Types of urinary incontinence and why it happens
Incontinence is leakage of urine from the bladder. It can happen to anyone at any age, but is more common in women. The idea that it affects only the elderly is not really true as pregnant women and active women who participate in sports, such as jogging, are starting to notice the problem.
What type of incontinence do you have?
There are two main types of incontinence:
- stress incontinence (leakage of urine when you cough, laugh, bend over or exercise)
- urge incontinence with overactive bladder (the sudden urge to pass urine, and maybe not reaching the toilet in time).
Many women have both types together and this is called mixed incontinence. Look at the box below to see what type you have. About 1 in 4 women with urinary incontinence also have faecal incontinence (Obstetrics and Gynaecology 2002;100:17–23).
Another type of incontinence that can happen in men is called ‘overflow incontinence’. This is caused by a blockage of the urethra (e.g. because of a large prostate), which prevents the person from urinating. Symptoms include:
- interrupted urinary flow (start and stop urinating)
- dribbling after urination
- continual leakage of small amounts of urine.
|Questions to ask yourself||Stress incontinence||Overactive bladder and urge incontinence||Mixed incontinence|
|Do you go to the toilet to pass urine more than 8 times a day?||No||Yes||Sometimes|
|Do you go to the toilet to pass urine more than once during the night?||Not usually||Most nights||Most nights|
|Do you ever have to hurry to reach the toilet in time (for urine)?||No||Yes||Yes|
|Do you ever not reach the toilet in time (for urine)?||No||Often||Often|
|Do you ever leak urine when you laugh, sneeze, cough, run or jump?||Always||No||Always|
|If you leak urine, is it just a drop or is it sometimes quite a bit more?||Small||Large (usually)||Large|
|Are you able to hold your urine alright, but you need to pass it more than 8 times a day, in small or large amounts each time?||See your doctor, because you might have a urine infection (small amounts) or diabetes (large amounts and you are thirsty).|
Reasons for stress incontinence
Leakage of urine when you cough, laugh or bend over, or with exercise such as jumping or jogging, is called stress incontinence. It is most common in young women (25–49 years of age). It occurs if the sphincter muscles are not strong enough to hold the urine in when the pressure in the abdomen increases (as happens when you laugh or cough). No one knows exactly why these muscles may become weak; some women notice the problem after childbirth or during or after menopause. Women with stress incontinence often have leakage of urine during sex, usually at penetration (when the penis enters).
Genes are now thought to be a very important cause of stress incontinence, which explains why this type of incontinence tends to run in families (Obstetrics and Gynecology 2005; 106: 125–38). Because of their genes, some women are born with a weak pelvic floor. It is probably a weakness of collagen, the tiny strengthening fibers of muscles.
Obesity. Being overweight is a major cause of incontinence. It puts stress on the pelvic floor muscles, so if you are obese you double the chance of pelvic floor weakness (New England Journal of Medicine 2009;360(5):481–90).
Childbirth is probably an important cause of stress incontinence. The actual birth is mostly responsible, not just the pregnancy (Acta Obstetricia et Gynecologica Scandinavica 2010;89(12):1511–22). Women who have had Caesarean sections may not develop incontinence. The nerves can be stretched and bruised during a natural delivery through the vagina, and they are then unable to make the pelvic floor work after the birth. As a result, the muscles become lazy and weak.
Hysterectomy. A woman who has had a hysterectomy is more likely to develop incontinence in middle age than a woman who has not had the operation.
Menopause may be another reason, perhaps because the lowering levels of estrogen make the pelvic floor muscles less efficient. However, recent research shows that although the likelihood of incontinence increases in middle-age, the hormone changes of the menopause may not be the main cause. It could be that middle-aged women are more likely to be overweight and to have had a gynecologic operation, such as a hysterectomy.
High-impact sports, such as jogging on hard pavements, are probably not good for the pelvic floor. Sports such as swimming and cycling are fine. Interestingly, women parachutists in the US Air Force have developed incontinence because the impact of landing has damaged their pelvic floor.
Lifting heavy objects strains the pelvic floor. If you have to lift anything heavy (such as a baby or small child!), get into the habit of doing it in the right way. Place your feet firmly apart in the walking position, and bend at the knees and hip but keep your back straight. Tighten your pelvic floor muscles, hold the heavy object close to you and then lift by straightening your legs.
Smoking 20 cigarettes/day (now or in the past) doubles your likelihood of urinary incontinence: another reason for never smoking.
Drugs can relax the pelvic floor around the ring of muscles at the neck of the bladder, making leakage more likely. The most common culprits are some blood pressure medications, particularly alpha-blockers such as prazosin and doxazosin, which are also prescribed to men who have a large prostate. If your incontinence problem seems to be related to starting treatment for blood pressure and you are a man, ask your doctor if you are taking an alpha-blocker. Other medications such as fluoxetine (Prozac) and muscle-relaxant drugs, can also promote urine leakage.
Reasons for urge incontinence and overactive bladder
The sudden need to pass urine desperately, and maybe not being able to reach the toilet in time, is a slightly different sort of incontinence called urge incontinence and overactive bladder. The cause is the bladder muscle; it starts to contract when it should be stretching to hold more urine. This is called an overactive or irritable bladder (the medical term is detrusor overactivity, because the bladder muscle is called the detrusor muscle). People with urge incontinence have to pass urine often (probably more than eight times a day and also during the night), but may not pass much each time. Women with urge incontinence often have leakage of urine during sex, usually at orgasm.
Reasons for mixed incontinence
Some people with incontinence have both stress incontinence and an overactive bladder. The ‘stress’ symptoms may be more prominent than the ‘urge’ symptoms, or vice versa.
Written by: Diane Newman
Edited by: Diane Newman
Last updated: Wednesday, February 1st 2012
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Of every 10 women, 4 have suffered from incontinence at some time in their adult life
Incontinence costs the UK National Health Service about £242 million/year
In the USA, 20 million people have incontinence of urine. The annual cost is about $12.4 billion for women and $3.8 billion for men
In the USA, at least $4.5 billion is spent on incontinence pads every year