Urinary incontinence, simply put, is the involuntary leakage of urine. In Australia, there are more than 5 million people who have some form of incontinence. It's a surprisingly common issue that can affect people of all ages, from young children to older adults.The condition may vary in severity and frequency, ranging from minor leaks when coughing or sneezing to a strong, urgent need to urinate that is difficult to control. While it might not be a life-threatening condition, it can definitely be a major inconvenience and disrupt your daily routine. 

Here, we’ll delve deeper into the various causes of urinary incontinence, helping you understand why it happens. We'll also explore different management strategies to regain control and improve your quality of life.

Types of urinary incontinence

Urinary incontinence can manifest in several ways, each with its own set of triggers and symptoms.

Stress incontinence

Stress incontinence is the most common form of incontinence, especially among women. It occurs when physical movements or activities like coughing, sneezing, laughing, or exercising increase intra-abdominal pressure and consequently pressure on the bladder. This added pressure can cause the bladder to leak urine unexpectedly. The root cause often lies in weakened pelvic floor muscles, which can result from childbirth, surgery, or hormonal changes, typically failing to support the bladder adequately under stress.

Urge incontinence

Urge incontinence, also known as overactive bladder, is characterised by a sudden, intense urge to urinate followed by an involuntary loss of urine. The urge to urinate may be so strong that it's difficult to reach the toilet in time, resulting in leakage. This type of incontinence can be caused by minor conditions like urinary tract infections or more severe issues such as neurological disorders, diabetes, or bladder abnormalities.

Overflow incontinence

Overflow incontinence occurs when the bladder cannot empty properly, leading to frequent or constant dribbling of urine.This type often stems from an obstruction to urine flow or nerve damage that inhibits bladder contractions, making it difficult to empty the bladder completely. Men with prostate gland problems or people with diabetes are particularly susceptible to this type of incontinence.

Mixed incontinence

Mixed incontinence is a combination of more than one type of urinary incontinence, with stress and urge incontinence being the most common pairing. Individuals with mixed incontinence may experience both sudden urges to urinate and leakage during physical activities. Diagnosing and treating mixed incontinence can be complex because it involves addressing the symptoms and causes of multiple types of incontinence simultaneously.

Reflex incontinence

Reflex incontinence is another distinct type of urinary incontinence, where urine leakage occurs without any warning or even an urge to urinate. This type of incontinence typically results from damage to the nerves that usually warn the brain of a full bladder, often due to neurological diseases, spinal cord injuries, or other severe conditions affecting the central nervous system. 

Causes of urinary incontinence

Urinary incontinence can stem from various factors, each affecting the bladder and surrounding muscles in different ways. Here’s a closer look at some common causes:

1. Ageing

As people age, natural changes in the bladder muscle and the nerves that control the bladder can lead to incontinence. The bladder capacity may decrease, and the frequency of involuntary bladder contractions may increase. Additionally, age-related changes in cognitive function, such as those seen with Alzheimer’s disease, can affect the ability to recognise and respond to the urge to urinate.

2. Pregnancy and childbirth

During pregnancy, the growing uterus exerts increased pressure on the bladder and pelvic floor muscles. This pressure, coupled with hormonal changes that relax pelvic floor tissues in preparation for childbirth, can weaken these muscles. Childbirth itself can further strain and damage the pelvic floor muscles and nerves, particularly with vaginal deliveries, leading to stress incontinence after pregnancy.

3. Menopause

The hormonal changes that occur during menopause, particularly the reduction in oestrogen, can affect the health of the bladder and urethra. Estrogen helps to keep the lining of the bladder and urethra healthy, and the decrease in oestrogen can lead to thinning of these tissues, increasing the risk of incontinence.

4. Neurological conditions

Certain neurological conditions, such as multiple sclerosis, Parkinson's disease, or a stroke, can interfere with nerve signals involved in bladder control, leading to urge incontinence or reflex incontinence. Damage to nerves that communicate bladder fullness can prevent the brain from receiving the message to empty the bladder at the appropriate time, resulting in involuntary leakage.

5. Urinary Tract Infections (UTIs)

Infections in the urinary tract can irritate the bladder, causing temporary incontinence. During a UTI, the bladder becomes inflamed and overly sensitive, which can trigger strong urges to urinate and result in leakage.

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6. Medications

Some medications can contribute to urinary incontinence by relaxing the bladder muscles, decreasing bladder control, or increasing urine production. Diuretics, sedatives, muscle relaxants, and some antidepressants are known to potentially aggravate incontinence issues.

7. Obesity

Excessive body weight increases pressure on the abdomen and pelvic floor muscles, which can lead to stress incontinence. The additional strain can weaken the pelvic floor over time, making it more difficult to control urination.

8. Vaginal infections or irritation

Vaginal infections or irritation, such as yeast infections or bacterial vaginosis, can lead to temporary urinary incontinence in some cases. Inflammation and irritation in the vaginal area can affect nearby structures, including the urethra, leading to symptoms such as increased urinary frequency or urgency, and in some cases, leakage.

9. Smoking

Coughing from habitual smoking can put repeated pressure on the pelvic floor muscles, leading to stress incontinence. Additionally, smoking can also irritate the bladder lining, exacerbating urge incontinence

What are the risk factors for urinary incontinence?

Several factors can increase the likelihood of experiencing urinary incontinence:

• Gender - Women are more prone to urinary incontinence compared to men because of unique anatomical and physiological changes women experience throughout their lives such as pregnancy, menopause and childbirth. 
• Age - The risk of urinary incontinence increases as people age. Age-related changes can weaken bladder muscles and impair nerve function.
• Obesity - As mentioned before, excess weight puts increased pressure on the abdomen and pelvic floor muscles, which can weaken these structures over time.

Chronic conditions - Neurological conditions like MS or Parkinson's can disrupt bladder control. Even diabetes can damage nerves controlling bladder function and increase UTI risk.

Management and treatment options

Urinary incontinence is often manageable with the right combination of treatments tailored to individual needs, and you can start by doing a little bit of lifestyle changes such as:

• Adopting a healthy diet and exercise regimen to maintain a healthy weight to help reduce pressure on the bladder.
• Strengthening the pelvic floor muscles through exercises like Kegels can improve bladder control and reduce leakage.
• Scheduling bathroom trips at regular intervals to gradually increase the time between voids and train the bladder to hold urine for longer periods.

Medications and supplements

Certain medications can help control bladder function or treat underlying conditions contributing to incontinence. For example, anticholinergic medications can reduce bladder spasms and overactivity, while oestrogen therapy may be beneficial for postmenopausal women with incontinence related to hormonal changes.

Additionally, supplements may offer alternative options for managing symptoms. For women, supplements containing ingredients like cranberry extract, pumpkin seed extract, and soy isoflavones can support bladder health and hormone balance. For men, specific supplements like the ones you’d find in Australian NaturalCare Prostate Care Complete may be beneficial, containing saw palmetto and Crateva. These ingredients are known for their potential to support prostate health and improve bladder function.

Surgical options

For severe cases of urinary incontinence that do not respond to other treatments, surgical procedures may be considered, which includes:

• Sling procedures - A surgical mesh or tissue sling that is placed under the urethra or bladder neck to provide support and prevent leakage.

• Bladder neck suspension - This procedure involves lifting and supporting the bladder neck and urethra to improve control and reduce leakage. 

Behavioural therapies

• Biofeedback - This technique involves using electronic sensors to monitor muscle activity and provide feedback to help individuals learn to control their pelvic floor muscles.

• Electrical stimulation - Electrical stimulation of the pelvic floor muscles can help strengthen them and improve bladder control

Conclusion

It's essential to recognise that urinary incontinence is not a condition to suffer in silence. Seeking medical advice for proper diagnosis and personalised treatment plans is crucial. Healthcare professionals can provide tailored guidance and support to help you navigate your journey towards improved bladder control and enhanced quality of life.

If you’re seeking additional information or support, there are resources available, including reputable websites, educational materials, and support groups dedicated to urinary incontinence In Australia:

• Continence Foundation of Australia
• The Australian Government Department of Health and Aged Care
• Australian Physiotherapy Association (APA) - The APA can help individuals find qualified physiotherapists with expertise in pelvic floor rehabilitation
• Pelvic Floor First

These resources can provide valuable insights, guidance, and a sense of community for you and caregivers facing the challenges of urinary incontinence.

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