This page discusses the diagnostic methods, causes, and types of urinary incontinence.
What is urinary incontinence?
Urinary incontinence is a medical condition that is characterised by a person’s inability to control the bladder sufficiently, leading to the involuntary urine leakage. Individuals who suffer from this problem may also experience strong, uncontrollable, and/or frequent urges to urinate.
While urinary incontinence can affect both genders, the problem is experienced more often by women than by men — particularly older women. This higher incidence in women is thought to be due to factors like pregnancy, menopause, and the physical construction of the female urinary system. Though it isn’t unexpected for some children to be incontinent during childhood, the condition is a cause for concern and definitely requires treatment if it hasn’t disappeared by adolescence.
How is urinary incontinence diagnosed?
Dr G can diagnose your problem by your symptoms, medical history, and a physical exam. He may order specialised tests to identify the type of incontinence you have and to confirm its underlying cause. The medical tests used to diagnose urinary incontinence include:
- Urinalysis: This test looks for traces of infection in your urine and may involve a urine culture.
- Bladder stress test: This test simulates conditions under which the accidental leakage of urine typically occurs. These conditions include coughing, laughing, and certain forms of exercise, amongst others.
- Ultrasound: This medical imaging technique uses sound waves to create an image of your bladder, kidneys, and urethra.
- Urodynamics: This procedure involves the insertion of a thin tube into your bladder. This will allow Dr G to measure your bladder’s pressure when full.
- Cystoscopy: This involves the insertion of a thin, hollow tube into your urethra. The tube, which has a mini camera affixed at one end, will allow Dr G to examine the interior of your urethra and bladder.
You may also be asked to maintain a diary that records how frequently you empty your bladder and what quantity of urine you pass. You may find it helpful to begin keeping this diary for a few days before you meet Dr G so that you will be able to answer his questions more accurately.
Urinary Incontinence: Causes
There are several different types of urinary incontinence, each arising from different physiological or psychological problems. These causes include:
- UTIs (Urinary Tract Infections)
- Weakness of muscles in the lower urinary tract
- Conditions that stress or stretch pelvic floor muscles (pregnancy, childbirth, and weight gain, amongst others)
- Overactive or irritated muscles in the bladder
- Nerve damage
- Cancer of the bladder
- Urethral blockage
- Bladder stones
- Hysterectomy (surgical removal of the uterus)
- Neurological disorders (Parkinson’s, Alzheimer’s, and Multiple Sclerosis amongst others)
Urinary Incontinence: Types
There are five types of urinary incontinence when categorised by symptoms. These are:
- Stress Incontinence: Stress incontinence refers to the release of small amounts of urine during activities that place pressure on your bladder. These activities include coughing, laughing, sneezing, exercise and lifting heavy objects. The weakening of pelvic muscles and connective tissue that result from conditions like pregnancy, menopause or obesity are often the cause of stress incontinence. Stress incontinence has been found to worsen during the week leading up to one’s menstrual period. This can be attributed to the lowered levels of estrogen that affect muscular pressure around the urethra. The incidence of stress incontinence increases in post-menopausal women. In most cases, this form of incontinence can be easily treated.
- Urge Incontinence: This form of incontinence refers to the release or gush of urine that occurs without warning or preceded by strong urge to urinate . The problem is often caused by irritable bladder muscles that contract at inappropriate times. The bladder spasms may be due to abnormal neural functioning. Urge incontinence may even be triggered by touching or hearing water. The condition can be worsened with certain liquids, medicines, and emotional states. Medical problems like uncontrolled diabetes and hyperthyroidism may also cause or worsen urge incontinence.
- Overflow Incontinence: This refers to the uncontrollable leakage of urine, in small amounts, as the result of an incompletely emptied bladder. This type of urinary incontinence is often caused by weak bladder muscles (as caused by nerve damage from diabetes and other certain illnesses) or urethral blockage (as caused by bladder stones, tumours and mismanagement of incontinence surgery).
- Overactive Bladder: This condition occurs as the result of abnormal neural functioning — when nerves instruct the bladder to squeeze at inopportune times, with little or no warning. The symptoms of an overactive bladder include frequent urination (eight or more times during waking hours, twice or more at night-time) urgent urination (sudden powerful urge to urinate), urge incontinence (the subsequent release of urine that follows an unexpected urge) and nocturia (waking up at night out of a desire to urinate).
- Functional Incontinence: This form of urinary incontinence primarily affects people with neurodegenerative disorders. It refers to the release of urine that results from one’s inability to reach the toilet in time. This category therefore encompasses people hampered by physical and cognitive illnesses, or external obstacles. Conditions that develop with age, such as arthritis, may also be responsible for some of these cases.
Other Types of Incontinence
Mixed incontinence: A common type of incontinence experienced by women, mixed incontinence refers primarily to the occurrence of both stress incontinence and urge incontinence acting together. The term may also refer to other combinations of urinary incontinence.
Transient incontinence: This is a temporary form of urinary incontinence. The factors that may be responsible for it include certain medicines, infections (from the common cold to urinary tract infections), mental or emotional impairment, severe constipation, and restricted mobility.
Most people who have problems with urinary incontinence are too embarrassed to seek help. If you suspect you have urinary incontinence, make an appointment with Dr G — your condition is one that can be treated, and this treatment can improve the quality of your life significantly. For more information on treating this condition, please read our page about Urinary Incontinence Treatment options.