There are different types of urinary incontinence.
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Stress incontinence is the most common type. It occurs when the pressure in the bladder becomes too great for the bladder outlet to withstand. It usually occurs because the pelvic floor muscles which support the bladder outlet are weakened. Urine tends to leak most when you cough, laugh, or when you exercise (such as when you jump or run). In these situations there is a sudden extra pressure ('stress') inside the abdomen and on the bladder. Small amounts of urine may leak, but sometimes it may be quite a lot and cause embarrassment. The common reason for the pelvic floor muscles to become weakened is childbirth. Stress incontinence is common in women who have had several children. It is also more common with increasing age and with obesity.
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Urge incontinence (unstable or overactive bladder) is the second commonest cause. This is when you get an urgent desire to pass urine. Sometimes urine leaks before you have time to get to the toilet. The bladder muscle contracts too early and the normal control is reduced. The cause is not known but it seems that the bladder muscle gives wrong messages to the brain, and the bladder may feel fuller than it actually is.
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Mixed incontinence. Some people have a combination of stress and urge incontinence.
More than 9 in 10 cases of urinary incontinence are due to the above causes. Other causes are less common. They include
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Neuropathic incontinence. This is when the nerves that control the bladder and surrounding structures are affected in some way. For example, some people with multiple sclerosis, spinal cord damage, brain disorders, etc, develop this type of incontinence.
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Overflow incontinence. This is when there is an obstruction to the outflow of urine. The obstruction prevents the normal emptying of the bladder. A pool of urine constantly remains in the bladder that cannot empty properly. However, pressure builds up behind the obstruction. The normal bladder emptying mechanism becomes faulty and urine may leak past the blockage from time to time. An enlarged prostate gland in men is the common cause of this. Treatment depends on the cause. For example, removal of the prostate (prostatectomy) if an enlarged prostate is the cause.
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Bedwetting (enuresis) occurs in many children, but some adults are affected.
What can be done about urinary incontinence?
Urinary incontinence can usually be improved, and can be cured in many cases. Each type of urinary incontinence is treated differently.
Assessment
It is important to know which type of incontinence you have. Tell your doctor if you leak urine on a regular basis. He or she will be able to assess your symptoms, examine you, and may do some simple tests to try to clarify the cause. You may also be asked to keep a diary for a few days to assess how often you go to the toilet, how much urine you pass each time, and how often you leak urine. Sometimes a referral to a specialist is needed to clarify the type of incontinence. The sort of tests that may be done by your GP or specialist to clarify the cause include the following:
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Urinalysis. This is a simple 'dipstick' test to check for infection, blood or protein in urine.
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Residual urine. This test finds out if any urine is left in your bladder, and how much urine is left, after you have gone to the toilet. The most accurate way of doing this is for a doctor or nurse to pass a thin catheter (a thin soft tube) into the bladder via the urethra. Urine then drains out to be measured. Another way this test may be done is by using an ultrasound scan of the bladder (although this can be a less accurate measurement).
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Vaginal and anal examination. A doctor or nurse may insert a gloved finger into the vagina and rectum (back passage). This can assess the strength and tone of the pelvic floor muscles. For men, the rectal examination can also assess the size of the prostate gland.
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Urodynamics. These are tests of urine flow that are sometimes done in a hospital unit if the cause of the problem is not clear.
Treatment
Treatment depends on the type of incontinence. Separate pages discuss stress incontinence, urge incontinence, and enuresis (bedwetting in children). For example: pelvic floor muscle exercises may cure stress incontinence; bladder training may cure urge incontinence; an alarm system may cure enuresis; medicines are sometimes used to help stop urge and stress incontinence, and also to stop enuresis. Other types of incontinence are less common and treatments vary, depending on the cause.
Your GP may advise on treatment or refer you to a continence advisor for advice on such things as pelvic floor exercises or bladder training. In some situations, you and your doctor may decide to 'wait and see' how things go before trying treatment. This is because some mild cases get better on their own over time without treatment. Sometimes a specialist needs to be involved in more difficult cases. Surgery is sometimes used to treat incontinence, especially stress incontinence.
If your incontinence persists and is not helped by treatment, your local continence advisor can give practical advice on how to manage. They may be able to supply incontinence pants, pads, etc. These days there are many different aids, gadgets and appliances that can greatly help when living with incontinence.
Further help and information
Continence Foundation 307 Hatton Square, 16 Baldwin Gardens, London, EC1N 7RG
Tel (Helpline): 0845 345 0165 Web: www.continence-foundation.org.uk
Helps people who have some problem with bladder or bowel control in their adult lives.
Incontact United House, North Road, London, N7 9DP
Tel: 0870 770 3246 Web: www.incontact.org
For people affected by bowel and bladder continence problems, and their carers.
©EMIS and PIP 2005
