Urinary Incontinence: Facts, Myths, and What to Look Out For

Leaking out urine may be embarrassing and seen as something that only occurs to young children or the elderly. However, this act may be more common than you think and usually occurs during laughing, coughing, sneezing or picking up something heavy.

While losing bladder control once in awhile is alright, you want to ensure that your bladder leaks are not symptoms of a condition called Urinary Incontinence.

Here’s all you need to know about it and some myths that are definitely not true.

What is urinary incontinence?

Urinary incontinence is the loss of bladder control.

Urine is stored in the bladder, which has muscles that tighten when you need to urinate. The bladder muscles tighten and force urine out through a tube called the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of the body.

When the sphincter muscles are not strong enough to pinch the urethra shut when the bladder muscles are tightened, this causes a sudden, strong and uncontrollable urge to urinate. This is called incontinence. Pressure caused by laughing, sneezing or exercising may trigger urine leaks.

Problem with the nerves that control the bladder muscles and urethra may also lead to urinary incontinence. The urine that leaks can either be a small amount or all at once.

What are the types of urinary incontinence?

There are four types of urinary incontinence:

• Stress incontinence – This is the most common type of incontinence that affects younger women. Stress incontinence happens when weak pelvic floor muscles put pressure on the bladder and urethra, making them work harder. Everyday actions that use the pelvic floor muscles like laughing, sneezing or exercising can cause urine leaks. Sudden movements can also cause urine leaks.
• Urge incontinence – Urge incontinence is usually characterised by a strong and sudden urge to urinate. Some women may feel like they never get to the bathroom fast enough, or wake up several times at night with a strong urge to urinate. Women with urge incontinence may also feel the urge to urinate more than eight times a day, but don’t actually have much to urinate once they get to the bathroom. Hence, urge incontinence is sometimes called “overactive bladder” and is more common in older women.
• Mixed incontinence – Mixed incontinence is a combination of both stress incontinence and urge incontinence.
• Overflow incontinence – When the bladder cannot empty completely, it is known as overflow incontinence. This happens due to dysfunctional nerves or a blockage in the urethra that prevents urine flow.

Who is at risk of having urinary incontinence?

The following groups are at risk of urinary incontinence:

• Pregnant women
• Women who just gave birth
• Women with oestrogen deficiency
• Women undergoing menopause
• Obese women

Does urinary incontinence affect women more than men?

Yes. Women have unique health events such as pregnancy, childbirth and menopause that may affect the urinary tract and its surrounding muscles. These events may cause the pelvic floor muscles that support the bladder and urinary tract to weaken. When muscles supporting the urinary tract weaken, they must work harder to hold urine. Sometimes, this extra stress can pressure may cause urinary incontinence.

Additionally, the female urethra is shorter than the male urethra, which means any weakness or damage in a woman’s urethra is more likely to cause urinary incontinence. This is because there is less muscle keeping the urine in.

How is urinary incontinence diagnosed?

Apart from asking you questions regarding your symptoms and medical history, your doctor may do tests such as:

• Urine test – You will be made to urinate in a cup, and your urine will be checked for infection or other causes of incontinence.
• Ultrasound – An ultrasound wand is used to take pictures of your kidneys, bladder and urethra. Anything unusual that may be causing urinary incontinence will also be noticed by your doctor.
• Bladder stress test – You will cough or mimic pushing during childbirth as your doctor watches for loss of urine.
• Cystoscopy – A thin tube with a camera is inserted into your urethra and bladder to look for damaged tissue. Depending on the type of cystoscopy needed, you may be given numbing medicine or be fully sedated.

Should I drink less water if I have urinary incontinence?

No. Many people think that bladder leaks are caused by drinking too much water and that they need to drink less to reduce the amount of urine that leaks out. However, it is important to be well hydrated for good health.

Getting in enough fluids prevents urinary tract infections, dehydration, keeps your kidneys and bladder healthy and prevents constipation. In fact, being dehydrated may make conditions of urinary incontinence worse.

If anything, you should reduce alcohol and caffeine intake as alcohol and caffeine can irritate or stress the bladder.

Do you have a question for me?

I am more than happy to answer them at enquiry@pkwomensclinic.com and +65 6636 9909.

References

1. https://pubmed.ncbi.nlm.nih.gov/29067433/
   Lukacz, E. S., Santiago-Lastra, Y., Albo, M. E., & Brubaker, L. (2017). Urinary Incontinence in Women: A Review. JAMA, 318(16), 1592–1604. https://doi.org/10.1001/jama.2017.12137
2. https://pubmed.ncbi.nlm.nih.gov/27119539/
   Ostle Z. (2016). Assessment, diagnosis and treatment of urinary incontinence in women. British journal of nursing (Mark Allen Publishing), 25(2), 84–91. https://doi.org/10.12968/bjon.2016.25.2.84

This article was written and medically reviewed by Dr Tan Poh Kok (PK Tan), a Senior Consultant Obstetrician and Gynaecologist at PK Women’s Specialist Clinic.