Urinary incontinence is a common health condition that involves loss of bladder control and involuntary leakage of urine. It can vary in severity, from occasionally losing a few drops of urine to leaking a substantial amount several times each day.

It can have a significant impact on quality of life, particularly as the condition can pose embarrassing situations in social or public environments. In most cases, it occurs as a result of an underlying health condition, which can be treated and lead to a dramatic improvement in symptoms.

The Urinary System

The bladder plays a central role in the complex process of urination, storing the urine until it is ready to be excreted via the urethra. There are several nerves and muscles involved in this process, along with the brain and central nervous system to control the actions.

The detrusor muscles in the bladder compose the sac used to store urine and contract to squeeze urine out. The sphincter muscles are located at the bottom of the bladder that are naturally contracted to hold the “gate” of the bladder closed and keep urine inside the bladder. When the sphincter muscles relax and the detrusor muscles contract simultaneously, the urine is pushed down the to be excreted via the urethra.

The central nervous system in particularly important as it is responsible for sending messages to the relevant muscles to urinate when we needed. When this fails, either due to a fault in the nervous system or with particular muscles, urinary incontinence may occur.

Types of Urinary Incontinence

There are five different types of urinary incontinence, as outlined below.

• Stress incontinence occurs when there is a leakage of urine due to pressure on your abdomen, like when coughing, laughing or lifting something heavy. It is more common in women and is often caused by circumstances that lead to weakening of pelvic muscles, such as childbirth or local surgery.

• Urge incontinence involves the sudden need to urinate, such that the individual often does not have enough time to reach a toilet. This is particularly common in elderly people and is often caused by a urinary tract infection or overactive bladder.
• Overflow incontinence is when small amounts of urine are leaked due to an overfilled bladder. Patients often have difficulty voiding completely, which affects more men, in particular, who are affected by enlarged prostate.
• Functional incontinence refers to leaking of urine due to another condition leading to difficulty reaching the toilet in time, rather than a problem with the urinary system. Diseases that make mobility difficult, such as arthritis, may cause this type of incontinence.
• Mixed incontinence is a combination of several types of incontinence. There are often multiple causes to be address in the appropriate management of the condition.

• Management

  When deciding the best course of action to treat urinary incontinence, it is important to consider the cause of the condition. This will often help to identify possible causes and present ways to improve the primary condition in addition to symptoms of urinary incontinence.

  Pelvic floor muscles are the muscles used to stop the flow of urination voluntarily. Kegel exercises can help to strengthen these muscles and have been shown to improve symptoms of many people who suffer from urinary incontinence and is particularly successful for stress incontinence.

  Some medications are also able to target the muscles responsible for the process of urination and are able to help control the urine flow. If there is a structural abnormality that is causing the symptoms, surgery may be beneficial to correct the anatomy of the urinary system and improve the condition.

  References

• http://www.acog.org/-/media/For-Patients/faq081.pdf
• https://www.nice.org.uk/guidance/cg171
• http://www.nia.nih.gov/health/publication/urinary-incontinence
• http://familydoctor.org/familydoctor/en/diseases-conditions/urinary-incontinence.printerview.all.html
• http://www.bmj.com/content/349/bmj.g4531