Bladder weakness or urinary incontinence is the accidental leakage of urine from the bladder. It is a common problem. Women are twice as likely to suffer from urinary incontinence as men, and the condition becomes more common as people get older. There are two main types of urinary incontinence – stress incontinence and urge incontinence. Less common types include reflex incontinence and overflow incontinence. Stress incontinence occurs when pressure is put on the bladder for example during exercise or sneezing. Urge incontinence occurs when there is an uncontrollable, sudden need to go to the toilet.
Urine is being produced by our kidneys all of the time and is stored in our bladder until we feel the need to go to the toilet. When urinating, muscles in the pelvis that support the bladder, called the pelvic floor muscles, relax while a valve in the bladder, called a sphincter, opens to allow urine to flow out. At the same time, muscles in the wall of the bladder contract, helping to force the urine out. Incontinence happens because there is loss of control of the bladder. It can be caused by several factors.
Stress incontinence is very common and happens when pressure is put on the bladder. This can happen when you sneeze, cough or carry something heavy and small amounts of urine leak out. Women often suffer from stress incontinence as the pelvic floor muscles can be weakened or damaged during childbirth. Women going through the menopause and men who have had a prostate operation may also be affected.
Urge incontinence, also called unstable bladder or overactive bladder, occurs when you get a sudden urge to go to the toilet but you do not have enough time to get there. In this condition the muscles in the wall of the bladder contract involuntarily overcoming the resistance offered by the pelvic floor muscles and sphincter and so forcing large amounts of urine out. The exact cause of urge incontinence is not known but in some cases it may be caused by an infection or by damage to nerves resulting from a stroke, spinal injuries or multiple sclerosis.
Reflex bladder is loss of control over the bladder sometimes after an injury or illness. Overflow incontinence occurs due to problems in bladder emptying often in elderly men with an enlarged prostate gland that obstructs the flow of urine and does not allow the bladder to empty completely. An infection of the bladder and some medicines, such as water tablets for high blood pressure, can also cause leakage.
A symptom of stress incontinence is the leakage of small amounts of urine particularly when sneezing, coughing, laughing, lifting heavy objects, bending or exercising. With urge incontinence there are sudden or frequent urges to urinate particularly when opening the front door to your home (latch key incontinence), when walking and during the night.
People tend to find urinary incontinence an embarrassing problem but it is very common and can often be cured or better controlled. There are also devices and incontinence products that can help manage bladder weakness and give sufferers the confidence to carry on with everyday activities.
Strengthening the pelvic floor muscles through exercise can help stress incontinence and your doctor, nurse or physiotherapist can advise you. They may also recommend devices that help to do the same thing.
Bladder retraining to stretch the bladder to hold more urine together with good drinking habits, e.g. cutting down on tea, coffee and alcohol particularly late at night, can help with an unstable bladder.
Medicines such as oxybutinin, propantheline, propiverine, solifenacin, tolterodine and trospium can all be used to treat urinary incontinence.
Surgery may also be an option but will not be used unless treatment with medicines has failed.
A range of catheters, sheaths, pads and pants is available to help control urinary incontinence and can be bought from the pharmacy or prescribed by your doctor or nurse.
When to consult your pharmacist
Talk to your pharmacist if you are concerned about urinary incontinence. Although there are no medicines that can be supplied over the counter without a prescription, the pharmacist will be able to offer advice on absorbent underwear that will help avoid any embarrassment caused by stress incontinence. If buying OTC medicines, let the pharmacist know if you have been prescribed medicines for incontinence as some should not be used together. A common symptom of medicines prescribed for urge incontinence is a dry mouth, tell your pharmacist if this should happen to you.
When to consult your doctor
If you have noticed accidental leakage from your bladder, see your doctor. If you have had a baby recently and are having ‘accidents’, seek advice as simple pelvic floor exercises may remedy the problem. Your doctor will ask when leakage occurs or may perform an examination to try to determine the cause of the incontinence. On occasion you may be referred to a specialist called an urologist for further tests.
- Being overweight can put pressure on the bladder – shedding a few pounds may help
- Avoid too much tea, coffee or fizzy drinks as they can irritate the bladder
- Be prepared by carrying a bag of essentials – spare pants and pads, baby wipes, towel and change of clothes if necessary
- Practise pelvic floor exercises to strengthen pelvic floor muscles that control the bladder and bowel
- Retrain your bladder so that you don’t go to the loo as often