Urinary Incontinence – FAQs

Urinary incontinence is the inability to hold urine leading to involuntary loss of urine. The urine loss can range from slight leakage of urine to severe frequent wetting. This condition severely affects quality of life by interfering with work, travel, social recreation and sexual activities.

At least 10% of people over the age of 65 years have urinary incontinence. According to World Health Organisation estimates, there are 200 million patients worldwide with symptoms of male or female urinary incontinence. However, as this condition is associated with shame, embarrassment and silence, the exact figure is not known.

With aging, the urge to urinate may occur more frequently and be harder to control: however, incontinence can affect men and women of all ages and is not a normal response to aging.

No, women experience incontinence two times more often than men. Pregnancy and child-birth, menopause and the structure of the female urinary tract account for this difference. However, both women and men can become incontinent from stroke, multiple sclerosis and other physical problems associated with old age.

Risk factors for urinary incontinence vary, but include:

• Pregnancy
• Childbirth
• Obesity
• Menopause
• Cigarette smoking
• Prostate enlargement and/or surgery
• Hysterectomy
• Radiation therapy to the pelvis
• Diabetes
• Parkinson’s disease
• Back injury
• Cerebral vascular accident
• Dementia.

There are three basic types of urinary incontinence :

• Urge incontinence
• Stress incontinence
• Overflow bladder

Urge incontinence or detrusor over activity is a common problem that increases in frequency and severity with advancing age. In this condition, the patient often loses urine for no apparent reasons while suddenly feeling the need or urge to urinate. In urge incontinence, the bladder involuntarily empties during sleep, after drinking a small amount of water, or while touching water or even when hearing it run (as when someone else is taking a shower or washing dishes).

The most common cause of urge incontinence is inappropriate and involuntary bladder contractions. These involuntary contractions may occur because of inflammation or irritation within the bladder or when certain neurological diseases impair control of bladder contractions.

• Urinary tract infections
• Cancer
• Parkinson’s disease
• Alzheimer’s disease
• Certain drugs such as hypnotics or narcotics
• Injury (such as those occurring during surgery)
• Benign prostatic hyperplasia (BPH).

Urge incontinence can also occur when mobility is impaired (for example, in patients with arthritis), making it difficult for patients to get to the bathroom in time. This condition is sometimes referred to mass “functional” incontinence.

Stress incontinence is the most prevalent form of incontinence in elderly patients. It is caused by malfunction of the urethral sphincter that causes urine to leak from the bladder when intra-abdominal pressure increases, such as during laughing, coughing or sneezing.

Physical changes resulting from pregnancy, childbirth and menopause are common causes of stress incontinence. It is the most common form of incontinence in women and is treatable. Certain muscles, known as the “pelvic floor muscles” support the bladder. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken. Stress incontinence can worsen during the week before menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause. Stress incontinence can also occur as a result of drugs, Surgical trauma or radiation damage.

Overflow bladder is usually seen in elder men. Urinary incontinence due to overflow bladder is more common in men because of the prevalence of obstructive prostate gland enlargement. In this condition urine accumulates in the bladder until maximum bladder capacity is reached. It then leaks through the urethra by “overflow”, usually manifesting as dribbling. However, increased intra-abdominal pressure, which occurs during coughing and sneezing, may also cause loss of urine, so that overflow incontinence may be confused with stress incontinence.

Overflow bladder incontinence occurs because of :

• Week bladder muscles caused by nerve damage from diabetes or other diseases (e.g., tumours, radiation, surgery)
• Obstructed urinary outflow, such as those caused by prostate enlargement and urinary stones
• Under active bladder contractions caused by certain medications. These medications lead to urinary retention with bladder distension.

When stress and urge incontinence occur together, it is sometimes referred to as “mixed incontinence”. This is common in women. “Transient” or temporary incontinence can be caused by medications, urinary tract infections, mental impairment, restricted mobility and severe constipation, which can push against the urinary tract and obstruct outflow.

Most types of urinary incontinence can be effectively treated and the symptoms improved the type of incontinence present is determined. In some patients, incontinence is often improved by weight loss. Smokers who have a chronic cough have fewer problems when they stop smoking (and stop coughing). Some common drugs can also aggravate the situation.