Incontinence

It's estimated that urinary incontinence affects up 13% of men and 37% of women in Australia but overall 70% of individuals do not seek any treatment.

In men urge incontinence, which is associated with prostate disease, increases to 50% for those aged over 85, but in general, incontinence appears to affect more women.

There are different types of incontinence and these are classified in the following terms:

• Stress incontinence – This can happen when a sudden pressure is exerted on the bladder and bowels. For example, sneezing, laughing coughing and during exercise. Many post-birth women are affected by stress incontinence as the pelvic floor muscles are stretched by childbirth.
• Urge incontinence – This happens when a sudden urge to urinate or defecates occurs from a position of not needing to go. This can mean there is not enough time to find a bathroom.
• Mixed urinary incontinence – This is a mixture of stress and urge incontinence.
• Overflow incontinence – This refer to a dribble of urine at intervals. It's caused by the bladder not emptying fully after urination. Infection can occur with this type of incontinence.
• Functional incontinence – This describes disabilities that make getting to the toilet difficult, such as arthritis or conditions such as dementia.

The symptom of urinary incontinence is the involuntary leakage of urine. This can happen for any number of reasons but the result is that urine leaves the body before the individual is ready to deal with it.

Incontinence can be distressing and may lead to psychological difficulties if it's not treated. Incontinence carries a social stigma that can be difficult to live with. It may prevent individuals leaving their home, raising the risk of social exclusion and loneliness.

The causes of urinary incontinence depend on the type of incontinence experienced. The most common types are stress and urge incontinence.

Causes of stress incontinence

Stress incontinence can happen because the pelvic floor is weak or there's damage to the opening of the urethra. Excessive bladder pressure from pregnancy or obesity, low levels of oestrogen, and damage to the nervous system can also lead to stress incontinence.

Simply put, the bladder muscles cannot contain urine when pressure is placed on it. This is very common.

Causes of urge incontinence

This happens when muscles in the bladder walls are overactive. It's not known exactly why this happens but causes are thought to include infections and diseases of the urinary tract, constipation, large amounts of alcohol or caffeine, and a lack of fluid intake that makes urine very strong and irritates the bladder.

Neurological conditions such as MS and some medications including HRT, antidepressants and sedatives can also cause urge incontinence.

Causes of overflow incontinence

Overflow incontinence is usually caused by a blockage in your bladder so it cannot entirely empty.

The remaining urine puts pressure on the bladder resulting in leaks. This can happen if you have bladder stones or constipation. In men, an enlarged prostate can block the bladder.

The detrusor muscles may fail to contract and stretch your bladder. This can happen as a result of medications or damage to the nerves.

Some people have a higher risk of developing urinary incontinence. These include:

• A family history 
• Increasing age 
• Having lower urinary tract symptoms
• Constipation
• Types of surgery
• Pregnancy
• Menopause
• Obesity
• Reduced mobility
• Neurological conditions such as multiple sclerosis
• Conditions including diabetes, cardiovascular conditions, respiratory conditions, and prostate difficulties
• Those taking certain medications.

Anyone experiencing incontinence should speak to their doctor for advice. Urinary incontinence is very common. In order to diagnose incontinence, your doctor will ask questions and may give you physical examinations.

Possible questions include:

• When the incontinence occurs
• If you need to take trips to the toilet at night
• If you take frequent trips to the toilet
• If it's is difficult to urinate
• How much liquid you drink e.g. water/caffeine/alcohol/ fruit juices

They will also check your medications. If you are taking any over-the-counter or herbal remedies ensure you tell your doctor.

These questions will help establish what kind of incontinence you are experiencing. If you are not sure about the answers you may be asked to keep a symptom diary, noting when and how often you experience incontinence.

A physical examination may look at the urethral opening to see if there are any abnormalities or infections present. Men may have a prostate examination to check for enlargement and women may be asked to demonstrate their pelvic floor muscle capability. You may be asked to cough – this will show whether urine leaks from the bladder under stress.

• A prostate examination may involve a gloved and lubricated finger inserted into the anus
• A pelvic floor examination may involve a gloved and lubricated finger inserted into the vagina to test muscles.

You may be asked to produce a urine specimen to check for any infections in the bladder.

If these tests don't uncover the reason for incontinence you may be referred for further tests at a clinic. These can include ultrasound examinations to see if the bladder empties fully, or an endoscope to check for stones or other obstructions.

There are many ways to manage and treat incontinence. These range from absorbent pads and lifestyle changes to prescription medicine. Surgery is a last resort.

Absorbent pads / handheld devices

Absorbent pads can manage urine leakage. They give you more confidence. Pads are absorbent and keep urine smells trapped. They are thicker than sanitary pads and available for men and women.

If you find it difficult to get to the toilet due to a physical impairment then consider a handheld urinal or a commode near your sitting area or bed.

Prescription medication

Prescription medicine is used successfully to gain control over bladder problems. Prescription medications relax the bladder muscles and/or increase muscle tone. This helps the bladder store liquid, be less sensitive and prevent it contracting involuntarily.

Pelvic Floor

Weak pelvic muscles contribute to stress incontinence. The pelvic floor controls the flow of urine through the urethra. If you stop urine mid-flow you will identify the muscles.

If you are able to squeeze these muscles you can work on improving their strength. Women who have recently given birth may have a very weak pelvic floor.

• Start by squeezing and holding the squeeze for three seconds.
• Do eight repetitions, three times a day as a minimum.
• The more you are able to do the stronger your muscles will become.
• Men who have had prostate surgery can benefit from exercising their pelvic floor.

If you're not able to contract these muscles you may be referred to a specialist who can help.

Bladder Training

Urge incontinence is improved with bladder training. This extends the amount of time you can hold urine in your bladder before needing to urinate.

Self management techniques and lifestyle changes can support urinary incontinence problems.

Some tips to help control your bladder are:

• Reduce the amount of caffeine you drink because it increases your urine output. Caffeine is found in tea, coffee, and cola. Swap them for caffeine-free hot drinks and water instead. Large amounts of caffeine are irritants and may make your bladder contract.
• Drinking too much or too little fluid can affect your bladder. Large amounts mean you are producing a lot of urine, but holding off drinks does not help because the urine produced is much more acidic and irritates your bladder.
• If you are overweight or obese, diet and exercise to reduce your weight. Excess pounds put pressure on your bladder and weaken the muscles.
• Eating more fruit and vegetables will help manage weight loss, but it will also combat constipation, which is a cause of incontinence.
• Avoid spicy foods like curry and citrus fruits as they can irritate your bladder.
• Smoking causes coughing which puts pressure and stress on the bladder. If you smoke, quit.

If all other methods fail, surgery is available for incontinence. The surgical option include:

• A tape procedure for women with stress incontinence – A plastic tape is threaded behind the urethra to support it in the correct place and reduce leakage.
• Colposuspension lifts up the bladder neck to prevent urinary leaks in women with stress incontinence.
• Sling procedures place a sling around the bladder's neck to support it and prevent leaks.
• Urethral bulking agents can be injected into the walls of the urethra in women with stress incontinence to keep the walls closed.
• An artificial urinary sphincter can be fitted. This procedure is more common in men.
• Botox injected into the bladder treats urge incontinence by relaxing your bladder muscles.
• Sacral nerve stimulation can be used to stimulate the detrusor muscle and improve your ability to hold back urine.
• Augmentation cystoplasty makes the bladder bigger using tissue from your intestine.
• Urinary diversion redirects urine so it's then collected outside the body.
• Clean intermittent catheterisation is a technique that involves using a catheter to remove urine from the body at regular intervals. Catheters can also be fitted inside the body.

Surgery is a last resort for urinary incontinence. There are many techniques and medications to try first, so if you are experiencing urine leakage speak to your doctor. You may have an infection, be drinking too much caffeine or have a weak pelvic floor.

If the cause is more serious then medications and surgery are options. There is no need to deal with incontinence on your own. Your lifestyle will improve if you are able to manage urinary incontinence effectively.