What is Incontinence?
Incontinence, or urinary incontinence, is a prevalent issue affecting millions of people in the UK. This condition results in the involuntary release of urine, often with little to no control. While figures may not be precise, it's estimated that between three and six million individuals in the UK experience some degree of urinary incontinence. Both men and women can be affected, although it tends to be more common among women.
Urinary incontinence can manifest in various ways, with the two most common forms being stress incontinence and urge incontinence.
Stress Incontinence occurs when pressure is applied to the bladder, such as when laughing or coughing, leading to urine leakage. This typically stems from weakened or damaged muscles, particularly the pelvic floor muscles and urethral sphincter, which are responsible for preventing urination.
Urge Incontinence, on the other hand, occurs when urine leaks following a sudden urge to urinate, often due to an overactive detrusor muscle that controls the bladder. Several factors can increase the risk of developing urinary incontinence, including obesity, pregnancy, vaginal birth, family history and ageing. Various triggers, such as the sound of running water or changes in body position, can prompt urge incontinence. It is often associated with Overactive Bladder Syndrome (OAB), characterised by frequent urination, even at night.
Roughly nine out of ten individuals with incontinence experience either stress incontinence or urge incontinence, but other forms of urinary incontinence exist, including mixed incontinence (combining stress and urge symptoms), overflow incontinence (bladder unable to empty fully) and total incontinence (severe, continuous urine loss).
Diagnosis
It's important not to feel embarrassed about seeking help for urinary incontinence. This common problem is frequently encountered by healthcare professionals, including your local Gilbride pharmacist.
To obtain a professional diagnosis, your healthcare provider will typically begin by asking questions about your symptoms and medical history. These inquiries may include:
- Occurrence of incontinence during activities like coughing or laughing
- Frequency of daytime and nighttime trips to the restroom
- Difficulty with urination
- Current medication use
- Fluid, caffeine and alcohol consumption
Your doctor may also recommend keeping a bladder diary for at least three days to track your urinary habits. This diary will include details about fluid intake, types of fluids consumed, urination frequency, urine volume, urgency episodes and incontinence episodes.
A comprehensive diagnosis may involve various tests and examinations to rule out underlying conditions, including physical exams, dipstick tests, residual urine tests, cystoscopy and urodynamic tests.
Management
Before turning to medication, lifestyle modifications are often recommended. These may involve reducing fluid and caffeine intake and losing weight if you are overweight, as weight loss can reduce the occurrence of urinary incontinence.
Pelvic floor muscle training is a recommended exercise to strengthen the muscles controlling urine flow. This can be combined with bladder training techniques, which extend the time between the urge to urinate and actual urination. If these non-invasive treatments prove ineffective, medication or surgery may be considered.
Stress incontinence is typically treated with duloxetine, a medication that enhances urethral muscle tone. For urge incontinence, antimuscarinics like oxybutynin, tolterodine and darifenacin are commonly prescribed, with mirabegron as an alternative if needed.
Prevention
You can take steps to reduce your risk of developing urinary incontinence:
- Maintain a healthy weight through a balanced diet and regular exercise.
- Adjust your liquid intake based on your doctor's recommendations, especially before bedtime.
- Be mindful of alcohol and caffeine consumption, as they can exacerbate urinary incontinence.
- Engage in pelvic floor exercises to strengthen relevant muscles.
- Consider bladder training to prolong the time between urges to urinate.
While not a preventative measure, urinary incontinence products like absorbent pads, hand-held urinals, catheters and vaginal or urethral devices can help manage the condition.
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