Urinary incontinence
June 2003
Complete or partial loss of voluntary control over bladder function.
Normally, muscles in the bladder wall push urine out of the bladder, while muscles in the neck of the bladder and urethra (the tube from the bladder to the outside of the body) control the opening and closing of the bladder outlet. Any disorder affecting these muscles or their nerve supply can result in a partial or complete loss of bladder control. Urinary incontinence becomes more common with increasing age and is more common in women than in men. In the UK, it is estimated that at least three million adults cannot control their bladders as they would wish, and as many as one in three people will have such problems at some time during their adult lives.[1]
It also sometimes accompanies dementia or stroke.
There are four main types of incontinence: stress, urge, overflow, and total. The symptoms and treatment are different for each type.
- The most common type of incontinence is stress incontinence in which small amounts of urine are expelled involuntarily. In most cases of incontinence, minimally invasive management (fluid management, bladder training, pelvic floor exercises and medication) is prescribed. However, if that fails, surgical treatment can be necessary. Strengthening the pelvic floor muscles with pelvic floor exercises is an effective form of self-help treatment. Other treatments may include the use of urethral injections of bulking agents to improve the function of the sphincter. In severe cases, surgery to reposition the bladder and improve its support may be needed to restore near-normal bladder control.
- People who have urge incontinence feel an unexpected and urgent need to pass urine due to an involuntary contraction of the bladder, resulting in the uncontrollable and sudden passage of large amounts of urine.
- In overflow incontinence, the bladder cannot empty because of a blockage at the bladder neck or in the urethra or because of a weak bladder muscle. The volume of urine then builds up in the middle bladder, causing an intermittent dribble. Urine outflow is usually obstructed by a urethra structure or, in men, by an enlarged prostate gland constricting the urethra. A weak bladder muscle may be due to an obstruction, diabetes mellitus, pelvic surgery, or a nervous system disorder such as spina bifida or multiple sclerosis.
- In total incontinence, there is no bladder control. The condition usually results from a nervous system disorder such as dementia or spinal injury. Surgery to treat pelvic cancers can also cause incontinence by damaging nerves that supply the bladder.
Urodynamic studies can determine the type of incontinence. Pads to absorb urine can be worn to protect clothes. Pelvic floor exercises and physiotherapy may help to improve bladder muscle tone. Incontinence due to incomplete bladder emptying can be relieved by intermittent self-catheterization to drain the urine or permanent bladder catheterization if the person is disabled.
References:
[1] The Continence Foundation
Further information:
- BBCi Health – Urinary incontinence
- COCHRANE INCONTINENCE GROUP - Abstracts of Cochrane Reviews
- MEDLINEplus Health topics – Urinary incontinence
- MEDLINEplus Medical Encyclopaedia – Urinary incontinence
- National Prescribing Centre - Prescribing in urinary incontinence
- NHS Direct Online
- The Continence Foundation – for people with bladder and bowel problems