Urinary incontinence is defined as the accidental loss of urine. In the United States, an estimated 25 million adults have it temporarily or chronically. Although it can occur at any age, it is more common in women after 50.
Globally, up to 37% of women over 55 have urinary incontinence, a percentage that varies depending on the region, and reaches up to 45% in women in Asia.
The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence, also called overactive bladder.
This gender difference in the incidence of incontinence could be because pregnancy, childbirth, and menopause can increase the likelihood of this condition.
In addition to the biological processes typical of women, the female urethra is shorter than the male, so any damage or alteration of this duct can easily cause urinary incontinence more easily in women.
Although in the collective imagination, urinary incontinence is associated with the passage of time, it is not a normal part of aging and can, and should, be treated.
Urinary incontinence is a condition that can significantly alter work and social life.
Urine is a liquid produced by the kidneys, which filter waste and extra water that the body produces. This fluid is ready to leave the body in the bladder, which has muscles that tense when you need to urinate. It is at this time that urine finds its way out through the urethra.
Incontinence can occur when the bladder muscles suddenly tense up and the sphincter muscles are not strong enough to close the urethra. This causes a sudden, strong urge to urinate that you may not be able to control.
Pressure from laughing, sneezing, or exercising can cause some urine to leak. Urinary incontinence can also occur if there is a problem with the nerves that control the muscles of the bladder and urethra.
Types of incontinence
Urinary incontinence manifests itself in different ways, and the most common types are:
Stress incontinence It occurs when stress or pressure on the bladder causes urine to leak. This can happen when you cough, sneeze, laugh, lift something heavy, or do physical activity. Its causes include weakness of the pelvic floor muscles and a bladder out of its normal position.
Urge incontinence It occurs when you have a strong urge to urinate and a few drops “escape” before you can get to the bathroom. It is often associated with an overactive bladder. Urge incontinence is more common in older people. Sometimes it can be a sign of a urinary tract infection. It can also occur in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
Overflow incontinence. It occurs when the bladder does not empty completely. As there is a lot of liquid left, a little can be lost. This form of urinary incontinence is more common in men. Some of its causes include tumors, kidney stones, diabetes, and the use of certain medications.
Incontinence worksl. It occurs when a physical or mental disability, speech problems, or some other problem prevents a person from reaching the bathroom on time. For example, a person with arthritis may have trouble unbuttoning their pants, or a person with Alzheimer’s may not realize that they need to go to the bathroom.
Mixed incontinence It means that you have more than one type of incontinence. In general, it is a combination of stress and urge incontinence.
Transient incontinence. It is a leakage of urine caused by a temporary situation such as a urinary infection or a new medicine. Once the cause is removed, the incontinence goes away.
When the bed gets wet
This is the loss of urine during sleep. This is more common in children, and is called enuresis. It usually occurs in early childhood, and in many cases it is suffered by children whose parents also wet the bed.
But it can happen to adults too.
In adults, bedwetting causes include some medications, caffeine, and alcohol use. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection, kidney stones, an enlarged prostate, and sleep apnea.
Who is most at risk
Adults who are most at risk of developing urinary incontinence are:
- Women, especially after going through pregnancy, childbirth, or menopause.
- Older adults. As you age, the muscles of the urinary tract weaken, making it difficult to hold urine.
- Men with prostate problems
- People with certain conditions such as diabetes, obesity, or long-term constipation
- The smokers
- People who were born with a birth defect that affects the structure of the urinary tract.
Diagnosis and treatment
To diagnose urinary incontinence, the doctor asks several questions about the patient’s medical history. Many healthcare providers ask the person to keep a diary of their incontinence one day before the appointment, so they can determine patterns that can help determine the cause and design treatment.
You can also perform a pelvic exam, in the case of women, and rectal, in both women and men, to be able to palpate the bladder.
If these office steps aren’t enough, your doctor will probably order blood tests and imaging.
Treatment depends on the type and cause of urinary incontinence. Those that have to do with lifestyle changes include:
- Drink an adequate amount of liquid at the right time
- Be physically active
- keep a healthy weight
- Avoid constipation
- No Smoking
Bladder training: involves urinating following a certain schedule that the doctor will indicate according to previously collected information. This can help stretch the bladder so it can hold more urine.
Do exercises to strengthen the pelvic floor muscles, called Kegel exercises, which involve tightening and relaxing the muscles that control the flow of urine
If these treatments don’t work, the provider may suggest other options, such as medications that can help relax the bladder muscles to prevent spasms, or that work by blocking the nerve signals that cause urinary frequency and urgency.
There are also devices that can be used temporarily to “educate” the bladder.
If these methods don’t work, your doctor may recommend a cSurgery to keep the bladder in its normal position. This can be done with a sling that is attached to the pubic bone.
In most cases, treating the underlying condition that causes urinary incontinence can help stop those unwelcome and annoying leaks from happening.
Sources: Medlineplus, Mayo Clinic, National Institute of Diabetes and Digestive and Kidney Diseases, scientific studies.