Urinary incontinence is a condition where you are unable to control urination, such that urine is lost at the wrong time and place. During urination, the muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence occurs if your bladder muscles contract suddenly or the sphincter muscles are not strong enough to hold back urine.
Pelvic floor exercises taught and practised early, before menopause, will help women reduce the risk of severe SUI in older age. Reducing intake of coffee and tea may reduce the symptoms of urge incontinence.
There are many types of urinary incontinence.
Urge incontinence is caused mainly by the presence of elements that irritate the bladder, such as the presence of urinary tract infection, bladder stones or even bladder tumours.
Overactive bladder syndrome (OAB) is a diagnosis of exclusion where there are no identifiable causes irritating the bladder, yet there is a severe urge to empty the bladder.
Stress urinary incontinence (SUI) is usually related to a weak pelvic outlet from previous trauma, multiple pregnancies, or undue repeated high abdominal pressure such as recurrent persistent cough, obesity or constipation.
Overflow incontinence occurs when the bladder is very full but unable to empty, and is related to weak bladder contraction in diabetics or patients affected by stroke.
Women who have had vaginal deliveries or are post-menopausal are at higher risk. You are also at risk if you are obese. Intake of irritants such as coffee or tea may worsen the problem.
The diagnosis is often obtained from a well-taken history and complete physical assessment. The latter gives the doctor an idea of your pelvic floor muscle tone and helps to exclude other diagnoses with similar symptoms.
Tests to exclude urinary tract infection, stones and bladder tumours may be needed. In some people, urodynamic studies, a complex assessment of changes in bladder activity during filling and emptying, may be needed to confirm the diagnosis.
Treatment strategies differ depending on the cause of the incontinence :
Stress urinary incontinence
Non-surgical options may include :
Surgical options may include :
Treatment options include :