Bedwetting is a common condition where toilet-trained children accidentally urinate during their sleep. It is not a sign of laziness, naughtiness, or any emotional immaturity. It is important not to blame or shame the child over this behaviour, which is not under the child's control. Strategies are available to treat this condition.…
What is urinary incontinence?
Urinary incontinence is the accidental loss of bladder control that results in urine leakage. It is more common in women, but can also occur in men. It can be variable in its severity and potentially embarrassing.
Signs and symptoms
Signs and symptoms associated with urinary incontinence can include:
- Leakage of urine caused by coughing, sneezing or exercising;
- Leakage of urine before reaching the toilet;
- Frequent urination or urgent need to urinate;
- Poor urine flow;
- Straining to empty the bladder;
- The feeling of an unemptied bladder;
- Getting up to urinate two or more times per night, and;
There are many causes of urinary incontinence. Some can be temporary, while others are longer-lasting physical changes that may affect only males or females.
Temporary urinary incontinence
Temporary urinary incontinence can be caused by diuretics, such as caffeine, alcohol, soft drinks, spicy food, citrus fruits and blood pressure medications. Diuretics increase the amount of urine produced, which places strain on the bladder to store more urine. If this capacity is exceeded, then urinary incontinence may develop. By avoiding such diuretics, urinary incontinence may be reversed.
A urinary tract infection can cause bladder irritations, strong urges to urinate and incontinence.
Constipation can put increased pressure on nerves that control your bladder, also leading to an increased need to urinate.
Physical changes causing urinary incontinence
In some people, the bladder muscle and/or the pelvic floor muscles that support the bladder can weaken over time and contribute to urinary incontinence. In women, events including pregnancy, childbirth, menopause and hysterectomy can cause urinary incontinence. In men, conditions including an enlarged prostate gland or prostate cancer can cause urinary incontinence.
There is an increased risk of urinary incontinence if you are female, obese or older in age.
There are multiple types of urinary incontinence. These include:
Stress incontinence is the most common form of urinary incontinence and can occur from coughing, sneezing, laughing, or lifting a heavy object. This commonly affects women who have given birth or have experienced menopause. It is caused by weak bladder and/or pelvic floor muscles.
Urge incontinence, also known as an overactive bladder, occurs when the bladder muscle becomes too active, leading to a strong urge to pass urine. It can be due to a urinary tract infection, some neurological conditions or commonly, the cause is unclear.
Overflow incontinence involves a slow dribble of urine from the bladder. This occurs when the feeling of a full bladder is reduced, leading to a build-up of urine. The bladder then spontaneously empties once it has reached full capacity.
Functional incontinence occurs when a person cannot get to the toilet in time due to a physical or intellectual disability, or memory impairment.
Methods for diagnosis
To diagnose urinary incontinence, your doctor will give you a physical examination and ask about the frequency and timing of your urinary incontinence. A urine sample may be collected to identify any infection, blood or other abnormalities. A bladder diary can also be used to keep track of instances of urges and incontinence.
Another test called post-void residual measurement involves using an ultrasound or catheter to measure the amount of urine remaining in your bladder after urinating. This can identify if your bladder is not emptying correctly. Your doctor may recommend urodynamic studies, which are more invasive tests to measure the flow and pressure of urine during voiding.
Types of treatment
Depending on the type of urinary incontinence, various treatments can be used. These can include:
Behavioral techniques involve training your bladder to hold off when you have the urge to urinate, creating scheduled toilet visits or 'double-voiding', a process in which you urinate twice within 10 minutes to ensure all urine is expelled.
Pelvic floor exercises
Pelvic floor exercises, also known as Kegel exercises, help strengthen the pelvic floor muscles. These are the muscles used to stop the flow of urine while urinating. When the bladder is empty, contract the pelvic floor muscles, hold for 10 seconds and then release. Repeat this process 10 times and perform three times each day.
Medications are commonly used to treat urinary incontinence. Medications, such as oxybutynin, can be helpful for urge incontinence. In women, estrogen cream can also be applied to rejuvenate and strengthen vaginal tissues. Other medications, including tamsulosin, can be used in men to relax the muscle fibers of the prostate gland and bladder, to make bladder emptying easier.
Absorbent pads and catheters
Absorbent pads are used to absorb any residual leaking of urine. They are very thin and can be worn under clothing. Men can also wear an absorbent padding that fits onto the end of the penis.
Urinary incontinence can also be treated by various surgical procedures. However, as there is the potential for complications, surgery is generally reserved for cases that do not respond to other treatments.
In women, this procedure involves creating a sling using body tissue or synthetic material to support the bladder and related structures. This can help to keep the urethra closed during coughing and sneezing.
In some cases, the bladder can prolapse (bulge or protrude) into the front wall of the vagina causing urinary incontinence. This can be corrected with prolapse surgery.
Transurethral resection of the prostate (TURP) may be performed to relieve blockage in an enlarged prostate gland. A central core of the prostate is removed to allow for easier urination. Unfortunately, although symptoms can improve with this procedure, it can also have a number of troublesome side effects including erectile dysfunction and urinary incontinence.
Artificial urinary sphincter
This involves inserting a fluid-filled ring around the opening of the bladder to prevent accidental urination. To urinate, the ring can be deflated by pressing a valve under the skin. This is a helpful treatment for men with an enlarged prostate or prostate cancer-related incontinence.
Complications associated with urinary incontinence can include an increased risk of urinary tract infections, skin rashes due to consistently wet skin, and impacts on personal life.
If you are experiencing urinary incontinence, there are many treatment and management options available. To treat the condition, you may be able to train your bladder using behavioral techniques, or strengthen your pelvic floor muscles to better control urination. In other cases, medications or surgery may be required. For urinary incontinence management, pads can be worn under clothing to absorb any uncontrollable leakage.
Depending on the type of urinary incontinence, it may be possible to help prevent the leakage of urine by maintaining a healthy body weight and healthy diet. Limiting caffeine and soft drinks may help reduce urinary incontinence. Strengthening your pelvic floor muscles by performing pelvic floor exercises can also help prevent urinary incontinence.
- Herbison Peter Jean Hay-Smith Gaye Ellis and Kate Moore. Effectiveness of Anticholinergic Drugs Compared with Placebo in the Treatment of Overactive Bladder: Systematic Review. BMJ (Clinical Research Ed.) 326 no. 7394 (April 19 2003): 84144. doi:10.1136/bmj.326.7394.841.
- Incontinence and Continence Problems. Better Health Channel. Accessed July 29 2014. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Incontinence_management.
- Stress Urinary Incontinence in Women: Choosing a Type of Midurethral Sling. Accessed July 29 2014. http://www.uptodate.com/contents/stress-urinary-incontinence-in-women-choosing-a-type-of-midurethral-sling?source=see_link.
- Urinary Incontinence. Accessed July 29 2014. http://www.aua.com.au/content_common/pg-urinary-incontinence.seo.
- Urinary Incontinence Treatments and Drugs - Diseases and Conditions - Mayo Clinic. Accessed July 29 2014. http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/basics/treatment/con-20037883.
- Urinary Incontinence Treatments for Women. Accessed July 29 2014. http://www.uptodate.com/contents/urinary-incontinence-treatments-for-women-beyond-the-basics?source=search_result&search=urinary+incontinence&selectedTitle=1%7E7.
FAQ Frequently asked questions
What is urinary incontinence?
Urinary incontinence is the inability to control when you urinate (pee). It can occur when people cough, sneeze or lift something heavy. It is most common among women who have given birth or who have gone through menopause. Weak pelvic floor muscles cause …
What are the symptoms of urinary incontinence?
Signs and symptoms of urinary incontinence include: urine leaking when you cough, sneeze, laugh or exercise; urine leaking before you are able to get to the toilet; a slow continuous dribble of urine; frequent urination; an urgent need to …
What causes urinary incontinence?
Urinary incontinence is caused by weak pelvic floor muscles. In women, pregnancy, childbirth, menopause and hysterectomy can lead to urinary incontinence. In men, conditions including an enlarged prostate gland or prostate cancer can cause urinary …
Who gets urinary incontinence?
Urinary incontinence can affect both men and women, but there is an increased risk of bladder incontinence if you are a female who has given birth or who have experienced menopause. People who are obese or older in age are also at increased risk.
How is urinary incontinence diagnosed?
Your doctor can diagnose urinary incontinence by performing a physical examination and asking you questions about the frequency of incontinence and the times at which incontinence occurs. Other diagnostic tools that can be used include a urine …
How is urinary incontinence treated?
If you are experiencing urinary incontinence, there are many treatment and management options available. To treat the condition, you may be able to train your bladder using behavioral techniques, or strengthen your pelvic floor muscles to better control …
Are there different types of urinary incontinence?
There are many types of urinary incontinence. These include: 1) Stress incontinence, which is the most common form and can occur from coughing, sneezing, laughing, or lifting a heavy object. This commonly affects women who have given birth …
What happens if urinary incontinence occurs during pregnancy?
Urinary incontinence commonly occurs during pregnancy. This is due to the increased pressure on your bladder. It is important to strengthen the pelvic floor muscles to help control your bladder. If urinary incontinence persists, …
Can urinary incontinence be cured?
In some cases urinary incontinence can be cured, this can occur by simply training your bladder or strengthening your pelvic floor muscles by performing Kegel exercises. In other cases, medications and surgery may be required.