Urinary incontinence is the loss of control over your bladder, and this condition affects adults more often as they age. There are multiple causes that may contribute to this condition, and the symptoms vary from mild to severe depending on the individual. Talk to your doctor if you believe you are experiencing urinary incontinence and they can recommend the appropriate treatments.
How Does Your Urinary System Normally Work?
You have both voluntary and involuntary control of your bladder, and a complex system of nerves and muscles maintains the normal cycle of filling and emptying (micturition). Your bladder is an involuntary muscle that contracts when it receives signals from your autonomic or involuntary nervous system, and this is how emptying occurs.
There is an internal gate or sphincter in your bladder that also gets the signal to relax and open, and this is partly responsible for allowing urine to flow into your urethra. The whole process of contraction and internal gate opening is completely based on a nervous system reflex that you have no control over.
What you do have control of, however, is your external sphincter. This is a second gate leading to the urethra, and the one that makes you feel the urge to go. When your bladder is filling with urine its muscled walls are expanding. This sends involuntary reflex signals that cause small contractions of the walls, and the pressure that is put on the external gate, the one you feel and control, is then processed by the brain as a need to go.
When you’re ready to urinate you instinctively tell your external gate to relax, which is coordinated by your nervous system with relaxation of your inner gate and contraction of the bladder. Under normal conditions, your involuntary nervous system keeps your inner gate shut during filling and you subconsciously keep your outer gate shut as well.
Causes and Symptoms of Urinary Incontinence in Adults
Any uncontrolled leaking of urine is called urinary incontinence and there are several different mechanisms that can lead to its presence. At least one out of every four adults in the US will experience this condition, though it does affect women more commonly than men.
Types of Incontinence and their Symptoms
The symptoms can be mild to more severe depending on the form of urinary incontinence you have, and the following are the most common types:
- Stress incontinence: this is the most common form among middle-age women, and is characterized by leaking small amounts of urine when laughing, coughing, sneezing, or doing exercises. This is due to the excess pressure placed on the bladder during these activities.
- Urge incontinence: this type more often accompanies underlying disease such as diabetes, stroke, Alzheimer’s, or multiple sclerosis. The main symptom is having a sudden, strong urge to urinate and then not being able to get to a bathroom in time, resulting in leakage.
- Overflow incontinence: this form occurs when you cannot empty your bladder. It remains perpetually full and any new urine your body produces continuously leaks out.
- Functional incontinence: instead of something being wrong with your urinary system itself, this type happens when there is another condition that prevents you from getting to the toilet normally.
Causes of Urinary Incontinence
In the case of stress incontinence, there is a weakness of the pelvic muscles or the bladder gates (sphincters) that keeps them from staying shut when pressure is applied. This is commonly seen in women who are postmenopausal or have had a vaginal childbirth, women who are currently pregnant, or have participated in high-impact sports long term, and men that have had their prostate removed. Obesity can be a predisposing factor as well as smoking or other conditions that cause chronic coughing.
Urge incontinence is also known as overactive bladder (OAB) and is caused by the bladder contracting when it isn’t supposed to. This is associated with many different things including diseases such as diabetes and Alzheimer’s, bladder or kidney stones, and urinary tract infections.
A bladder that won’t empty is often due to an obstruction of some kind, and is very common in men with an enlarged prostate. It can also be due to diabetes, nerve damage, weak bladder muscles, and even some medications.
Anything that affects mobility will potentially contribute to functional incontinence including arthritis, vision issues, certain disabilities, and cognitive issues like dementia. Addressing the cause of the functional incontinence is the best way to help ease symptoms in the long run.
Diagnosing Urinary Incontinence in Adults
If you believe you are experiencing any of the types of urinary incontinence, your doctor will be able to perform diagnostic tests including a pelvic floor exam, urinalysis, ultrasound, or bladder stress test to hopefully determine which type of incontinence you have and what the underlying cause is. Your doctor will also do a physical exam and ask you about your health history including what you eat and drink, and details about how much and how often you urinate.
Urinary incontinence can affect every aspect of your life, but it isn’t an inevitable process of aging or something you just have to live with. There are many treatment options that your doctor can discuss with you, but hopefully there will be less uncertainty now that you have an understanding of urinary incontinence.