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Urinary Incontinence

Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is any involuntary or unwanted loss of urine. It is considered a medical condition if it happens regularly. The risk of developing incontinence increases with age, but younger people may also develop it. Women are more likely to suffer from this condition than men.

Incontinence is common and causes distress and embarrassment. Many people go without treatment because they feel uncomfortable discussing incontinence with their doctor.

If incontinence is frequent or affects your quality of life, it is important to seek medical advice. In most cases, incontinence can be treated or cured with various treatment options. These include pelvic floor exercises, drug treatment, or surgery. Together with your doctor you can discuss which treatment is best for you.

Causes of urinary incontinence

Some of the most common causes of urinary incontinence are:

  • Hormone deficiencies
  • Weak pelvic floor muscles
  • Neurological lower urinary tract dysfunction
  • Urinary tract infections
  • Benign prostatic enlargement (BPE)

Common risk factors include:

  • Pelvic surgery
  • Prostate surgery
  • Childbirth
  • Menopause

Urinary incontinence becomes more common with increasing age. However, it should not be seen as a normal part of ageing.

Types of urinary incontinence

There are different types of urinary incontinence, depending on how and when you lose urine. This is related to which part of the lower urinary tract is affected (Fig. 1a and 1b).

Stress urinary incontinence

Stress urinary incontinence (SUI) means that you lose urine during certain activities, like:

  • Coughing, sneezing, or laughing
  • Exercise like running or jumping
  • Lifting heavy things such as groceries

This happens because during these kinds of activities the pressure on your bladder increases. Your urethra or urinary sphincter cannot resist the pressure of a full bladder, and will leak urine.

Urgency urinary incontinence

Urgency urinary incontinence (UUI) happens when you get a sudden need to urinate which you cannot postpone. The bladder muscle contracts and you urinate when you do not want to.

Mixed incontinence

Your doctor may diagnose you with mixed urinary incontinence if you suffer from both SUI and UUI symptoms.

Fig. 1a: The male lower urinary tract. (urinary incontinence)
Fig. 1a: The male lower urinary tract. Fig. 1b: The female lower urinary tract.

Talking to your doctor

Talking about incontinence issues with a urologist may be uncomfortable, but it is important to do so. Untreated urinary incontinence can lead to health problems like infections, skin rashes, or sexual dysfunction. It can also cause stress, depression, low self-esteem, or shame. These problems can lead to isolation and affect your work and social life.

The doctor can help to improve your symptoms or even cure your condition. Your doctor needs to find out which type of incontinence you have and what causes it. This will help to find the right treatment.

Your doctor or nurse is the best person for discussing any questions about incontinence. You should not feel embarrassed about asking about any of your concerns.

It can be useful to prepare some questions before you make an appointment. Examples of questions you can ask during consultation are:

  • Why is this happening to me?
  • Is there a cure for my problem?
  • What tests do I need?
  • Which treatment option would you recommend for me and why?
  • What will happen in the next months and years if I do not get treatment?
  • What will happen in the next months and years if I do get treatment?
  • Will medication help with my incontinence?
  • Are there any side effects to the medication?
  • Do I need surgery?
  • What surgical options are there for me?
  • How soon can I expect a result from the treatment?
  • How often will I have to go back to the doctor?

You do not need to ask all of them. Choose the ones you think are most important to you.

Terms your doctor may use

  • LUTS (lower urinary tract symptoms) is a term used for the collection of symptoms which can point to a number of diseases affecting the urinary tract.
  • Neurological lower urinary tract dysfunction is a dysfunction of the lower urinary tract caused by problems in the nervous system that influence its activity.
  • Nocturia is waking up once or more per night because of the need to urinate.
  • Urine leakage is any involuntary loss of urine.