Urinary incontinence

Urinary incontinence is defined as an involuntary leakage of urine in quantities sufficient to constitute a social and hygiene problem. It is the result either of dysfunction in the muscles that support the urinary ducts or of a neurological abnormality affecting the bladder

Urinary incontinence is defined as an involuntary leakage of urine in quantities sufficient to constitute a social and hygiene problem. It is the result either of dysfunction in the muscles that support the urinary ducts or of a neurological abnormality affecting the bladder. Thirty-five percent of women autonomous and healthy women aged 60 and over have mild to moderate urinary incontinence, while only approximately 17 percent of men in that same age group are affected.

Whether it is mild or severe, the consequences of untreated urinary incontinence can be numerous and significant, affecting physical, social, sexual or professional activities. The condition is also associated with many psychosocial problems, as affected individuals can eventually become anxious and depressed, with a tendency to isolation. In addition, certain forms of incontinence can cause recurrent urinary tract infections, lesions, redness or skin infections. In elderly individuals, the condition is linked to a significantly higher risk of falls, as the urgent need to urinate makes the affected person rush to the washroom.

Risk factors

Women are twice as likely to develop urinary incontinence due to their anatomical features, to weakening of their pelvic musculature resulting from pregnancies and childbirth, or to menopause, which brings about a decrease in sexual hormones. Elderly individuals are also at risk for gradually becoming incontinent as the muscles located around their urinary ducts lose their tonus and efficiency.

Several diseases can also lead to incontinence, including benign prostatic hypertrophy, chronic bronchitis, recurrent urinary tract infections, bladder cancer, or neurological diseases such as Parkinson’s or Alzheimer’s.

Some risk factors are modifiable, meaning that we can improve or solve the problem through lifestyle changes. These factors are extremely important, because controlling them can be enough to overcome a mild case of incontinence. Obesity is one of the main modifiable risk factors. It is estimated that excess weight triples the risk of suffering from incontinence, as a result of the pressure placed on the bladder. Other modifiable factors include smoking, constipation, anxiety, and excessive alcohol or caffeine intake. Lastly, it is good to know that certain medications can cause or worsen urinary incontinence. A good example is the use of diuretics, which are often used to control blood pressure or peripheral edema.

Different types of incontinence

There are many kinds of urinary incontinence, from transient and reversible to chronic and irreversible. Chronic incontinence can be categorized into five sub-types:
- Stress incontinence (also known as effort incontinence) is the most frequent and accounts for 50 percent of cases among women. It occurs when abdominal pressure, even slight, causes the loss of small amounts of urine. For persons with this type of incontinence, exercising, coughing, sneezing or laughing can result in bothersome leaks.
- Urge incontinence (also known as overactive bladder) makes up 25 percent of cases in women. In this case, the patient urinates too often or is unable to get to the washroom in time to prevent leakage. When an individual has both of these first two types of incontinence, the condition is called mixed incontinence.
- Overflow incontinence mainly affects men. The leakage occurs when the bladder is too full and the pressure exceeds the resistance threshold, hence the overflow. This occurs during sleep, with these individuals having full control of their bladder during the day.
- Lastly, functional incontinence occurs in persons who are unable to get to a washroom quickly enough due to a neurological problem, physical incapacity or mental disability.

Non-pharmacological measures

Non-pharmacological measures play an important role in preventing and treating urinary incontinence, since various simple measures can make a noticeable difference. Controlling your liquid intake is one way to control night-time leakage. You should drink a sufficient amount during the day, then decrease your liquid intake around 5:00 p.m. and avoid drinking any liquids after 9:00 p.m. Avoid alcohol, since it has a well-known diuretic effect, as well as coffee, citrus fruits, chocolate and artificial sweeteners, as these can all irritate the bladder.

A healthy diet (in order to maintain or regain a healthy body weight), along with a sufficient daily intake of fibre and liquid (to prevent constipation), should be part of any urinary incontinence treatment. Urinary symptom relief can also be obtained through proper management of any medical condition that can cause or worsen incontinence.

Several behavioural therapies have also been proven effective in controlling urinary symptoms. One of these is bladder training, a very simple technique that boasts an 80 percent success rate. It involves implementing a schedule to retrain the bladder by urinating not when we need to, but according to a set schedule. The goal is to gradually increase the amount of time between voids. For example, you might begin with a schedule of one visit to the washroom every two hours and thereafter extend the time between visits by 30 minutes, based on your tolerance. Persons are considered continent when they reach a period of four hours between voids.

Kegel exercises, another type of behavioural therapy, are mainly used in cases of stress or urge incontinence. The aim of these exercises is to tone the pelvic muscles by contracting them for five seconds and then releasing them; this is done repeatedly. In order to locate the muscles that need exercising, you must relax your abdominal, thigh and buttock muscles and contract the muscles that you use to stop urination during voiding. Kegel exercises result in an appreciable urinary incontinence improvement in 50 to 75 percent of cases, in both women and men.

Other measures that are sometimes recommended include having an adapted washroom, wearing easy-to-remove clothing and using a walking aid.

Medical treatments

Several types of drug treatments are available and may be initiated when non-pharmacological measures are not sufficient. Choosing a treatment depends on the specific type of incontinence. The least invasive therapy is usually chosen, in order to minimize discomfort and keep adverse effects at a minimum. Each of the various drug classes has its own mode of action and adverse effects profile. If you have any questions on this subject, do not hesitate to consult your pharmacist.

Lastly, various surgical techniques and absorbent products are also available to help persons affected by urinary incontinence.

There are many ways to help relieve urinary incontinence. For more information, don’t hesitate to speak to your pharmacist.