Urinary Incontinence is not a life-threatening disease, but the symptoms may seriously influence the physical, psychological, and social well-being. Loss of control, shame, isolation, and depression can be some of the personal affects, and only 50% seek help. The reasons can be misinterpretation of symptoms, misbelieves, unawareness, and shame.
The reason and explanation is often found in relation to childbirth. The effects of childbirth can be a weakened musculature and connective tissue causing poor closing mechanisms. But also the female oestrogen level can influence the elasticity level of the pelvic floor. The tissue becomes looser during menopause when the hormone production is decreasing.
The pelvic floor supports the abdominal organs, the bladder, uterus, and intestines, and it also has a great influence on the closing function of the vagina, rectum, and urinary tract.
A flaccid and malfunctioning pelvic floor can cause you to develop incontinence and loss of bladder control.
Knowledge about the different types of incontinence can help guide you to the best possible help. Living with incontinence does not have to become an issue, and it is still possible to live an active and social life.
The two most common types of incontinence for women are stress incontinence and urge incontinence. Many women experience both stress and urge incontinence, also known as "mixed" incontinence.
Stress incontinence is the most common type of incontinence, and occurs when the bladder is under stress or pressure. It is often caused by weakened pelvic floor muscles which weakens the support under the urethra and makes it difficult to close the urethral opening and hold back urine. Stress incontinence causes leakage of urine during physical activity such as running, lifting, jumping, coughing, laughing, sneezing, etc. Often only a few drops.
It’s common that the pelvic floor muscles are getting weaker after pregnancy, childbirth and after the age of 40 but it can happen at any age.
Weakness of the pelvic floor muscles can lead to depressed uterus, which presses the bladder and leads to incontinence. Like other muscles, pelvic floor muscles need training to maintain strength. Other treatment can be surgery and hormone vaginal suppositories for postmenopausal women.
Women with urge incontinence feel an intense and sudden urge to urinate. The urge is so strong that it is not possible to hold back the urine and the toilet must preferably be in a close range. It’s often referred to as an overactive bladder and is caused because the bladder contracts involuntarily.
The urge to urinate is felt frequently throughout the day, and, as a result, people with urge incontinence often end up going to the toilet more often than necessary, making the bladder even weaker. Others avoid drinking liquids, even though hydration is very important when keeping a healthy bladder.
Often urge incontinence can improve with adjustment of drinking habits and bladder training. Other treatments may include bladder relaxants, electrostimulation and hormone vaginal suppositories for postmenopausal women.
Mixed incontinence is a combination of stress and urge incontinence and the condition is mainly seen in women. As a rule, there is a predominance of either stress or urge incontinence.
The symptoms and its severity therefore depend on which one of the two types is most prevalent.
Incontinence can be caused by various reasons, but the most common cause of incontinence is weakened or damaged pelvic floor muscles. This is often related to pregnancy, childbirth, or hormonal changes during menopause. In the case of sudden onset of incontinence, though, suspect that it could be urinary tract infection.
It is important to note that incontinence can also be caused by underlying neurological disorders, and you should always consult a health care practitioner if you are experiencing incontinence.
More than one-third of women experience urinary incontinence during pregnancy,as the baby grows, the uterus pushes down on the bladder, urethra, and pelvic floor muscles.
The pregnancy hormone hCG also causes an increase in the amount of blood in the body, and the supply of blood to the kidneys is faster than normal. The result is that the bladder fills up faster and pregnant women have to go to the toilet more often during their pregnancy.
Also the increased change of the hormone progesterone level during pregnancy can weaken the pelvic floor by loosen ligaments in the pelvis that help you hold urine.
Most problems with bladder control during pregnancy go away within 1 year after childbirth, once the muscles have had some time to heal.
Speak to your health-care practitioner if your urinary incontinence symptoms persist in relation to treatment.
Some women start experiencing urinary incontinence when they reach menopause. With decreasing oestrogen levels, the mucous membrane and tissue in the urethra can become less elastic and more flabby, which means that the urethra does not close off to the bladder as effectively. This can cause urine leaks to appear.
The decreasing oestrogen level can affect your abdominal muscles and cause your bladder to move around, which can cause urinary incontinence and leakage of urine.
In addition, the pelvic floor muscles that support the bladder may become weakened with time. When the muscles that support the urinary tract are weakened, the muscles in the urinary tract work harder to hold back the urine. The extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage.
Another reason for urinary incontinence in women can be pelvic organ prolapse due to weak muscles and ligaments and this condition increases with age.
The most common prolapse type is called cystocele and is when the bladder drops from its normal position in the pelvis and pushes on the wall of the vagina which can cause mostly stress incontinence but also urge – and mixed incontinence.
Overweight can primarily lead to stress incontinence, as especially fat around the stomach can cause pressure on the bladder making it even more difficult to avoid leakages.
For healthy adults, the urinary bladder can hold around ½ litre, but humans often feel the urge to urinate when there is 250-300 ml of urine in the bladder. The urge to urinate can normally be controlled until it is socially acceptable to pass the urine. This means that we usually receive a 'warning' in good time before we need to go.
To be able to suppress the urge to urinate, we need normal control mechanisms in the brain and in the nerves in the spinal cord which gives order to either ’go’ or ’no-go’. The connections in the nerve system must be intact.
Disorders that may disturb the nervous signals can result in loss of control of the bladder or the ability to empty it completely:
Urinary tract infections
Women are more often exposed to urinary tract infections than men because of a short urethra where bacteria easily can travel to the bladder and cause urinary tract infections. The infection can cause swelling and irritation of the bladder and thereby cause urine leakages.
The good news is that most types of urinary incontinence can be treated or the symptoms can be relieved.
Urinary incontinence is not a disease but a symptom that something is wrong. Approx. 70% can be cured of incontinence or the symptoms can be relieved. In addition, many products and professional guidance exists to help improve quality of life while the problem persists.
You need to control your incontinence as it should not control you. Therefore it’s important to seek professional help to get the right treatment, guidance, and tools to keep living the life you want to. Therefore, do not hesitate to contact your local doctor or incontinence nurse and get the best treatment available.
Incontinence is the involuntary loss or leakage of urine or feces. Incontinence can affect anyone and can have various causes. It is not a disease, but a symptom.
Incontinence can have various causes. Understanding the underlying cause and type is vital to understand the different treatments and products that are available.