem. The inability to hold back urine is perceived as loss of control over one's own body – which is hard to take for an adult. People with urinary incontinence often feel socially excluded and that their quality of life is strongly impaired. That often results in social withdrawal, isolation and even depression. But urinary incontinence can be remedied completely in most cases.

How does a doctor diagnose urinary incontinence?

In most cases, the different types of urinary incontinence can be differentiated by means of a so-called basic diagnosis. Do not be embarrassed about talking to a general practitioner or a specialist about your problem. They are experienced in addressing that kind of issue. Suitable therapeutic measures can be initiated after that. During an in-depth talk of the doctor with the patient (to take the patient's history), the doctor will enquire about the specific complaints.

A "bladder diary" gives your doctor valuable information: In it, the patient has to record the volume of fluid ingested as well as the time and the volume of urine (ml) of each voiding, and whether he/she was already wet or still dry at that point in time, over a period of two days. The basic diagnosis also includes the examination of lower abdomen, genital area, urine (exclusion/evidence of urinary tract infection) and a check for residual urine (whether the bladder is voided completely). These days, that is done completely pain-free by means of an ultrasound exam of the bladder before and after voiding.

Depending on the causes of urinary incontinence the doctor suspects, further diagnostic methods are applied, such as:

  • Computed tomography (CAT scan)
  • Bladder examination (cystoscopy)
  • Urological exams in order to check urine flow, bladder pressure, and uterine pressure in women
  • Determination of the PSA (prostate-specific antigen) level in men.

What treatment methods are available for urinary incontinence?

The specific treatment of urinary incontinence depends on the given type. In advance, however, measures for the elimination of possible other causes have to be taken, such as the treatment of a bladder infection, hormone replacement therapy in the event of a hormone deficiency, or the elimination of a voiding impairment, e.g. caused by an enlarged prostate in men.

In the event of stress incontinence, pelvic floor exercises and behavioural therapy can help. Behavioural therapy comprises controlled drinking, regular voiding of the bladder, weight loss, adjustment of bowel movements and, in the event of smoker's bronchitis, quitting smoking. Pelvic floor exercises are a very efficient measure. That requires the instruction and control by a physical therapist. After learning how to do them correctly, pelvic floor exercises should be done at home as well and consistently over the years.
If these therapeutic measures are not sufficient for the treatment of urinary incontinence, a satisfactory result can be achieved by means of surgery that is not very stressful for the patient in about 80 percent of the patients treated that way.

In most cases, urge incontinence is treated non-operatively and comprises different forms of bladder training and medications which counteract the frequent, strong urge to void the bladder and therefore also urge incontinence (so-called antimuscarinic agents, also muscarinic receptor antagonists or anticholinergics). There is a variety of products for the treatment of urinary incontinence. In elderly patients who often have to take several medications at the same time, substances with less drug-drug interactions due to their molecular structure and which cause no adverse reactions of the central nervous system have proven to be successful.

For female patients who suffer from mixed incontinence, a therapy combining therapeutic methods for urge and stress incontinence is recommended.

In the event of overflow incontinence, an urologist can determine the causes preventing the voiding of the bladder by means of special examinations (urodynamics) and initiate the required therapeutic measures against urinary incontinence. The first measure is always the voiding of the overfull bladder, in general by means of a catheter.

What can you do yourself against urinary incontinence?

Physical and mental fitness counteract the development of urinary incontinence. Consult a doctor as soon as you notice the first signs. Preventative pelvic floor exercises are also useful. Further tips for the prevention of urinary incontinence:

  • Drink a lot of fluid. Take care to drink low-irritant beverages, such as herbal tea or fruit juice.
  • Do not drink any large volumes before going to bed. That increases the risk of wetting yourself involuntarily during the night.
  • Take your time when going to the toilet and try to empty your bladder completely. Then the urge to void the bladder is felt less often, and bacteria can multiply less easily.
  • Relaxation exercises such as autogenic training, breathing therapy or massages can help to reduce emotional tension.
  • Micturition or bladder training can be useful. You should keep a bladder diary (as described above) for a few days upon consultation of your doctor. You can achieve a more effective voiding of the bladder by actively extending or shortening the intervals.

Certain foods can also cause temporary urinary incontinence because they stimulate the bladder and have a diuretic effect. These include:

  • Alcohol
  • Caffeine
  • Decaffeinated tea or coffee
  • Carbonated beverages
  • Artificial sweeteners
  • Citrus fruits and other foods that are highly acidic, contain a lot of sugar or spices

Please note: This text is for your general information. Please do not make a diagnosis yourself, but consult a doctor in the event of questions or complaints. He/she is the only one to assess the symptoms correctly based on his/her clinical experience and to take further diagnostic steps as necessary.