Word on Health

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Word On Bladder Weakness

Our grateful thanks to Dr. Chris Steele for his input to our on-air radio report. Our thanks also to NHS Choices for the information reproduced below.

Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people Women and men. When and how this happens varies depending on the type of urinary incontinence you have.

Common types of urinary incontinence

Most people with urinary incontinence have either stress incontinence or urge incontinence.

Stress incontinence is when you leak urine when your bladder is put under extra sudden pressure – for example, when you cough. It's not related to feeling stressed.

Other activities that may cause urine to leak include: 

  • sneezing 
  • laughing 
  • heavy lifting 
  • exercise

The amount of urine passed is usually small, but stress incontinence can sometimes cause you to pass larger amounts, particularly if your bladder is very full.

Urge incontinence, or urgency incontinence, is when you feel a sudden and very intense need to pass urine and you're unable to delay going to the toilet. There are often only a few seconds between the need to urinate and the release of urine.

The need to pass urine may be triggered by a sudden change of position, or even by the sound of running water. You may also pass urine during sex, particularly when you reach orgasm.

This type of incontinence often occurs as part of a group of symptoms called overactive bladder syndrome, which is where the bladder muscle is more active than usual.

As well as sometimes causing urge incontinence, overactive bladder syndrome can also mean you need to pass urine very frequently and you may need to get up several times during the night to urinate.

Other types of urinary incontinence

Mixed incontinence is when you have symptoms of both stress and urge incontinence. For example, you may leak urine if you cough or sneeze, and also experience very intense urges to pass urine.

Overflow incontinence, also called chronic urinary retention, occurs when the bladder cannot completely empty when you pass urine. This causes the bladder to swell above its usual size.

If you have overflow incontinence, you may pass small trickles of urine very often. It may also feel as though your bladder is never fully empty and you cannot empty it even when you try.

Total incontinence urinary incontinence that's severe and continuous is sometimes known as total incontinence.

Total incontinence may cause you to constantly pass large amounts of urine, even at night. Alternatively, you may pass large amounts of urine only occasionally and leak small amounts in between.

Lower urinary tract symptoms (LUTS) The lower urinary tract comprises the bladder and the tube urine passes through out of the body (urethra).

Lower urinary tract symptoms (LUTS) are common in men and women as they get older.

They can include:

  • problems with storing urine, such as an urgent or frequent need to go to the toilet, or feeling like you need to go straight after you've just been
  • problems with passing urine, such as a slow stream of urine, straining to pass urine, or stopping and starting as you pass urine
  • problems after you've passed urine, such as feeling that you've not completely emptied your bladder or passing a few drops of urine after you think you've finished

Experiencing LUTS can make urinary incontinence more likely.

When to seek medical advice  See your GP if you have any type of urinary incontinence. Urinary incontinence is a common problem and you shouldn't feel embarrassed talking to them about your symptoms. (NHS Choices offer an online bladder assessment test you can take - click here and scroll down the webpage that the hyperlink takes you to, to access it)

This can also be the first step towards finding a way to effectively manage the problem.

Urinary incontinence can usually be diagnosed after a consultation with your GP, who will ask about your symptoms and may carry out a pelvic examination (in women) or rectal examination (in men).

Your GP may also suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.

Causes of urinary incontinence

Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.

Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder.

Overflow incontinence is often caused by an obstruction or blockage to your bladder, which prevents it emptying fully.

Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a bladder fistula.

Factors that can increase the chances of urinary incontinence developing, include:

  • pregnancy and vaginal birth
  • obesity
  • a family history of incontinence
  • increasing age – although incontinence is not an inevitable part of aging
  • damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy) in women, or removal of the prostate gland in men
  • neurological conditions – that affect the brain and spinal cord, such as Parkinson's disease or multiple sclerosis
  • an enlarged prostate gland (in men)
  • bladder stones
  • constipation
  • certain connective tissue disorders – such as Ehlers-Danlos syndrome
  • certain medications

Treating urinary incontinence

Initially, your GP may suggest some simple measures to see if they help improve your symptoms.

These may include:

  • lifestyle changes – such as losing weight and cutting down on caffeine and alcohol
  • pelvic floor exercises – exercising your pelvic floor muscles by squeezing them, taught by a specialist 
  • bladder training – where you learn ways to wait longer between needing to urinate and passing urine, guided by a specialist
  • You may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals.
  • Medication may be recommended if you're still unable to manage your symptoms. 

Surgery may also be considered. The specific procedures suitable for you will depend on the type of incontinence you have.

Surgical treatments for stress incontinence, such as tape or sling procedures, are used to reduce pressure on the bladder or strengthen the muscles that control urination.

Operations to treat urge incontinence include enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles.

Preventing urinary incontinence

It's not always possible to prevent urinary incontinence, but there are some steps you can take that may help reduce the chance of it developing.

These include:

  • controlling your weight
  • avoiding or cutting down on alcohol
  • keeping fit – in particular, ensuring that your pelvic floor muscles are strong

Drinking habits

Depending on your particular bladder problem, your GP can advise you about the amount of fluid you should drink. 

If you have urinary incontinence, cut down on alcohol and drinks containing caffeine, such as tea, coffee, and cola. These can cause your kidneys to produce more urine and irritate your bladder.

The recommended daily limits for alcohol consumption are:

  • three to four units a day for men
  • two to three units a day for women
  • A unit of alcohol is roughly half a pint of normal-strength lager or a single measure (25ml) of spirits.

If you have to urinate frequently during the night (nocturia), try drinking less in the hours before you go to bed. However, make sure you still drink enough fluids during the day.

Pelvic floor exercises

Being pregnant and giving birth can weaken the muscles that control the flow of urine from your bladder. If you're pregnant, strengthening your pelvic floor muscles may help prevent urinary incontinence.

Men may also benefit from strengthening their pelvic floor muscles with pelvic floor exercises. Click here to find out more about pelvic floor exercises. 

All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.