What is urinary incontinence?

Urinary incontinence is a condition diagnosed leaking of urine involuntarily. It happens either because the urinary bladder fails to hold the usual amount of urine or the urinary sphincter muscles tone and strength loss. It can affect people of all ages but is more prevalent among the older age groups and reported more among women than men. In most cases, the condition can be managed by bladder training exercises, however, in some advanced cases surgical treatment for urinary incontinence might be required.

This article will discuss the risk factors and causes of urinary incontinence, its symptoms, and how it can be managed.

Causes and Risk Factors

• Age: With growing age, the muscles and tissues in the bladder and pelvic area can weaken, leading to urinary incontinence.

• Gender: Women are more likely to experience urinary incontinence than men due to differences in their anatomy and hormonal changes.

• Pregnancy and childbirth: Bodily stresses like pregnancy and childbirth can cause the muscles in the pelvic floor to get weakened, leading to urinary incontinence. 

• Menopause: Hormonal fluctuations during menopause can also lead to urinary incontinence.

• Obesity: Excess weight can put pressure on the bladder and pelvic muscles, weakening the muscles and leading to urinary incontinence.

• Neurological conditions: Certain conditions such as multiple sclerosis, Parkinson's disease, and spinal cord injuries can affect the nerves that control the bladder and lead to urinary incontinence.

• Medications: Diuretics and antidepressants can have side effects like urinary incontinence.

• Chronic cough: Frequent coughing can put stress on the bladder leading to urinary incontinence.

What Is the Relationship Between Prolapse and Urinary Incontinence?

Pelvic organ prolapse and urinary incontinence share a close relationship, primarily due to their association with the pelvic floor muscles and supporting structures. The pelvic floor is responsible for supporting the bladder, uterus, and rectum and can weaken which leads to pelvic organ prolapse (POP). POP occurs when those organs descend into the vaginal canal getting displaced from their healthy positions. This displacement can disrupt the normal function of the urethra and bladder, contributing to urinary incontinence. The weakening of pelvic floor muscles is a common factor in both conditions. While these conditions frequently coexist, they are distinct, requiring comprehensive evaluation by healthcare professionals and treated separately.

Types of Urinary Incontinence

Stress incontinence: In this type of incontinence, the pelvic floor muscles get weakened and fail to support the bladder properly, leading to urine leakage when the bladder is put under stress, such as during coughing, sneezing, laughing, or exercise.

Urge incontinence: This type of incontinence is caused by overactive bladder muscles that contract involuntarily and causes a sudden and intense urge to urinate, followed by an involuntary loss of urine before you could reach a bathroom.

Overflow incontinence: It occurs when the bladder becomes too full and urine leaks out, even when you don’t feel any urge to urinate. It is caused by a blockage or obstruction of the urinary tract, or by weakened bladder muscles that are unable to empty the bladder completely.

Mixed incontinence: It is a combination of stress and urge incontinence, where the person experiences both types of symptoms. It is a common type of incontinence, especially in older adults.

Typical Symptoms of Urinary incontinence

• Involuntary leakage of urine, which may be a few drops or a large amount, depending on the severity of the condition.
• Feeling a sudden and intense urge to urinate, followed by an involuntary loss of urine (urge incontinence).
• Urine leakage during physical activities that put pressure on the bladder, such as coughing, sneezing, laughing, or exercising (stress incontinence).
• Inability to hold urine
• Dribbling urine
• Feeling that the bladder is never fully emptied.
• Needing to urinate frequently, even at night (nocturia).
• Burning sensation or pain during urination.
• Feeling embarrassed, anxious, or depressed because of the condition.

How to diagnose urinary incontinence?

• Medical history and physical examination: Your doctor might ask you to get some tests done to identify the underlying causes of your urinary condition. Often, he might perform a pelvic exam to check for any abnormality that might be causing the condition.

• Urine tests: Your doctor may request a urine sample to check for signs of infection, blood, or other abnormalities that could be contributing to bladder control issues.

• Bladder diary: Often, physicians ask patients to maintain a bladder diary for urine incontinence involving tracking fluid intake, urination frequency, and episodes of incontinence over a period of time to help identify patterns and triggers that could be contributing to the condition.

• Imaging tests: Sometimes, doctors also recommend imaging tests, such as an ultrasound, MRI, or CT scan, to check for any abnormalities in the urinary tract, such as blockages or tumors.

Your doctor can also request you to get additional tests like urodynamic tests and cystoscopy done depending upon your medical history and the severity of the condition.

Non-Surgical Treatment Options

Treatment for urinary incontinence depends upon the underlying cause and its severity. In mild and moderate cases, urinary incontinence can be managed by non-surgical treatment like:

• Lifestyle modifications: Avoiding alcohol and caffeine intake, quitting smoking, maintaining a healthy weight, consuming a high-fiber diet to avoid constipation, and managing chronic cough can significantly improve urinary incontinence.

• Pelvic floor muscle exercises: Exercises like Kegels can help strengthen the pelvic floor muscles supporting the bladder, and thus, improve bladder control and reduce incidences of urinary incontinence.

• Bladder training: It involves trying to hold off the urge to urinate and scheduling bathroom visits at regular intervals to help train the bladder and reduce involuntary urine leakage. It helps lengthen the interval between bathroom trips over time.

• Medications: Certain drugs like anticholinergic drugs can help with symptoms of bladder control issues. Urge incontinence medications like Mirabegron can help relax your bladder muscles and improve its ability to hold urine. It also improves the bladder’s ability to void itself completely. Topical estrogen can also help improve the muscle tone and rejuvenate tissues in the urethra.

Surgical Treatment Options

• Sling procedure: It is a minimally invasive surgical procedure that involves placing a synthetic mesh tape under the urethra to support it and prevent urine leakage.

• Bladder neck suspension: It involves lifting and stitching the bladder neck and urethra to the pubic bone to provide support and prevent urine leakage.

• Artificial urinary sphincter: This device is implanted around the urethra to act as a valve to control the flow of urine. When inflated, the sphincters prevent urine leakage and when deflated, it allows urination.

• Colposuspension: This surgical procedure involves lifting and stitching the bladder neck and urethra to the pelvic ligaments to provide support and prevent bladder control loss.

Ways to Prevent urine leakage

Maintaining a healthy weight by regular physical activity and proper balanced diet, practicing pelvic floor muscle exercises for incontinence like Kegel exercises, and avoiding bladder irritants like alcohol and tobacco can help prevent urinary incontinence.  

Urinary incontinence is the inability to control one’s bladder leading to involuntary urine leakage. Though a common issue, urinary incontinence can land you in embarrassing situations. You are likely to experience urinary incontinence once in a while in your life due to different stresses like coughing hard or sneezing. It is usually nothing to be concerned about. If bladder control issues begin to affect your daily activities, it is best to consult your doctor.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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