What is incontinence?
Urinary incontinence is involuntary urine leakage. The extent of involuntary leakage of urine varies across people who are incontinent. In each specific circumstance, urinary incontinence can be further diagnosed based on relevant factors such as, type of incontinence, frequency and severity. Fecal incontinence, also known as bowel incontinence, is a condition used to describe involuntary loss of solid or liquid stool.
Different types of urinary incontinence
Stress urinary incontinence is the involuntary leakage of urine due to increased abdominal pressure. This pressure can come from physical exertion or actions such as coughing, sneezing, or laughing. Stress urinary incontinence usually only involves small amounts of urine, but this depends on how full the bladder is and how high the pressure is when the abdominal pressure occurs.
Stress urinary incontinence is generally connected to weakened pelvic floor muscles. This means that the important support around the urethra and bladder is not functioning the way it should, leading to urine leakage when there is increased pressure from the abdomen.
This is the most common type of urinary incontinence in women and there are several reasons for this. Women have a shorter urethra and a weaker pelvic floor than men. Pregnancy and childbirth is also a risk factor, along with heredity. The urethra´s supporting structures, the muscles and connective tissue, degenerate with age, which could then lead to a weakening of the support of the urethra and bladder.
There are factors that can worsen this condition due to the fact that they cause increased abdominal pressure. Constipation, obesity and chronic cough in asthma, or COPD (chronic obstructive pulmonary disease) are other examples of factors that cause this type of abdominal pressure.
In men, prostate surgery could be a cause for stress urinary incontinence. Pelvic floor muscle training can prevent and often cure stress urinary incontinence.
Urge urinary incontinence
Urge urinary incontinence is the involuntary leakage of urine accompanied by, or immediately preceded by, urgency to urinate, which is difficult to defer. The urge can be very sudden. Urge urinary incontinence comes in different symptomatic forms and levels. For example, it can result in small frequent losses between micturition or a complete emptying of the bladder.
You may find that your urinary frequency increases so that you need to urinate more than the usual four to eight times per day. This may also include one or more times per night, also known as nocturia. In certain cases, bladder training can help you to urinate less frequently. Bladder training might also help you to avoid urinating at night.
Urge urinary incontinence can be caused by many different reasons. For example, it can occur if there is a bladder outlet obstruction such as an enlarged prostate, or constipation. Having a urinary tract infection or simply drinking too much water are a few other examples. It is important to get a proper diagnosis regardless of what type of urinary incontinence you are dealing with to be able to get the right treatment.
Mixed urinary incontinence
Mixed urinary incontinence is a combination of both stress urinary incontinence and urge urinary incontinence. It shares the symptoms of leakage associated with both urgency and exertion, for example from sneezing and coughing.
Overflow urinary incontinence
Overflow urinary incontinence occurs when the bladder cannot empty completely and then is gradually filled with residual urine. This happens mostly with an enlarged prostate that causes bladder outlet obstruction. The obstruction prevents the bladder from fully emptying and causes urinary retention. The bladder becomes greatly distended by urine and the closing mechanism cannot resist the pressure, which causes leakages.
A weak and overextended bladder muscle that is unable to contract is another common cause. This can in turn be caused by factors such as, diabetic sensory neuropathy, herniated discs, or spinal stenosis.
Common symptoms when dealing with overflow urinary incontinence are dribbles, an overactive bladder with frequent toilet visits both day and night, a weak urine stream or difficulties in emptying the bladder. Pain may not always be present, but the amount of urine retained should be significantly more than the normal bladder capacity, which is 300-600 mL.
Risk factors include certain types of medications, benign prostatic enlargement, prolapse and nerve damage.
Neurological Bladder Disorder
Several muscles and nerves work together to enable urinary continence and effective control of the emptying of the bladder. Damage to the brain, the spinal cord, or the nerves as a result of trauma or illness can affect the way the brain and bladder communicate. This lack of communication between the bladder and the brain results in the inability to control the bladder, preventing the bladder from emptying itself completely. Urinary incontinence could therefore appear at illnesses like stroke, dementia and multiple sclerosis or Parkinson’s disease.
Post-micturition dribble is the involuntary loss of urine immediately after one has finished passing urine, usually after leaving the toilet in men, or after rising from the toilet in women. This happens if there is any urine remaining in the urethra after urinating. The problem is more common for men, but it can also affect women who have poor muscle support for the urethra.
Functional urinary incontinence
This is an inability to reach the toilet in time caused by, for example, immobility, environmental barriers, impaired cognitive status, etc. Factors that could make it hard to reach the toilet in time could be reduced mobility, impaired vision, not understanding how to get to the toilet, or not being able to remove ones clothes fast enough before urinating. It is important to have an individual and holistic approach to continence solutions. This means thinking about all and any contributing factors, whether they are directly related to the person or to their environment.