How to deal with urinary incontinence

What urinary incontinence is

Urinary incontinence is the involuntary leakage of urine that occurs during ordinary activities — laughing, coughing, lifting shopping or walking. It affects both women and men, and its background is most often changes in the body that make control over urination more difficult.

The most common causes

Urinary incontinence usually develops gradually. In women it most often appears after pregnancy, during the menopause or after intense effort, when the pelvic floor muscles lose their elasticity. In men it is usually linked to prostate enlargement or to neurological disorders. The causes listed include:

• weakening of the pelvic floor muscles after pregnancy or childbirth
• hormonal changes related to the menopause
• prostate enlargement and prostate disease
• neurological disorders affecting bladder function
• chronic urinary tract infections
• obesity, which increases pressure on the bladder
• certain medicines affecting the production and excretion of urine
• caffeine, alcohol and carbonated drinks in the daily diet

After childbirth and during the menopause

After childbirth the muscles responsible for controlling urination may be weakened and need time to regain their tone. During pregnancy the growing uterus pressed on the bladder for many months, and stretched tissues do not return to their previous state at once — which is why small leaks may appear when walking, laughing or lifting a child.

During the menopause the mechanism is different: falling oestrogen levels affect the moisture and elasticity of tissues and the tone of the muscles. The bladder then reacts faster, and more frequent urgency and difficulty holding urine during sudden effort become more noticeable.

Types of urinary incontinence

Identifying the type of incontinence is the basis for planning treatment. Observing the situations in which leakage occurs helps with this:

• stress incontinence — leakage appears when laughing, coughing, walking briskly, climbing stairs or lifting a weight; it is most often linked to weakened pelvic floor muscles
• urge incontinence — the bladder reacts with a sudden, hard-to-control need to urinate, often with a feeling of fullness despite the bladder not being full
• mixed incontinence — both mechanisms occur at the same time

It is also worth noting how often you visit the toilet and whether you wake at night — this information makes diagnosis easier for the doctor.

Which tests are used in diagnosis

During the visit the doctor discusses the complaints and selects tests according to the type of problem. Most often these are:

• a laboratory urine test
• ultrasound of the urinary tract — assessment of the bladder and exclusion of an obstruction to urine flow
• urodynamic tests — assessment of bladder function during filling and emptying
• in women, assessment of pelvic floor muscle tone; in men, assessment of the prostate

There is no need to wait for symptoms to intensify — diagnosis can be started at any stage.

Methods of treatment

The approach is chosen by the doctor according to the type and severity of the problem. The methods used are:

• urogynaecological physiotherapy — exercises strengthening the pelvic floor muscles
• bladder training — used especially for urge incontinence
• pharmacotherapy — stabilises bladder function and limits sudden urgency
• minimally invasive procedures improving the quality of tissue around the urethra and vagina
• surgery — reinforcement of the urethra in more advanced cases

The choice of method depends on the diagnosis and the patient's health; the decision is made by the doctor after an examination.