BPH

Urinary Incontinence: Causes, Symptoms, and Treatments

Bladder problems are widespread, but more so among elderly adults.

Studies have shown that more than 13 million people in the US alone, both men and women, are suffering from urinary incontinence, also known as UI.

This is a universal problem, and research has indicated that folk worldwide are suffering from some form of urinary incontinence.

Although urinary incontinence in women is more prevalent, it also affects a large number of men.

This does not usually cause serious health problems, but can be embarrassing if it happens unexpectedly at inopportune times.

Incontinence may be short-term caused by issues like a bladder infection, some medications, and should be reasonably easy to treat successfully.

An ongoing problem may require medical intervention to establish the cause.

What is Urinary Incontinence?

Urinary incontinence, or UI, is the accidental release of urine when you cannot properly control your bladder.

It can happen suddenly.

When you cough, sneeze, laugh, exercise, and even when you get the urge, but cannot get to the bathroom in time.

This condition is unpleasant and embarrassing in every respect, but it is in no way life-threatening.

Women appear to be twice as prone to the condition as men are, mainly due to weakened muscles during pregnancy, difficult childbirth, abdominal surgery, and to some extent, the actual structure of the female urinary tract.

Types of Urinary Incontinence

There are different types of urinary incontinence, including:

  • Stress incontinence – Stress incontinence is when pressure on the bladder causes urine to leak when you laugh, exercise, or cough and sneeze.

  • Urge incontinence. Also known as urgency urinary incontinence. You have a sudden, intense urge to urinate, followed by an involuntary loss of urine.

  • Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

  • Functional incontinence. A physical or mental health condition keeps you from making it to the toilet in time.

There is a belief that UI is a normal sign of aging, and while it may be more common among older adults, this is not strictly true.

If you are always incontinent and you have concerns, there may be an underlying medical condition that has not been diagnosed. A visit to the doctor will help to establish what is causing the problem.

The good news is that UI is usually a very treatable condition.

Causes of Urinary Incontinence

Here are some medical issues which may add to UI symptoms.

  • Chronic diabetes may have caused nerve damage, which can affect bladder control.

  • Benign Prostatic Hyperplasia (BPH) is a common condition, affecting more than 50% of men in their sixties. As the prostate gland enlarged, it blocks the urethra, resulting in the bladder needs to contract harder to get the urine out. This can cause the bladder to weakened and end up holding urine in, causing overflow incontinence.

  • Diseases like Parkinson’s, Alzheimer’s disease, and multiple sclerosis (MS), which affect the brain and central nervous system, may also cause a measure of incontinence with time. Urge incontinence happens where MS nerve damage takes place in the parts of the brain and spinal cord that control the bladder.

  • An overactive bladder is a condition that causes the bladder to squeeze at the wrong times resulting in an almost uncontrollable urge to urinate and possible urine leakage.

  • Weak muscles in the lower urinary tract caused by some nerve damage due to surgery, especially in women who have had a hysterectomy.

  • Persistent constipation may cause the rectum to swell and press on the bladder forcing a leak of urine from time to time.

  • Whatever the problem of UI might be, bear in mind that effective treatment can only commence once a doctor has established the root cause of the issue.

Symptoms of Urinary Incontinence

There are two main types of UI, namely stress incontinence and urge incontinence. Here are some of the symptoms:

Stress incontinence occurs when pressure is put on the bladder, such as by coughing, sneezing, and some types of vigorous exercise.

This happens when the muscles are weak, and you are unable to tighten them to close off the urethra, causing urine to leak out suddenly.

This is the most common kind of bladder control in women, with the primary symptom being accidental leakage of urine.

Studies have shown that sometimes the muscles are in such a weakened state, that a part of the bladder may protrude from the vaginal area.

Urge incontinence happens when you have a strong urge to urinate but are often unable to get to the bathroom in time.

Another issue that may contribute to urge incontinence is that of an overactive bladder, which is prone to unexpectedly pushing urine out of the bladder.

However, researchers advise that more studies are needed regarding this matter.

Milder symptoms can include some people experiencing occasional minor leaks, while others may experience moderate urine leaks more frequently.

Living with incontinence can be extremely stressful, and studies have indicated that some simple relaxation techniques have helped to reduce anxiety about the issues.

Practice some deep breathing exercises to ease your muscles and relax your body. With time, relaxation may help you get better control by using the power of your mind.

Diagnosing Urinary Incontinence

As various causes can lead to UI, medical experts agree that diagnosing the condition is not a straight forward matter. There are different severities of stress incontinence as shown in the table below:

The doctor will probably order tests to establish whether there is an underlying medical issue, and then ask questions about your eating, drinking, and urinating problems.

Following this, they may perform diagnostics such as:

  • Urinalysis– A sample of your urine is checked for abnormalities.

  • Bladder diary– For several days you record information such as how much you drink, when you urinate, the amount of urine, how many times you’ve had the urge to urinate, and the number of incontinence episodes.

  • Post-void residual measurement– This measures the amount of urine left in the bladder (postvoid residual) after you urinate. A large amount of leftover urine may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

Are you at risk?

Certain factors may increase your risk of developing urinary incontinence. These can include:

Gender– Your gender. Females are more prone to have stress incontinence due to weakened bladder and pelvic muscles as a result of pregnancy and vaginal childbirth, which has been more difficult than usual.

Urinary incontinence– (UI) is an important social problem that affects more than 50% of postmenopausal women. During menopause, your estrogen levels drop, and this often causes the pelvic muscles to weaken. It will become more difficult for you to control your bladder, and UI symptoms may develop and even worsen with time.

Prostate Problems– Men who have any prostate problems are highly at risk. Most of the prostate issues involve swelling that presses on the urethra, the tube carrying urine, which passes from the bladder through the prostate to be expelled through the penis.

Weight– If you are overweight, there is increased pressure on the bladder and surrounding muscles, which may allow urine to leak out if you cough or sneeze.

Smoking– If you are a smoker, tobacco can cause your risk of stress incontinence to rise. Smoking is known to cause chronic coughing, and urine may leak if you have a coughing fit. Research has shown that tobacco is also a bladder irritant, which can result in an overactive bladder.

Diabetes– Your risk is also raised if you have a neurological disease such as diabetes, which often causes nerve damage.

Age- As you age, the muscles in your body, including the bladder, lose some of their strength. These bodily changes reduce the amount of urine the bladder can hold and may increase the chances of an expected leak of urine.

Bear in mind that urinary incontinence is not a life sentence. It can be successfully treated and give you back your life so you can move forward.

Complications of Urinary Incontinence

  • Chronic UI can impact on your physical, personal, and emotional life. Here are some of the issues you may experience.

  • Skin rashes, skin infections, and inflamed sores can develop in the genital area from constantly wet skin.

  • UI increases your risk of persistent urinary tract infections, which are mainly treated with antibiotics. Antibiotics are known to cause thrush, which also has to be medically treated.

  • Thrush can invade the entire genital area, especially the vagina and anus, thus leading to a very uncomfortable condition if not treated.

  • UI and the related anxiety can negatively affect your social life, work-life, and personal relationships, and have the potential to turn you into something of a recluse due to shame about the condition.

  • The sex life of both men and women can be severely impacted by urinary incontinence, and can potentially be brought to a halt.

  • Urine spilling out during sex can be a devastating and embarrassing experience. Some folk becomes so anxious about possible leakage that they tend to avoid sex altogether eventually. To help prevent urine leakage, make sure that your bladder is empty before engaging in sexual activity.

  • A very anxious man may develop a significant cause of erectile dysfunction, simply from emotional issues resulting from fears that leaking urine during sex will cause untold embarrassment, and do damage to his masculine image.

You may be stressed and very anxious and just do not see any light at the end of the tunnel, but there is no need for you to suffer physically and emotionally from UI issues. Go back to the doctor and find out what your options are.

Some ways you can help yourself prevent and cope with UI

UI isn’t always preventable, but there are natural ways you can use to lower your risk of landing up with urinary incontinence, as well as ease symptoms you may have.

Try and help yourself in the following ways:

  • Get into a habit of urinating every 2 to 3 hours, whether you have the need or not.

  • Try to quit smoking and give your bladder muscles a new lease of life. If you have a smoker’s cough, cross your legs when you cough, so you do not leak urine.

  • Lose weight if you need to. This will take the pressure off the bladder muscle and help to prevent leaks if you cough or exercise.

  • Managing your weight should include regular exercises such as walking, swimming, and even some gym work. Kegel exercises are highly recommended as they are excellent for strengthening the pelvic floor muscles.

  • Deal with any constipation you may suffer by including foods in your diet like fruit, vegetables, beans, and whole grains every day. Foods that are high in fiber will help to keep you regular and prevent bloating of the small intestine, which may press on the bladder.

  • Change your lifestyle habits and create a healthy diet for yourself. Reduce foods like chocolates, chili peppers, acidic citrus fruits, vinegar, and spicy foods like strong curries. These foods irritate the bladder and can cause inflammation and promote urination.

  • Cut back on alcohol intake. Alcohol is a diuretic which can fill the bladder and give you the urge to urinate more than usual. Leaks can happen if you don’t get to the toilet quickly.

Medical Treatments

Treatments for UI will depend on factors like the type of incontinence, how bad it is, and whether there is an underlying medical issue.

If there is a medical issue, the doctor will deal with that before tackling the incontinence problem.

Prior to recommending a particular course of treatment, consideration will be taken into account regarding the patient’s age, general health, and mental state.

Here are some medications that are effectively used to treat urinary incontinence:

  • Mirabegron which relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount of urine you can pass at one time, helping the bladder to empty more completely.

  • Men are often prescribed with alpha-blockers such as Flomax or Uroxatral, which relax the bladder-neck muscles as well as the muscle fibers in the prostate, making it easier to empty the bladder.

Other options a doctor might recommend:

Visiting a physiotherapist for muscle massage treatment, as well as getting advice on a Kegel exercise routine to help strengthen the pelvic floor muscles that support the bladder, uterus, and the small intestine.

Supporting these essential floor muscles will help to control leaking. The Kegel exercises are essential, as a complete collapse of the pelvic muscles will require major surgical repair.

For women who are active in sports, a urethral insert is advised, which is a small tampon-like disposable device inserted before a game such as tennis or squash, which is vigorous enough to trigger incontinence. The insert acts as a plug to prevent leakage and is easily removed later before urinating.

If medication, diet, exercises, and physiotherapy do not work, then besides a tube that goes from the bladder, through the urethra, and expels urine into a bag worn on the outside of the body, surgery becomes a hopeful option for success.

Types of Surgical Procedures for Urinary Incontinence

Sling procedures– Sling procedures involve using synthetic mesh material to create a pelvic sling around the neck of the bladder, where it connects to the urethra. The slings help to support the urethra, keeping it closed if you cough or sneeze, which prevents leaking.

Bladder neck suspension– A procedure known as bladder neck suspension is designed to provide support for the urethra and bladder neck. The surgery is done under a general anesthetic as it involves an abdominal incision.

Artificial Sphincter– In some cases, a device is known as an artificial sphincter or valve may be inserted to control the flow of urine from the bladder to the urethra.

Prolapse surgery– Prolapse surgery is performed to lift all of the muscles in the pelvic area, which have collapsed.

The surgical procedures are not dangerous, but like any operation, there are risks involved. Fortunately, surgery for urinary incontinence has proved to be very effective and is usually minimally invasive.

Protective Garments

In past years, protective garments were bulky and awkward to wear. These days the garments are almost like regular underwear and can be worn comfortably under everyday clothes.

Pads and panty-liners also made of absorbent material and can be worn with confidence. These are more suitable for women with urinary incontinence.

Still, men who have problems with dribbles can use a drip collector, which is a small pocket of absorbent material worn over the penis, held in place by tight-fitting underwear.

Notes to remember

  • If your sex life begins to fall apart, and your relationship takes the strain, your partner might not know what is happening. This is the time to put aside embarrassment – talk to your partner and try to work through it together.

  • Visit a therapist who can help you with anxiety issues, and show you relaxation techniques and behavioral therapy for tense muscles.

  • Embrace and stick to a Kegel exercise routine and bladder training. Visit a physiotherapist for some muscle massage, and if you are not sure what to do, ask for guidance regarding the Kegel exercises and learn which muscles should be focused on.

  • Make some lifestyle changes and follow a healthy diet, cutting out foods that are known to irritate the bladder and cause inflammation.

  • Lose some weight. Even if you are not obese, it will not harm slim down a bit and dump the fat.

  • Your self-esteem and confidence may have dropped because of the urinary incontinence issue. By accepting the fact that UI is a very treatable condition, you can put aside embarrassment, rebuild your self-esteem, and begin to move forward again with confidence.

Conclusion

Although UI is an unpleasant, awkward ailment, it is not life-threatening, nor is it a life sentence.

It can be successfully treated with medication and with surgical procedures, but in many cases, some simple lifestyle changes like losing weight, following a healthy diet, and doing muscle strengthening exercises, may prove useful before medication or surgery is resorted to.

As in all health matters, if something doesn’t clear up or gets worse, don’t allow fear of what the problem might be keeping you from getting medical attention.

The key to successful treatment for any ailment is early detection, including what you might consider being just a small matter of leaking urine.

Sources

  1. https://www.nafc.org/
  2. https://www.nia.nih.gov/health/urinary-incontinence-older-adults
  3. Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol. 2009;11(3):145–165.
  4. Helfand BT, Smith AR, Lai HH, et al. Prevalence and Characteristics of Urinary Incontinence in a Treatment Seeking Male Prospective Cohort: Results from the LURN Study. J Urol. 2018;200(2):397–404. doi:10.1016/j.juro.2018.02.075
  5. https://www.nature.com/subjects/urinary-incontinence

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