Urinary incontinence

THE ONLINE CLINIC IS NO LONGER PRESCRIBING TREATMENT FOR URINARY INCONTINENCE.

What is urinary incontinence?

Urinary incontinence is the involuntary discharge of urine. It is a symptom, not a disease.

There are three main types of urinary incontinence:

• Stress urinary incontinence (SUI): that is the involuntary leakage that occurs with effort/exertion, or when sneezing/coughing
• Urge urinary incontinence (UUI; also known as overactive bladder): that is the involuntary leakage that occurs with or is immediately preceded by urgency
• Mixed urinary incontinence (MUI): that is the involuntary leakage associated with effort, exertion, sneezing or coughing and also with urgency

Other types of urinary incontinence include:

• Overflow incontinence (also known as chronic urinary retention): the bladder does not empty completely when you pass urine. It therefore enlarges to above normal, and urine leaks out
• Functional incontinence: a physical disability (e.g., arthritis) or mental disability (e.g., dementia) prevents the individual getting to a toilet before they pass urine
• Transient incontinence: leakage occurs over a short period of time and goes when the cause is resolved

Urinary incontinence is frequently a cause of concern, particularly surrounding its effects on social and physical activities, psychological wellbeing, and hygiene. Incontinence varies in degree of severity (a few drops to total emptying of bladder), frequency (once or many times daily, or only occasionally), and predictability (predictable to unpredictable).

Who gets urinary incontinence?

Both men and women can develop urinary incontinence. The prevalence of incontinence is usually low in young women, peaks around menopause, and rapidly rises between 70 and 80 years of age. SUI and MUI are more common (found in approximately half and one-third of women, respectively) than UUI incontinence, but UUI is more likely to need treatment. Overall, about 3–17% of women have moderate to severe bother, with severity increasing with age. In men, the prevalence of incontinence is much lower than that for women, occurring in 3–11% of all men. Overall, 40–80% of men have UUI, and 10% have stress incontinence.

What causes urinary incontinence?

SUI and UUI incontinence occur through different mechanisms. People with SUI have urethral sphincter (ring-like muscles circling and closing the opening from the bladder to the urethra, which conveys urine) and pelvic muscle problems, those with UUI have bladder problems, and those with MUI have both.

With SUI, leakage happens because the muscles (e.g., urethral sphincter and pelvic floor muscles) that are used to stop urination are weakened or damaged. Thus, during everyday activities pressure on your bladder is increased and the sphincter cannot stop the urine in the bladder from leaking out.

With UUI, leakage usually happens because the detrusor muscles controlling the bladder are over active. Thus, the bladder muscles suddenly contract as it fills, causing an increasing sensation of a need to pass urine that eventually leads to leakage.

Urinary incontinence in women is often caused by pregnancy, childbirth, the menopause, and hysterectomy. These natural events may cause bladder and pelvic muscle weakening, and bladder nerve and supportive tissue damage, which are required for bladder control and holding the bladder in position within the body. In men, an enlarged prostate or prostate cancer may affect bladder control. Incontinence may also be associated with age, due to the natural changes in muscle, which can weaken and reduce the bladder’s capacity and ability to hold urine. Obstructions, such as a tumour in the urinary tract or bladder stones, can prevent the normal urine flow and result in leakage. Disorders of the nervous system, caused by conditions such as multiple sclerosis, or stroke, or a spinal injury, can disrupt nerve signals controlling the bladder and result in urinary incontinence.

Urinary incontinence can be temporary, occurring as a result of consuming some foods (e.g., spicy foods, citrus fruits, and artificial sweeteners) and drinks (e.g., alcohol, caffeine, decaffeinated coffee and tea, and carbonated drinks). Some medicines may also stimulate the bladder, increasing urine production, such as diuretics (water tablets), sedatives, muscle relaxants, and high doses of vitamins (B and C). Temporarily, urinary incontinence may also result from a medical condition that can be treated, such as bladder or urinary tract infections that irritate the bladder, and constipation whereby compacted faeces cause overactivity of the nerves to the bladder. Urinary incontinence is made worse by being overweight, as extra pressure is placed on the bladder.

How is urinary incontinence diagnosed?

Firstly, a doctor will ask you about your bladder emptying habits, and how often, how much, and when urine is leaked. Then, following an examination for other signs of illnesses causing incontinence, several tests may be carried out, including a bladder stress test (to assess urine leakage), urine test (to test for substances and for infection), ultrasound and cystoscopy (to ‘see’ your urinary system), and urodynamics (to measure bladder pressure).

How is urinary incontinence treated?

There are various ways to treat urinary incontinence, so discuss with your doctor which treatment is best for you. These include:

Behavioural treatments: These treatments can change what you do to improve your condition. They include pelvic muscle exercises (Kegel exercises), which done regularly can at least reduced leakage caused by SUI, and sometimes UUI, by strengthening muscles involved in bladder control. Usually, a specially-trained nurse teaches you the way to do these exercises, which basically involve squeezing and relaxing muscles in your genital area. Bladder retraining involves teaching your bladder, by going to the toilet regularly (don’t wait until you need to go), and then increasing the time between visits. Delay the time from urge to pass water until you have to go. Double voiding, whereby you pass urine, wait a few minutes, then try again, may help as this more completely empties your bladder.

Medicines: Medicines to treat incontinence frequently include anticholinergics (to calm an overactive bladder); mirabegron (to relax the bladder muscle, and increase the quantity of urine your bladder can hold/release); alpha blockers (to relax bladder and prostate muscles, making bladder emptying easier); and topical oestrogen (that renews urethra and vaginal tissues reducing symptoms of incontinence).

Medical devices: For women, medical devices include urethral inserts (plugs to stop leakage during exercise, and removed before urinating); and pessaries (stiff rings worn during the day inserted into the vagina to hold up the bladder to prevent leakage).

Interventional therapies: This type of therapy includes nerve stimulators (devices that deliver electrical pulses to stimulate the nerves involved in bladder control); botulinum toxin type A injections (into the bladder muscle for overactive bladders; and injections of a bulking material (into tissue around the urethra to maintain closure of the urethra and decrease urine leakage).

Surgery: Surgical procedures can be effective for SUI when other treatments have not helped. These include pelvic slings that keep the urethra closed, bladder neck suspension that gives support to the urethra and bladder, prolapse surgery to correct the ‘dropped’ bladder, and an artificial urinary sphincter to close the urinary sphincter until you choose to urinate.

Absorbent pads and catheters: When treatment can not completely solve the problem, then there are products to reduce the embarrassment and inconvenience of urine leakage. Pads worn under usual clothing absorb any urine trickles, while a catheter inserted into the urethra can be used to empty the bladder.

How can I reduce the risk of urinary incontinence?

The risk of urinary incontinence can be minimised by maintaining a normal body weight.

While there is insufficient evidence to confirm whether lifestyle interventions are helpful, dietary changes can be made to avoid excess consumption of those foods and drinks known to aggravate the condition (see above), to avoid drinking too much fluid, and to eat sufficient fibre to prevent constipation. If you think you are taking a medicine that exacerbates your urinary incontinence, do not stop taking it but talk to your doctor who may be able to switch your medication.

Some factors that increase the likelihood of urinary incontinence cannot be modified, including being female (SUI) or male (UUI), age, and certain diseases (e.g., neurological diseases and diabetes).