BLADDER CONTROL PROBLEMS (INCONTINENCE)

WHAT IS INCONTINENCE?

Urinary incontinence is the medical term for loss of bladder control. It is the involuntary loss of urine from the bladder – that is to say, urine leaks out of the bladder without its owner’s permission. Some people with urinary incontinence also have problems with bowel control.

HOW MANY PEOPLE ARE AFFECTED?

About 10% of women below age 65 suffer regular or severe urinary incontinence. Women are 7-8 times more likely to have the problem than men, although elderly men and women tend to be equally afflicted. In the older age groups incontinence tends to be both more common and more severe. About 25% of people over 65 years of age develop bladder control problems.

Minor degrees of incontinence are much more common, affecting probably as many as 1 in every 3 adult women. Indeed, 54% of the female population experiences some degree of involuntary loss of urine during their adult life. Minor problems tend to get worse with time, childbirth, and the menopause (change of life). This need not be inevitable and such deterioration can be prevented, often by simple treatments.

In childhood, the most common bladder control problem is bed-wetting, that continues after the age of 5 years. About 15% of children are still regularly wetting their beds at the age of 6. By 10 years of age only 10% are still doing so, and by 15 years, all but 4% of children have grown out of the problem. Childhood bed wetters are twice as likely to develop bladder control problems during adult life. By taking part in a bladder training program, with appropriate medication if needed, bedwetting can usually be cured.

WHO ARE MOST AT RISK?

Loss of bladder control can affect almost anyone regardless of age, sex or social group. Up to 70 years of age, women are more likely to suffer from incontinence than men, but after that age, the incidence of the problem in men increases sharply. There are a number of conditions which may increase the risk of developing incontinence. These include recurrent urinary tract infections (cystitis), diabetes, pregnancy or having had 4 or more children. In older members of society, impaired mobility, especially when the assistance of others is required, chronic constipation, and dementia can increase the risk.

Diseases of the nervous system can seriously affect an individual’s ability to control the function of the bladder. In children, spina bifida and intellectual handicaps are frequently associated with poor bladder control. Spinal injuries almost invariably cause problems and many people with multiple sclerosis are affected to some degree. In later life, strokes, Parkinson’s disease and dementia can compromise both the ability and the motivation to have bladder control. In older men, enlargement of the prostate gland may lead to bladder irritation. After removal of the prostate gland, most men’s bladders return to normal within a few weeks or months, but some continue to have problems.

Even if you are in one of these high-risk groups you should not despair. Much can be done to improve or cure bladder control problems in even the most severe cases. However, in order to benefit from the resources that are available, you must first seek help rather than passively accepting the problem or believing that nothing can be done. Something can always be done to help you.

WHAT TYPES OF INCONTINENCE ARE THERE?

The main types of incontinence are:

Stress Incontinence – The involuntary loss of urine immediately associated with coughing, sneezing,
lifting, straining or other physical exertion. The term “stress” relates to the mechanical stress of the abdominal muscles compressing the bladder wall, working against weakened sphincter muscles. Childbirth, obesity, constipation and changes in the sphincter muscles after menopause can aggravate stress incontinence. Some drugs (eg Minipress) can aggravate incontinence caused by sphincter weakness.

Patient Information Leaflets (click on a link below to download information). The following resources have been provided by the UroGynaecological Society of Australasia and are intended to be used as a guide for information of general nature.

Urge Incontinence – The involuntary loss of urine associated with a strong desire to urinate. The sufferer is unable to get to the toilet in time due to extreme urgency. The need to visit the toilet may occur very frequently during the day and often at night also. This is caused by an overactive or ” unstable” bladder which contracts to try and empty without its owner’s permission. The contractions give rise to an urgent desire to pass urine and leakage occurs if a toilet cannot be reached in time.

overactive Patient Information Leaflets (click on a link below to download information). The following resources have been provided by the UroGynaecological Society of Australasia and are intended to be used as a guide for information of general nature.

Dribble Incontinence – Leakage of urine without warning or provocation. This is a demoralising condition because leakage can occur at any time and is unpredictable. As a consequence, protective appliances are needed nearly all the time.

Overflow Incontinence – Involuntary loss of urine associated with a chronically distended and overfull bladder. The bladder may be distended as a result of incomplete emptying. This, in turn, may be caused by obstruction to the outlet of the bladder (by enlargement of the prostate gland for example), or as a result of a failure of the bladder muscle to contract properly. Bladder failure of this kind may be caused by disease of the nervous system, by some drugs or by psychological factors.

Reflex Incontinence – Loss of bladder control associated with disease of the nervous system and sometimes with loss of bladder sensation. Due to overactive reflexes in the spinal cord the bladder contracts, as if to empty, at inappropriate times and places usually resulting in total flooding incontinence. The bladder may not empty satisfactorily in these circumstances, and urinary infections and overflow incontinence may occur as well.

Of course, it is possible for an individual to suffer from more than one type of incontinence.