The inability to hold urine, resulting in leakage or wetting.
Causes of Incontinence
As the bladder fills, its muscular walls involuntarily contract. This would lead to urination except that a sphincter of muscle around the outlet from the bladder remains closed under voluntary control until the desired time to release urine.
The natural tendency of the sphincter is to relax once the bladder is moderately full, as happens in infants. Children and adults gain voluntary control over the sphincter so that they can hold and release urine at will. However, ageing, dementia and disease of the nerves, such as multiple sclerosis, can weaken this voluntary control, so that once again the bladder-empties automatically when it is only partially full. Urge incontinence can also be as a result of nerve damage caused during bowel and prostate surgery.
In stress incontinence anything that increases abdominal pressure, for example sneezing, coughing, laughing or simply standing, causes leakage of urine through the inefficient sphincter. This is a major cause of adult incontinence.
The anatomy of the neck of the bladder is critical to the control of urine. In women childbirth often results in changes to this anatomy and weakens the muscles of the pelvic floor. These factors commonly lead to prolapse (descent) of the womb and stress incontinence.
Incontinence may be made worse by minor infections; this is more common in women, particularly after the menopause.
Symptoms of Incontinence
Urine leaks occur. If leaking follows straining, the likelihood is stress incontinence, that is, weakness of the sphincter. If there is an urge to pass small, frequent amounts of urine there is probably a nerve problem or a chronic irritation of the bladder neck. There may also be signs of dementia such as memory loss and breakdown of personality. There may be a previous history of stroke or abdominal surgery.
It is important to detect infections or diabetes by testing the urine. The diagnosis of the type of incontinence is aided by very precise tests of urine flow and bladder pressure, called eystometric studies. These help predict the value of treatment with drugs as opposed to physiotherapy or surgery.
Treatment of Incontinence
Assuming any infection has been treated, incontinence in women is helped by hormone replacement therapy (HRT), which restores the health of the sphincter muscle. The drugs which decrease unwanted bladder muscle contractions, for example flavoxate and oxybutynin, work best for women. Newer drugs include tolterodine and tamsulosin.
For stress incontinence, pelvic floor exercises strengthen the muscles around the bladder that assist continence, and are recommended after childbirth. In cases of severe stress incontinence, surgery can restore the anatomy around the bladder neck (repair of prolapse).
For incontinence with brain disease, the above-mentioned drugs can reduce the frequency of incontinence, as does restricting fluid intake before bed and taking the person to the toilet regularly. In the worst cases it may be best to drain urine with a catheter. Modern catheters arc non-irritant and designed to stay in place for several weeks.
Lastly, it is possible to divert urine into the bowel or into a bag on the abdomen, called a urostomy. Such operations are done for incontinence after bowel surgery.
Commonly Asked Questions
How common is incontinence?
Exact figures are not available; by the age of 70 probably at least 10% of women and 2—5% of men experience incontinence. 7 lie figure rises rapidly above that age.
Why do so many people simply put up with it?
Incontinence has a bad public image with overtones of self-neglect and dementia. Evidently, this is quite unjustified. Also there is a lack of knowledge about treatments available for both men and women, regardless of age.
Complementary Treatment of Incontinence
Shiatsu-do techniques calm the nervous system and have positive benefits on the emotions; they also boost immunity – all factors in combating incontinence. Some yoga positions can help, in conjunction with specific exercises to strengthen the pelvic floor. Hypnotherapy – the therapist will use visualization, suggestion and regression to strengthen the bladder and uncover the origin of the incontinence.