BLADDER LEAKAGE: TYPES, CAUSES, AND TREATMENT OF URINARY INCONTINENCE

Urinary incontinence, also known as bladder leakage, happens when a person leaks urine involuntarily. It may be due to many things, but it often occurs when a person loses partial or complete control of their urethral sphincters.

Urinary incontinence is a common condition, affecting between 9.9 to 36.1% of the global population, according to the World Health Organization (WHO). In Canada, about 10% of the population, approximately 3.5 million people, experience some form of urine inconsistency. Both men and women can have urine inconsistency, but the prevalence is higher in women, who experience it about twice as often as men. Generally, urinary incontinence occurs more often as people grow older; however, it is a condition that can be prevented and managed with age.

Types Of Urinary Incontinence

There are different types of bladder leakage with unique symptoms. These include:

Stress Incontinence

Some actions such as coughing, laughing, sneezing, or exercising can put pressure on your bladder and cause you to leak. You may have experienced this form of incontinence at some point when you laughed heartily. If this happens to you often, you may have stress incontinence. Often with stress incontinence, only a small amount of urine leaks. In more chronic cases, the bladder may empty completely.

Stress incontinence happens when your pelvic floor or urethral sphincters get weak or damaged. Women are more at risk of having stress incontinence because the physical changes due to pregnancy, childbirth, and menopause may weaken these structures that support the closed urethra. As a result, your urethral sphincters may not tighten enough to prevent urine from leaking through the urethra during activities that cause pressure on the bladder (such as coughing). Some surgical operations like a hysterectomy can also weaken your pelvic floor, leading to stress incontinence. Perimenopausal women may also experience a decrease in their estrogen levels, which weakens their bladder and pelvic muscles, resulting in stress incontinence. When men have stress incontinence, it is usually due to urinary sphincter damage resulting from prostate surgery or a pelvic fracture. For both men and women, being overweight or obese can be an added risk factor as their weight places too much stress on their bladder during activities that increase abdominal pressure.

Urge Incontinence

If you lose control of your bladder after a sudden intense urge to urinate, you may have urges incontinence. Another term used to describe urge incontinence is an overactive bladder, although some people have a mild overactive bladder and don’t leak. Urge incontinence is common in both men and women, especially in adults. People with this condition have a sudden strong desire to urinate and may not get to the toilet in time before losing control of their bladder and urinating. Often when this happens, the bladder muscle, the detrusor, suddenly contracts as a signal to urinate even when the bladder is not full. An overactive bladder also causes you to urinate more often than normal at random times.

Urge incontinence can be a symptom of physiological problems causing you to lose control of bladder contraction. Examples of such problems could be brain damage due to an accident or neurological diseases. Some diseases such as Parkinson’s, diabetes, and multiple sclerosis can also damage the nerves controlling your bladder, leading to urge incontinence. But many people have overactive bladder with or without urge incontinence without a good medical explanation. If your bladder gets irritated and inflamed, such as in cystitis resulting from urinary tract infections (UTIs), you may also develop urge incontinence.

Overflow Incontinence

If you don’t empty your bladder completely when you urinate and build up a lot of urine in the bladder, you may experience involuntary leakage of your bladder’s remaining content later. Overflow incontinence, also known as dribbling, is often caused when something blocks the urine passage from the bladder to the urethra. The most common cause of this blockage is prostate enlargement in men, putting men at higher risk of this type of incontinence. Aside from prostate-related conditions that happen to men, scar tissue (strictures), tumors, bladder stones, prolapsed uterus or prolapsed bladder can also block the passage of urine through the urethra.

Sometimes, overflow incontinence happens due to decreased activity of the bladder itself (a hypotonic or atonic bladder). When this happens to both men and women, they do not feel the usual urge to urinate. As a result, the bladder overfills, and the pressure pushes the urine out through the urethra, leading to leakage.

Functional Incontinence

Suppose you have no physiological problems with your urinary tract but have other issues preventing you from getting to the toilet in time to urinate. In that case, you may have something called functional incontinence. These issues may include health conditions that leave you bedridden or restrained, mental illnesses that affect cognitive abilities like Alzheimer’s, inability to find a toilet nearby, or in time.

Some medications such as diuretics or drinking too much alcohol and caffeinated drinks can lead to temporary cases of functional incontinence.

Mixed Incontinence

If you have symptoms of a combination of any of the above types of incontinence, such as stress incontinence and urge incontinence, you may be living with mixed incontinence. Mixed incontinence is common amongst aged people but can sometimes happen to men who have had prostate surgeries. Keeping a ‘bladder diary’ of a typical 24 hour period can be very helpful for your doctor to review. This should include fluid intake (what and how much), times that you peed, times that you leaked, and how much (roughly).

Treatment of Urinary Incontinence

being diagnosed with urinary incontinence by our doctor, your recommended treatment option will be based on factors such as your age, type of incontinence, and mental state. Your treatment options may include:

Physical Exercises and Therapy

Your doctor may recommend pelvic floor exercises such as Kegel exercises to help strengthen your urethral sphincters and pelvic floor muscles responsible for controlling the voiding of urine. To do a Kegel:

Identify the right pelvic muscles. You can do this by pretending to avoid passing gas or holding your urine mid-stream.
Contract those muscles for 3-5 seconds
Relax them for 3-5 seconds
Repeat the cycle ten times

Bladder Training

You may also be required to train your bladder by choosing certain periods after which to urinate. You may learn to delay urinating, practice double voiding, or have a urine timetable.

Medication for Urinary Incontinence

Sometimes, your doctor may recommend medications alongside other treatment options to help you regain bladder control. Some of these medications include anticholinergics to calm overactive bladders and topical estrogen to support healthy urethral tissue.

Medical Procedures

Medical devices such as urethral inserts and Pessary devices may be introduced to help maintain the urethral structure and prevent leaking. For people with overactive bladders, Botox injections into the bladder muscle can also be recommended.

Surgery

If other therapies do not work, your doctor may recommend surgery such as Sling procedures or insertion of an artificial urinary sphincter.

Other lifestyle management options include:

Maintaining a healthy weight
Watching your alcohol and caffeine consumption
Wearing easily removable clothes that aren’t tight at the waist
Not waiting too long to urinate

Conclusion

Although urinary incontinence is common with a higher likelihood as you age, it is not inevitable. With the right medical guidance, you can live a wholesome life without urinary incontinence being a barrier. Do you have symptoms of urinary incontinence? You can talk to a doctor here about the best treatment options available for you.

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