Urinary Incontinence: Causes, Diagnosis & Treatment

In Australia, 15% of men and up to 37% of women experience some form of incontinence. It can be an embarrassing problem and many people delay getting the help they need but there are many solutions available. Most people can be successfully treated.

Effective Solutions to Urinary Incontinence Prevalence

How does a healthy bladder work?

The bladder is a hollow organ in the lower abdomen. It stores urine, the body’s liquid waste produced by the kidneys. Urine passes from each kidney into the bladder through a pair of tubes called ureters. Urine exits the bladder to the outside of the body through another tube called the urethra.

There are two muscles that work in tandem to allow bladder control:

  1. The urinary sphincter, which is a circular muscle that surrounds the urethra. You must be able to tighten this muscle to prevent urine from leaking out.
  2. The muscle in the bladder wall called the detrusor muscle. This muscle must relax during filling so the bladder can expand and contract during emptying to expel the urine.

As the bladder fills with urine, pressure is exerted on the bladder wall and the desire to void (urinate) is felt. This triggers the brain to send a message to the detrusor muscle that surrounds the inner lining of the bladder, forcing the muscle to contract which in turn forces the urine to flow out of the bladder.

At the same time, the sphincter muscle that surrounds the urethra relaxes, letting urine flow into the urethra and out of the body.

This process requires both nerves and muscles working together to prevent urine leakage. Damage, weakening and injury to either muscles or nerves can result in incontinence.

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine from the body. When the muscle (sphincter) that holds the bladder neck closed is not strong enough to retain urine in the bladder, the result is urinary incontinence.

Incontinence may occur when:

The muscle is too weak
The bladder muscles contract too strongly and at the wrong time.
The bladder is not emptied regularly or completely.

What causes incontinence?

 The potential causes of incontinence include:

Trauma to the pelvis, e.g. childbirth or prostate removal surgery
Spinal cord injury or nerve damage
Neurological disorders that interrupt the normal signals between the bladder and the brain including illnesses like multiple sclerosis or Parkinson’s disease.

What are the types of incontinence?

There are three main types of incontinence:

Stress incontinence is the accidental release of urine when pressure is applied to the bladder, such as when you cough, sneeze, laugh or lift something heavy. It is caused by weakness of the sphincter muscle.

Urge incontinence is when the bladder contracts at the wrong time giving you the feeling that you have to urinate immediately even if you have just emptied your bladder.

Overflow incontinence is caused by leakage of urine from an overly full bladder and it occurs in patients where the bladder outflow is obstructed or the detrusor muscle is simply too weak to allow the bladder to empty properly. There is often no sensation of needing to void.

Diagnosing urinary incontinence

Incontinence is diagnosed with some or all of the following tests:

Urinalysis and urine culture: Your GP may have performed this test already. It is to check whether your incontinence is the result of an infection in the urinary tract or whether you have other symptoms like microscopic haematuria.

Urodynamic study:these are performed in our outpatient clinic. The tests involve –

measuring the amount of urine in the bladder before emptying
the force of the urine as it leaves the body
the internal pressure of the bladder as it fills
the control of the urethral sphincter muscles
fluid being inserted into the bladder to check for leaking
a post-void residual to measure the amount of urine left in your bladder after emptying

Cystoscopy: Sometimes diagnosis will involve inserting a scope to examine your bladder.

These procedures can be performed in the Urology Outpatient Clinic.