What is incontinence?

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:

• Stress incontinence - is the most common type of incontinence in women and occurs when the sphincter muscle gives way, when the bladder is put under pressure and some urine escapes. This can happen during activities such as, laughing, sneezing, coughing, running or when lifting things. In severe cases, urine might leak out when walking or getting up from the sitting position. In all cases only a small amount of urine is usually lost at any one time.
  Despite its name, stress incontinence is not caused by stress but by physical changes to the body. This usually occurs when the pelvic floor muscles become weak, this can happen because of child birth, weight gain, certain types of surgery or after the menopause.
• Urge incontinence - this is another common type of incontinence and is caused by an overactive bladder. Urge incontinence occurs when you suddenly have the urgent need to pass urine and so you may pass a volume of urine before you are able to reach a toilet, you may also need to urinate frequently. An overactive bladder usually occurs because the bladder sends a message to the brain saying that is full when it usually isn't. The changes to these muscles can be caused by a bladder infection, drinking alcohol or certain medications. Urge incontinence is also common in people with nerve problems, such as multiple sclerosis, dementia and in those who have suffered a stroke. Urge incontinence can mean that your bladder empties itself during sleep, after drinking a small amount of water or even when you touch or hear running water. This type of incontinence is most common in older people and in women after the menopause.
• Overflow incontinence - this is when an obstruction develops and so the bladder cannot empty fully. As a result you may feel that your bladder is never completely empty or you feel you need to empty your bladder but can't. Overflow incontinence is common in older men, particularly if their prostate enlarges, as this can cause the urethra to become blocked. Urinary stones can also cause the urethra to be blocked. This type of incontinence is rare in women.
• Functional incontinence - this type of incontinence occurs in people who have normal bladder control but are unable to reach a toilet in time due to a physical disability, such as Alzheimer's disease or a person in a wheelchair, who can be blocked from getting to the toilet in time.

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:

• Avoid drinks that contain caffeine, such as cola and coffee as these can make you pass more urine.
• Keep your weight down, if you are overweight incontinence is more likely to occur.
• Empty the bladder at regular intervals so that it never becomes too full.
• Exercise your pelvic floor muscles, this can be done by simply tightening the muscles of the pelvic floor as if you are trying to stop the flow of urine mid-flow.
• Wear special pads to protect your skin from any leaking urine.
• Take regular exercise, try to walk as much as possible.
• Wear clothes that are easy to manage.
• Avoid drinking alcohol, it is a diuretic and stimulates the kidneys to produce more urine.

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