What is urinary incontinence? – Urinary incontinence is the inability to control when to pass urine, resulting in urine leaking out of the bladder without control. It has negative impact on the quality of life of those affected.

What is the normal process of evacuation of urine?

Normally, urine is produced from the kidneys, transported to the bladder, for storage, by the ureters and let out of the bladder through the urethra. A group of muscles form an elastic band (sphincter) around the neck of the bladder where it joins with the urethra.

The sphincter closes tightly when there is no need to pass urine. When this system is working optimally, you only release urine at will through the urethra when you get to a convenient place to do so.

Why does urinary incontinence occur?

Urinary incontinence occurs when any part of the system described above does not work as it should or there is damage to any part of the system.

Who can have incontinence?

Incontinence can affect anyone at any age. However, certain factors make it more common in certain groups of people. For example, incontinence is commoner in women than men.

This may be due to women having shorter urethra than men; effects of pregnancy, labour and menopause on the pelvic floor which supports the sphincter. Incontinence is also commoner at older age due to weakness of the pelvic support muscles. Other factors include enlarged prostate and previous prostate surgery.

What are the causes of urinary incontinence?

The causes of urinary incontinence may be temporary (short term) or permanent. Temporary causes of urinary tract infection include:

1. Urinary tract infection (UTI) – Infection along the urinary tract irritates the tract, increasing the need to urinate more frequently.
2. Drugs – Incontinence is a side effect of some medications such as diuretics.
3. Pregnancy – Incontinence occurs in pregnancy due to the pressure of the uterus on the bladder, reducing its capacity; as well as pregnancy hormones that relax the pelvic muscles, including the sphincter.
4. Alcohol – Alcohol stimulates the need to urinate frequently, water being a significant component of it and its waste product.

Long term causes of urinary incontinence include:

1. Diabetes – Excess sugar in urine attracts water in large quantity, increasing the quantity of urine produced and the need to urinate frequently. Frequent filling of the bladder increases the risk of urine leakage. Uncontrolled diabetes also affects bladder function, leading to leakage of urine.
2. Pelvic floor weakness – Weakness of the pelvic floor muscles affects bladder control, resulting in incontinence.
3. Menopause – The change in hormone levels that accompany menopause has significant impact on the strength of the muscles of the pelvis.
4. Enlarged prostate – Prostate is located around the neck of the bladder. Its enlargement affects normal functioning of the muscles of the bladder neck which maintain continence.
5. Complication of surgery – Damage to the bladder or the sphincter during surgery on the pelvis, such as prostate surgery, may result in long term incontinence.
6. Stroke –When the brain cells responsible for bladder control are affected by stroke, the result is urinary incontinence.
7. Injury to the bladder – Prolonged labour may result in injury to the bladder, from where urine leakage may occur

What are the symptoms of urinary incontinence?

The main symptom of urinary incontinence is involuntary leakage of urine, which may be continuous or occasional. The quantity of urine leaked per time may be minimal or large. You may experience skin changes around the area constantly being wet by urine (dermatitis). 

What are the treatment options for incontinence?

Treatment options for incontinence include:

Lifestyle changes – Some specific lifestyle modifications to improve incontinence include:

1. Regular pelvic floor exercise to strengthen the pelvic muscles.
2. Discontinuation of alcohol.
3. Avoiding drinking too much water or beverages before physical activity and late at night.
4. Regular emptying of the bladder without waiting for the urge to urinate.
5. Avoiding lifting of heavy objects.
6. Emptying the bladder before physical activities.
7. Bladder training: This entails gradually increasing the time intervals to pass urine, with the aim of increasing the bladder capacity to hold urine.

Medical treatment – Some drugs help to relax the bladder muscles so it can empty completely when passing urine. Antibiotics are needed for the treatment of infection in those with UTI. Menopausal women may benefit from hormone (oestrogen) replacement therapies, which return the tones of the muscles of the bladder and pelvic floor, subsequently relieving incontinence. 

Surgical treatment – This involves various injection of substances into the muscles of bladder and urethra or insertion of agents that stimulate the nerves to function in cases where the bladder control is the problem; or suspension of the bladder neck in order to accommodate more urine before having the urge to urinate. In those with damaged sphincter, artificial sphincter may be useful; while those with surgical or birth injury to the bladder, will require closure by experts.

How can urinary incontinence be prevented?

Some causes of urinary incontinence can be prevented while some may be difficult to prevent.

1. Prevention of prolonged labour may reduce the impact of labour on the pelvic floor, emphasizing labour management by skilled birth attendants.
2. Regular pelvic floor exercise may reduce the risk of urinary incontinence by helping with bladder control.
3. Maintenance of healthy weight by eating healthy diet, avoiding sedentary lifestyle and exercising regularly.