Robin Howe, RN

What is incontinence?
Urinary incontinence is involuntary leakage of urine caused by poor bladder control. Other than in babies and toddlers, it is not normal and if you are suffering from it you should see your doctor in case you have an underlying illness or condition. Most often, incontinence occurs due to weak pelvic floor muscles.

Here are some key signs of poor bladder control:
• Frequent visits to the toilet to pass small amounts of urine (more than 8 times in a 24-hour period)
• Feelings of a strong and sudden desire to urinate and being unable to hold on
• Having to pass urine several times during the night
• A feeling of not having emptied your bladder even though you’ve just urinated
• Leaking urine when you laugh, cough, sneeze or walk

How does the bladder work?
The urinary bladder is a balloon-like organ that expands to accommodate about 450 ml of urine comfortably for about 2-5 hours. It is situated in your pelvis, held in place by bands of fibrous tissue called ligaments that are attached to other organs and the bones in your pelvis.
Urine is stored in your bladder until you are ready to empty it. Muscles called sphincters stop the urine from leaking by closing tightly around the neck of the bladder that opens into the urethra, a tube that opens just in front of the vagina in women and, in men, passes through the prostate gland and along the length of the penis.
Normally, when you urinate the bladder muscles tighten to squeeze urine out of the bladder and the sphincter muscles relax to release urine down through the urethra. Urinary incontinence may occur when illness, poor pelvic strength or injury interfere with part of this process.

• Infection of the urinary tract
• Pelvic floor muscle weakness in women who have given birth or women who have gone through the menopause (post-menopausal women)
• An enlarged prostate in men
• Use of certain drugs such as diuretics and sedatives
• Damage to the nerves that control bladder function
• Conditions such as Alzheimer’s or Parkinson’s disease, a stroke, or spinal cord injury
• Physical limitations that affect mobility and ability to reach the toilet in time, for example, having arthritis

1. Urge incontinence — the feeling of urgently needing to go to the toilet at once with a sudden loss of urine. Overactive contractions of the bladder can cause this feeling, which can be due to lack of pelvic floor muscle strength, infection (urinary tract), some conditions such as Parkinson’s disease or stroke or anxiety.
2. Overflow incontinence — this can happen when an obstruction or weakening in the bladder muscle stops the bladder from emptying completely. It can be due to a spinal injury or enlarged prostate. The bladder becomes overfull but either does not sense that it is full or is blocked at its opening and so urine leaks out in small amounts intermittently.
3. Stress incontinence — this leakage happens when you cough, laugh, sneeze or exercise and is the most common cause of incontinence in women. This can be due to weakness of the urinary sphincter or of the pelvic floor muscles. Pregnancy and childbirth are often a cause. The lack of estrogen in women who have been through the menopause may also contribute to weakening of the urethra. Men who have had prostate surgery may also be susceptible to stress incontinence.
4. Functional incontinence — this type of incontinence is associated with loss of memory. A person may not be able to remember where the toilet is or what it’s for, or those people with poor mobility may not be able to get there in time.

What can I do?
Many people are embarrassed and reluctant to talk about problems with urinary incontinence and will avoid social situations — just in case they have an episode.

Urinary incontinence is not a normal part of ageing and should not be thought of as such. It can often be treated. See your doctor if you have any leakage of urine and discuss what treatment options are available. You can also be referred to a specialist or continence advisor. You do not have to live with incontinence. There are non-invasive treatments that really work! You won’t necessarily need pills or surgery to become continent.

What is the treatment?
The type of treatment suitable for you will depend upon the type of urinary incontinence you have. Bladder re-training and pelvic floor muscle rehabilitation are common treatment options. In some cases, surgery or medication may be required. Sometimes estrogen cream may help post-menopausal women with stress incontinence.

There are lifestyle modifications that may help. For example, drinking 6-8 glasses of water a day, unless your doctor advises otherwise; reducing your consumption of caffeine and alcohol; avoiding and treating constipation; and giving up smoking, as the cough caused by smoking can result in urine leakage. You should also avoid going to the toilet ‘just in case’.

If you are suffering from urinary incontinence, see your doctor for advice on treatment options that are suitable for your type of urinary incontinence.