Introduction
Urinary incontinence describes the condition where there is the involuntary loss of urine (i.e. leakage of urine). This includes situations where there may be a small amount of urine that 'leaks' out in certain circumstances (such as when sneezing or laughing), to complete loss of bladder control usually preceded by a strong urge to urinate. The term 'incontinence' can also apply to a similar lack of control of bowel movements, where it is referred to as 'faecal incontinence' (not covered here).
Urinary incontinence is very common - nearly 5 million people in Australia experience some form of incontinence in their lives. Women who have given birth, particularly via vaginal delivery, are susceptible to incontinence (30% have or have had the condition) and 20% of children suffer incontinence (i.e. 'wet the bed') at some point during their childhood.
Causes
Many factors can cause issues with incontinence. These include:
- Weakness in muscles in the pelvic floor (this is a very common cause), often due to childbirth.
- Conditions affecting the brain, spinal cord or nerves exiting the spinal cord that are involved with the pelvic floor, bladder or bowel function.
Some other health conditions are associated with incontinence. The most commonly associated conditions include:
- Dementia
- Diabetes
- Enlarged prostate
- Multiple Sclerosis
- Parkinson's Disease
- Stroke
- Urinary tract infections
Incontinence is classified into many distinct types. The most common are:
Stress
Incontinence associated with physical exertion. This type is generally associated with childbirth, obesity and surgery affecting organs in the pelvis (i.e. prostate surgery).
Urge
This is where there is a sudden need to urinate associated with the leakage of urine. Sometimes no specific cause is identified, and in other cases, this can be caused by BPH or neurological conditions such as multiple sclerosis, stroke and Parkinson's disease.
Functional
This is where the incontinence is due to a problem whereby the patient is unable to get to a toilet in time. This can be a physical disability or a neurodegenerative disorder (for example dementia).
Incontinence associated with the chronic retention of urine
Incontinence that occurs due to the bladder not emptying properly. This can be caused by benign prostate hyperplasia and peripheral neuropathy from diabetes
Tests / Diagnosis
A doctor will need to perform a range of tests to determine the cause of the condition. The first of these is a review of medical history and symptoms and a physical examination. Further tests may include:
Urinalysis
A test to determine the composition of urine and the presence of a urinary tract infection.
Ultrasound
To assess the structure of the kidneys and the bladder and the ability of the bladder to empty completely.
Cystoscopy
This involves the insertion of a camera into the urethra and through to the bladder allowing the doctor to inspect the urethra and the lining of the bladder.
Urodynamics
This test allows for an accurate assessment of how the bladder is functioning when it is being filled and when the patient attempts to empty the bladder. This test is often employed in difficult cases and before operative intervention.
Related Information
Overactive bladder
Female sling
Male Sling and Sphincter
Intravesical Botox
Urethral bulking
Sacral Neuromodulation