Incontinence in Men and Women: The Main Causes and Treatments

Urinary incontinence has a surprisingly common range of symptoms in both men and women. It is a delicate area of discussion for anyone with difficulties in controlling urine elimination because it is private and oftentimes quite an embarrassing subject to mention.

 A leaky bladder is not a consequence of aging as first thought by many, though as we become older the symptoms worsen. Bladder problems affect all age groups, and in adults underlying causes determine the scope and severity of symptoms.

Simply put, urinary incontinence is leakage of urine from the bladder. The medical condition may involve urinating at the wrong time or uncontrollable wetting. It is not considered a disease but rather a symptom of several dysfunctions of the bladder or urethra.

 There are four main urinary dysfunctions that are most commonly encountered by individuals, these are: stress, urge, overflow and mixed urinary incontinence.

 Stress Incontinence

When uncontrollable wetting happens, it means that the muscles that keep your bladder closed (sphincter) are either too weak or too active. If your bladder is weak, incidence of wetting will occur when you sneeze, get into a fit of laughter, or lift heavy objects. This is called stress incontinence and is brought about during physical activities that lead to intra- abdominal pressure (IAP) or weakness of the pelvic floor. Individuals with this type of muscle weakness usually encounter continuous leakage.

Urge Incontinence

With an overactive bladder you may experience a sudden, compelling urge to void or urinate while very little is in the bladder. The primary problem with this condition is that the person cannot voluntarily hold on to or retain urine in the bladder, due to muscle (detrusor muscle) over-activity. Although the bladder empties completely, any small amount of urine produced will result in the urge to go.

Overflow Incontinence

Another common problem of frequent dribbling is urinary overflow. Individuals with this type of leakage never feel completely emptied. The condition is due to over-inflation or distension of the bladder. This problem is often seen in men with prostate complications (prostatic hyperplasia), patients with multiple sclerosis, and spinal cord trauma.

Mixed Incontinence

Some persons have mixed urinary difficulties, which is a combination of weak bladder urge and/or overflow incontinence.

These four main types of urinary conditions comprise 8 of the most common causes affecting over 14 million people in the UK and as many as 13 million Americans.

8 Most Common Causes of Urinary Incontinence

1: Pregnancy

A growing foetus and expanding uterus will naturally increase bladder pressure and is the primary reason for urinary leakage in pregnancy. The muscles in the bladder sphincter and in the pelvic floor can be overwhelmed by the extra stress exerted on the bladder. The bladder sphincter is a muscular valve that lies at the bottom of the bladder to control the flow of urine. When other pressure factors add stress to the sphincter such as coughs, sneezes, or laughing, it induces contractions that result in leakage.

Even after pregnancy a leaky bladder may continue because childbirth weakens the pelvic floor muscles.

2. Menopause

During the process leading up to menopause, the female hormone, oestrogen, drops significantly. Oestrogen plays a significant role in a woman’s body. In addition to regulating monthly periods and other bodily changes, including pregnancy, oestrogen is the primary mechanism that keeps the bladder and urethra toned and healthy.

A major cause of stress and urge incontinence in menopausal women is the marked reduction in oestrogen levels. Lack of oestrogen causes the pelvic muscles responsible for bladder control to weaken, resulting in wetting. The urge to void is a discomforting and sometimes painful episode caused by the bladder muscles squeezing at the wrong time. Nocturia (night-time urges) also accompanies the symptoms.

3. Diabetes

Nerve damage from persistently high levels of sugar in the blood is a common problem associated with diabetes mellitus. Storage and periodic elimination of urine depends on a fully functioning nerve control system, but with diabetes the nerves in the bladder and bowel are damaged.

Nerve damage leads to three of the main types of urinary problems: overflow, stress, and urge incontinence.

4. Obesity

Obesity and diabetes are highly relatable medical conditions in which the former can induce the latter. Obesity can cause urinary problems of frequent dribbling due to the increase weight placed on the muscles of the pelvic floor. Recent studies have shown that weight loss can reduce symptoms.

Similar symptoms of urinary dysfunctions associated with diabetes mellitus are manifested in individuals with obesity.

5. Urinary Tract Infection

A common cause of urge incontinence is urinary tract infections (UTI) such as cystitis, prostatitis, and vaginitis which are common infections that can irritate the bladder. This irritation can result in transient, strong urges to urinate. Millions of people worldwide are estimated to have at least one episode of UTI in the course of their life.

6. Enlarged Prostate

In older men incontinence often stems from an enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH). When the prostate enlarges, the tissue surrounding the walnut size prostate stops it from expanding, causing the gland to press against the urethra. The bladder wall becomes irritable and begins to contract even when it has only small amounts of urine. Eventually the bladder weakens.

It is estimated that in the United States more than 4.5 million BHP sufferers visit the doctor in a single year.

7. Prostate Surgery

Prostate surgery often influences the inability to control the passage of urine in a large number of men. Surgeries such as radical prostatectomy or transurethral resection of the prostate (TURP) can sometimes damage the sphincter muscles leading to a weakened bladder. Sometimes the irritation is as a result of the catheter that is put in place after surgery.

In general after prostate surgery, stress incontinence is an acquired temporary urinary dysfunction. Most men find that the leakage disappears after 4 to 6 months.

8. Obstruction

A tumour or stones anywhere along your urinary tract can block the normal flow of urine and cause overflow incontinence. Urinary stones, which are hard stone-like masses that can form in the bladder, kidneys or ureters and are common obstruction causes that lead to urinary dysfunction.

Treatment

Your general practitioner may provide lifestyle advice where relevant, such as: discussion of weight, fitness regime and fluid intake; moderating the amounts of caffeine and artificially sweetened beverages consumed.

Kegel Exercises: a popular recommendation for women that is highly successful is Kegel exercises. This exercise strengthens the pelvic floor muscles by repetitiously squeezing and holding the pelvic muscles and then relaxing them. Women can accurately detect the muscles of the pelvic floor by momentarily stopping the flow of urine during a void. Women who are unsure where the pelvic muscles are should ask their doctor for further instructions. A doctor may suggest vaginal cones or weights that help women tone the pelvic muscles.

Men are not exempt from this exercise. It is, important however to start these exercises off with a health care professional, such as a physiotherapist, urinary nurse or doctor to ensure proper technique and use of the right muscles. Males may notice that when they squeeze the muscle, that action pulls their perineum slightly towards their bodies.

Pelvic Floor Exercises: using biofeedback equipment, this is a method of learning to voluntarily control specific muscle functions with the aid of a machine.

Surgical Options: includes sling procedures to support the urethra. A device is inserted into the bladder, under the urethra in order to support it and stop it from leaking out. This aids in lifting a sagging bladder or urethra into position. The patient will either undergo a local or general anaesthetic for this procedure.

Insertion device: for women, an instrument is inserted into the vagina, such as a pessary which is a rigid ring worn throughout the day, designed to hold up the bladder.

Botox Treatment: this option controls the bladder’s nerves and is injected into the bladder muscles; it lasts around 12 months and may help those with an overactive bladder.

It should be noted that although men are just as likely as women to suffer from urinary incontinence, statistics show that the majority of sufferers are women.

Many people are too embarrassed about their condition to seek professional help. Your general practitioner can put you at ease and explain the possible causes for uncontrollable wetting, gather your medical history, examine you (which include a pelvic exam), and most likely treat you. The majority of patients with urinary difficulties can be treated successfully. Otherwise, you may also be referred to a specialist if condition warrants.

The most common problems with urinary incontinence can be remedied conservatively without surgery or managed through medical advice to allow individuals to return to normal daily activities.