Urinary Incontinence

Urinary incontinence can be of many types; these include:

• Stress incontinence occurs when urine leaks due to pressure on the bladder e.g., when sneezing, coughing, laughing, exercising, or lifting heavy weights.
• Urge incontinence occurs when there is a sudden, strong, and uncontrollable urge to urinate.
• Overflow incontinence occurs when the bladder cannot be completely emptied, leading to frequent leakage of small amounts of urine. This is more common in individuals with chronic conditions like diabetes, stroke, or multiple sclerosis (MS).
• Neurogenic incontinence occurs when bladder dysfunction or the lack of bladder control arises from brain, spinal cord, or nerve problems. Neurogenic incontinence is extremely common in people with spinal cord injuries, cerebral palsy, and stroke; sometimes, it may also be congenital (caused by birth defects).
• Total incontinence occurs when the bladder cannot store urine, causing continuous leakage.
• Mixed incontinence occurs when more than one factor contributes to urine leakage. 

The symptoms of urinary incontinence can vary based on the type. Lower urinary tract symptoms (LUTS) are common features associated and include:

• Problems with storing urine occur when there is a sudden or frequent urge to urinate, or a feeling of needing too empty the bladder again just after you have done so.
• Problems with passing urine occur when there is straining to pass urine, a slow stream of urine, or intermittent stopping and starting during.
• Problems after urination feeling that the bladder is not completely emptied or the leakage of few drops of urine after urination.

Several factors can contribute to urinary incontinence, and these may differ between individuals. Some common causes include:

• Weak pelvic floor muscles, often resulting from childbirth, pregnancy, or menopause can lead to stress incontinence by reducing bladder support.
• Overactive bladder results in urgent and frequent urges to urinate, often leading to urge incontinence.
• Neurological conditions such as multiple sclerosis, Parkinson’s disease, and stroke interfere with nerve control of the bladder.
• Urinary tract infections (UTIs) cause irritation to the bladder, causing temporary incontinence. Once the infection is treated, incontinence usually resolves.
• Medications such as diuretics can increase urine production and lead to incontinence.
• Obesity increases pressure on the bladder, contributing to stress incontinence.
• Chronic coughing associated with conditions such as chronic bronchitis can weaken pelvic floor muscles, leading to leakage when coughing.
• Hormonal changes during menopause can affect bladder function and pelvic support.

A proper diagnosis involves history-taking, examinations, and investigations. Steps include:

• Physical examination of the pelvis can be conducted to assess floor strength and check for abnormalities.
• Urinalysis detects infections  or blood, with treatment given if an infection in confirmed .
• Urodynamic testing measures how well the bladder and urethra are store and release urine, helping identifying the cause.
• Imaging tests such as ultrasound  or MRI when anatomical abnormalities are suspected.

Treatment options depend on the type and cause of urinary incontinence. Common approaches include:

• Pelvic floor exercises (Kegel exercises) strengthen the pelvic floor muscles, improve control of leakage.
• Bladder training involves scheduled bathroom visits, gradually increasing the time between urinations.
• Medications may relax the bladder in urge incontinence, while hormonal therapies help women after menopause.
• Lifestyle modifications, including weight loss, reducing caffeine and alcohol intake, and quitting smoking, can significantly improve symptoms.
• Absorbent products like pads or adult diapers provide security against leakage.
• Physical therapy with a trained specialist offers tailored pelvic floor rehabilitation.
• Surgical options may be recommended in severe cases to support the bladder or improve control.

You should see a doctor if urinary incontinence is persistent, worsening, or affecting daily activities and quality of life. Seeking help early can lead to more effective management.

Not all types of urinary incontinence can be prevented, but steps to reduce risk include:

• Maintaining a healthy weight reduces pressure on the bladder.
• Staying active strengthens pelvic floor muscles and improves bladder function.
• Performing pelvic floor exercises such as Kegel, keeps pelvic support strong.
• Limit irritants such as caffeine, alcohol, and spicy foods reduces bladder irritation.
• Staying hydrated supports bladder health, through excess water before activities should be avoided.
• Seek help for constipation prevents straining can weaken the pelvic muscles.

The appropriate specialist to approach for urinary incontinence is usually a urologist or urogynaecologist, depending on whether the issue is general or specific to women’s health. In some cases, a gynaecologist, neurologist, or physiotherapist with expertise in pelvic floor disorders may also be involved.