The urinary incontinence results in uncontrollable and involuntary loss of urine that occurs the day or night. It is not a disease, but a symptom most often related to a physical disorder.
Urinary incontinence is more common with age. However, it is not only older people who suffer from it. In North America, it is estimated that it affects globally 1 in 4 women (and from 60 years, at least 1 in 3). Men are twice as likely to be affected, for reasons of anatomy.
Too few people dare to talk to their doctor. However, in most cases, there are solutions to solve the problem or to control it successfully, even if the incontinence lasts for months or even years.
Causes of Urinary incontinence
Here are the main causes of urinary incontinence . They vary according to the type of incontinence (see below).
- A weakening of the pelvic floor muscles (perineum). These muscles are located at the bottom of the pelvis. They are used to keep the bladder in place and to control the evacuation of stool and urine.
Pregnancy and vaginal deliveries can weaken them. The musculature can also relax with aging and loss of physical fitness.
- The ” bladder descent “. It affects only women and occurs when tissues between the bladder and vagina are so weak or stretched that they can no longer support the weight of the bladder. It becomes more difficult to control (see diagram). Muscle strengthening is often enough to put the bladder back in place, but sometimes surgery is necessary.
- A prostate disorder or surgery to the prostate (see illustration in Prostate Hypertrophy).
- A chronic health problem that affects the control of the muscles of the bladder through the nerves. For this reason, even if one wants to refrain from urinating, it is difficult or impossible to get there. Diabetic neuropathy, Parkinson’s disease, multiple sclerosis or spinal cord injury can have this effect.
- Taking certain medications (for example, antidepressants, nasal decongestants, and muscle relaxants).
- A difficulty walking , preventing travel to the bathroom in time.
- Constipation with faecal (compressed and hardened stools in the rectum).
Types of urinary incontinence
Urinary incontinence on exercise This is the most common form of urinary incontinence in women . This is the leakage of a small amount of urine due to increased pressure in the abdomen, hence on the bladder, caused by physical exertion, coughing, sneezing, laughter, etc. . The pelvic floor muscles must be weakened for these situations to cause leakage of urine. The flight is not necessarily preceded by a desire to urinate.
In men, this type of incontinence can appear following a partial or total removal of the prostate (prostatectomy) if the surgery accidentally reaches the sphincter located at the bottom of the bladder and makes it less effective.
Urinary incontinence. This incontinence represents a quarter of female incontinence, but it can affect the child and the elderly man. It is also called ” overactive bladder ” or “uninhibited bladder”. Just walking, thinking about urinating (unlocking the house door, for example), or hearing running water can trigger sometimes severe urine loss. People with urination therefore frequently.
This type of incontinence often results from a chronic health problem that affects the nervous control of the bladder. Normally, the urination control center , located in the frontal lobe of the brain, helps to restrain urination even if the urge is present. It sends signals to the muscles of the bladder to prevent contractions. People who have this area of the brain affected (for example, as a result of a stroke , Alzheimer’s disease or Parkinson’s disease) no longer control their desires.
Urine loss can also be triggered by the following situations: drinking alcohol , coffee, urinary tract infection, etc.
Mixed urinary incontinence. This form of urinary incontinence associates with at least 2 forms of this disorder. The most common combination is stress incontinence and emergency incontinence. It accounts for about a quarter of female urinary incontinence.
Urinary incontinence by overflow (or overflow). It results from an overflow of urine in the bladder. This can then let out urine in an uncontrolled way. This overflow can be explained by an obstacle to the emptying of the bladder, for example, as a result of a disorder of the prostate, the main cause of this type of incontinence in humans. It may also be due to an inability of the bladder to empty due to weakness of the bladder muscle, which then has difficulty in contracting (for example, due to diabetes or neurological disease).
Functional incontinence. Some physical or mental conditions may prevent a person from going to the bathroom in time. This incontinence is common in the elderly because of multiple mobility problems, such as osteoarthritis of the hip or knee, hip fracture, sequelae of a stroke , and so on.
Total incontinence. It is an incontinence characterized by a continuous flow of urine, day and night. Affected individuals have no voluntary control of their bladder, which is no longer able to play its role as a reservoir of urine. Total urinary incontinence is most often the consequence of physical lesions occurring, in particular, because of an accident or disease that reaches the spinal cord, or by total or partial destruction of the sphincter that controls the exit of the urine, as a result of prostate surgery, for example.
Consequences and possible complications
Because of the taboo surrounding urinary incontinence , many people are reluctant to consult. They deprive themselves of the help and treatments offered. However, when left untreated, incontinence can significantly limit physical activity and disrupt social, sexual and work life.
Chronic urinary incontinence increases the risk of recurrent urinary tract infections . It can also cause redness of the skin that surrounds the genitals (up to infections and ulcers), as it creates moisture.
The symptoms of urinary incontinence
- On exertion : leakage of urine during an effort, usually weak or sudden. We are not always aware of the losses.
- Emergency : Conscious and usually large losses of urine, sudden urges to urinate that always precede urine leakage, but do not give time to go to the bathroom. The urgent need to urinate can occur at night.
- Mixed : combination of symptoms of stress urinary incontinence and emergency urinary incontinence to varying degrees.
- Overflow ( overflow ) : Small amounts of urine escape several times throughout the day. Urination (the action of urinating) begins with difficulty. The flow is weak and often leaves the impression that the bladder is not empty. The need to urinate is also apparent during the night.
- Functional : losses related to difficulty moving quickly.
- Total : constant losses, day and night.
Note. When urine loss is accompanied by pain or burning sensation during urination, urine changes color and odor, and urges to urinate frequently, it is possible that urinary tract infection is involved. See a doctor.
People at risk for Urinary incontinence
- The women run 2 times more likely to suffer from incontinence than men because of their anatomical characteristics, pregnancy, childbirth and menopause.
- The elderly may gradually become incontinent because the muscles pelvic floor lose their tone. In addition, they are increasingly exposed to neurological disorders.
- The people with diabetes.
- Physical inactivity.
- Obesity. Excess weight causes constant pressure on the bladder and pelvic floor muscles, which weakens them.
- Smoking. A chronic cough can cause or aggravate urinary incontinence.
Prevention of urinary incontinence
|Basic preventive measures|
Keep or regain a healthy weight
This avoids the constant pressure that the excess weight exerts on the bladder and the muscles around it. To know your body mass index, do our test: Body Mass Index (BMI) and waist measurement .
Strengthen the pelvic floor muscles
Pregnant women have an interest in practicing Kegel exercises (refer to the Treatments section) to prevent weakening of the pelvic floor muscles. As a result of delivery, those with urinary problems should also do these exercises and, if necessary, undertake pelvic floor rehabilitation (also known as perineum) at a physiotherapist or specialized physiotherapist.
Prevent and treat prostate disorders
Prostatitis (inflammation of the prostate), benign prostatic hypertrophy or prostate cancer can cause incontinence.
A chronic cough may cause occasional incontinence or aggravate existing incontinence related to other causes.
In both men and women, constipation can cause incontinence. With the rectum behind the bladder , blocked stools can exert pressure on the bladder, causing urine loss.
Monitor your medication
Medications in the following categories may cause or aggravate incontinence: antihypertensive medications, antidepressants, heart and cold medications, muscle relaxants, sleeping pills. Discuss with your doctor.
|Measures to prevent aggravation|
Reducing the amount of fluids that are consumed does not eliminate incontinence. It is important to drink enough , otherwise the urine becomes very concentrated. This can irritate the bladderand trigger urge incontinence (emergency incontinence). Here are a few tips.
Beware of irritating foods
This measure is for people with emergency urinary incontinence.
Prevent urinary tract infections
A urinary tract infection in someone with or immediately approaching urinary incontinence can cause urine loss. Better to prevent urinary tract infections or treat them quickly.
Medical treatments for urinary incontinence
|It is important to consult a doctor in case of symptoms that are similar to urinary incontinence. Once diagnosed, other health professionals can offer helpful help. It may be an incontinence nurse consultant or a physiotherapist specialized in bladder rehabilitation. A list of incontinence professionals in Canada is available on the website of the Continence Care Foundation .|
The treatment varies depending on the cause and the severity of the urinary incontinence . If necessary, it is necessary, of course, to cure the disease that causes incontinence, in addition to treating the symptoms.
See the Prevention section for more information on foods to reduce or avoid.
These techniques generally require the accompaniment of a physiotherapist or a physiotherapist or a nurse . Some specialize in incontinence problems.
This recognized practice improves the tone of the pelvic floor muscles (perineum). Both women and men can use it in case of stress incontinence or urgency.
The exercises should be done regularly for several weeks to give a beneficial result. 40% to 75% of women who go to court noted an improvement in their control urinary. In the case of men, this practice is mainly used after removal of the prostate (prostatectomy).
Note. By strengthening the pelvic floor muscles, Kegel exercises can also enhance sexual pleasure .
|How to practice Kegel exercises|
|In the beginning, practice these exercises while lying on the back, knees bent and slightly apart (at the width of the pelvis). Once mastered, start sitting them up and then stand up.
– Contract the pelvic floor muscles by holding the contraction for 5 to 10 seconds . (Make sure you get the right muscles!) You need to feel the contraction of the muscles around the vagina or penis, as if to hold back urine or stool. (Caution: do not contract the muscles of the belly and buttocks.)
For more information, see the information sheet produced by the Continence Foundation (Sites of Interest section).
Biofeedback can help women feel the contractions of their pelvic floor muscles better and control them better. This technique allows visualizing on a computer screen contraction and relaxation of muscles during the practice of Kegel exercises. This visualization, which is done with a sensor placed in the vagina, leads to become aware, in a very precise way, the intensity of a contraction and its duration.
This can be done in different ways, depending on the type of urinary incontinence .
- We can delay urination . At first, when the urge to urinate is felt, we try to wait 10 minutes before relieve themselves. This time is then increased to 20 minutes, the goal being to space urination by at least 2 hours (maximum 4 hours).
- In the case of incontinence by overflow, one can practice the exercise of the double emptying . It consists of urinating and then trying again a few minutes later. It allows you to learn how to empty your bladder better to avoid overflow of urine.
- We can adopt a fixed schedule. It’s about going to the bathroom at a set time, rather than waiting to feel like urinating. The goal is to space urination by at least 2 hours and up to 4 hours. This practice is very important and often effective in older people with mobility issues.
- To control the urgent need to urinate, it can be relaxing by taking a few deep breaths. One can also distract one’s attention by taking care of oneself: by reading, by doing crossword puzzles or dishes, for example.
Electrostimulation, or electrical stimulation, involves inserting an electrode into the vagina or anus to stimulate and tone the pelvic floor muscles. By associating this method with biofeedback, one can visualize muscular contractions on a computer screen. This allows them to feel better, so that they can control them. This approach is usually reserved for people for whom behavioral techniques are ineffective.
Some medications can reduce contractions of the bladder . They are therefore useful in cases of emergency urinary incontinence : oxybutynin (Oxybutynin and Ditropan, for example), flavoxate (Urispas) and tolterodine (Detrol). One of their side effects is dry mouth, which can cause patients to drink more. There are various ways to mitigate them. Discuss with your doctor.
Local estrogen therapy may help reduce symptoms for some women during menopause . The application of estrogen is done in the vagina as eggs (for example, Vagifem), rings (Estring) or cream. The doses of hormones used are very small in the case of eggs and rings. They are a little higher for cream, which sometimes requires the use of a progestin (eg Provera) to reduce the risks associated with long-term hormone therapy. For more information, see our Menopause fact sheet.
Other drugs may be used to treat the disease that causes urinary incontinence, for example, antibiotics in case of urinary tract infection.
Various devices and accessories
– Absorbent pads
– Adult diapers
– Devices for collecting urine (men)
– Protective underwear
They are often used as a last resort.
– Catheter. It is a flexible and very thin tube connected to an external bag. The tube is inserted into the urethra, allowing the urine to drain into the bag. In some cases, patients can learn how to insert and remove the catheter (3 or 4 times a day), which avoids wearing a bag permanently.
Pessary. The doctor introduces a rigid ring into the vagina to hold the bladder in place and prevent it from descending. It is useful for women who have a bladder descent.
In many cases, surgery may be required. In women, it is most often used to hold the bladder in place or up when bladder descent, by an intervention called cystopexy .
One can also:
– operate a bladder tumor, a uterine fibroid, a urogenital fistula or a tumor of the prostate;
– put in place a device for suspension of the bladder neck and bladder in women;
– install an artificial urinary sphincter (especially in men);
– install a device that stimulates the sacral nerve (nerve located behind the sacrum).