What are the causes of urinary incontinence and how is it managed?

How does the bladder function and how do we keep dry (i.e. continent)?  

     In normal circumstances the bladder fills up with urine with its muscular wall remains relaxed and its outlet (the urethra) remains closed to keep the urine contained inside it (i.e. to remain continent). The filling of the bladder with urine occurs unnoticed until a good volume of urine is reached. The bladder will then send signals to the brain, which will perceive the sensation of wanting to pass urine. Under appropriate conditions, the brain will then consciously control the emptying of the bladder by causing contraction of the muscular wall of the bladder and relaxation of muscles of the bladder outlet (urethra).

What are the causes of urinary incontinence and how is it managed?
Urinary incontinence may be due to one or more of the following causes:

1. Failure to keep the urethra closed due to weakness of surrounding muscles and ligaments (i.e. weakness of pelvic support). 
2. If the bladder muscle becomes overactive and contracts at times when bladder emptying is not required. 
3. If the bladder becomes oversensitive and sends signals to the brain with the sensation of wanting to pass urine before the bladder is actually full.
4. Inability to empty the bladder i.e. voiding difficulty.

     Conservative treatment (pelvic floor muscle exercises and bladder retraining) can be helpful for all other causes of incontinence. Depending on the extent of the problem conservative treatment may be very helpful for less severe cases of incontinence (60% successful). In severe cases, pelvic floor muscles exercises are less successful but these exercises should be tried, while further investigations or treatment are considered, to ensure that they are done correctly. This is essential because these exercises are the most important factor in preventing a recurrence or worsening of the incontinence. 

     

     You will therefore be asked to do these exercises daily for life whether you need further treatment or not In cases where the predominant symptom is urinary urgency or urge incontinence (intense desire to pass urine with leakage on the way to the toilet) some medication may be tried to relax the bladder if pelvic floor exercises were not helpful. If medication is unsuccessful further investigations including cystoscopy and/or bladder function tests may be required. If the predominant symptom is urinary stress incontinence on physical activity e.g. coughing, and the pelvic floor muscle exercises are unhelpful, it will then be necessary to carry out bladder function tests. These tests help to establish the cause of the incontinence to be able to decide on the most suitable treatment, including surgery, thus reducing the chance of complications.