Urinary incontinence (UI) is a problem that affects many people around the world, especially women. This phenomenon can significantly reduce quality of life and lead to serious emotional and social problems. In this article we discuss when and how urinary incontinence manifests itself, what types of incontinence we may encounter, and the causes.
What is urinary incontinence?
Urinary incontinence is defined as the uncontrolled excretion of urine that is independent of the patient’s will. It can range from complete loss of bladder control to an inability to hold urine in certain situations, such as during exercise or coughing. The condition affects both men and women, although it is much more common in women.
Types of incontinence
Urinary incontinence can be divided into several main types:
- Stress Urinary Incontinence (SUI): Manifests as urine leakage during physical activity that increases abdominal pressure, such as coughing, laughing, sneezing or lifting weights. SUI is the most common form of incontinence in women, especially after childbirth or during menopause.
- Urge Incontinence (SUI): Characterised by a sudden and intense urge to urinate accompanied by uncontrolled urine leakage. This type is more common in older people and may be associated with overactive bladder.
- Mixed incontinence: A combination of symptoms of stress urinary incontinence and urge incontinence. The patient may experience both urine leakage during exertion and sudden urge to urinate.
- Overflow incontinence: Occurs when the bladder does not empty completely, leading to frequent small urine leaks. The cause may be, for example, a blockage in the urinary tract or weakness of the bladder muscles.
Causes of urinary incontinence
The causes of urinary incontinence are varied and can include both physiological and psychological factors. The most common causes include:
- Weakening of the pelvic floor muscles: these muscles are responsible for keeping the bladder in position. Their weakness, e.g. after childbirth, can lead to stress urinary incontinence.
- Hormonal disorders: During menopause, estrogen levels drop, which reduces tissue elasticity and can lead to bladder control problems.
- Urinary tract infections: Can cause temporary incontinence due to bladder irritation.
- Anatomical obstructions: Blockages in the urinary tract, such as prostatic hypertrophy in men, can lead to incontinence.
- Neurological factors: Conditions such as multiple sclerosis, Parkinson’s disease or stroke can damage the nerves that control the bladder, leading to incontinence.
Diagnosis and treatment
Diagnosis of urinary incontinence usually involves a thorough medical history, physical examination and urodynamic tests to help assess bladder and urethral function. In some cases, additional imaging tests, such as ultrasound or MRI, may be necessary.
Treatment of urinary incontinence depends on the type and cause. For stress urinary incontinence, exercises to strengthen the pelvic floor muscles (Kegel exercises), lifestyle changes and behavioural therapy may be effective. In more severe cases, surgical intervention may be necessary.
Urge incontinence is often treated pharmacologically, e.g. with anticholinergic drugs that reduce bladder activity. Behavioural therapy and bladder training are also used in some cases.
Summary
Urinary incontinence is a problem of complex aetiology that can significantly affect quality of life. Early diagnosis and appropriate treatment can provide significant relief and improve the patient’s quality of life. It is important that people experiencing this condition do not hesitate to seek medical help, as numerous treatments are available that can effectively alleviate symptoms.
Additional information
Can andropause affect male incontinence?
Yes, andropause, the male equivalent of menopause, can affect urinary incontinence in men. Andropause is associated with a natural decline in testosterone levels in the body, which can lead to various physiological changes that affect the urinary system.
How does andropause affect urinary incontinence?
- Decrease in muscle mass: A decrease in testosterone levels can lead to an overall reduction in muscle mass, including pelvic floor muscles, which play a key role in bladder control. Weakening of these muscles can result in continence problems, especially during exercise, which is similar to the stress urinary incontinence seen in women.
- Prostate problems: Andropause is often associated with the development of benign prostatic hyperplasia (BPH), which can lead to pressure on the urethra and difficulty emptying the bladder. This can cause more frequent urination, urinary urgency and even overflow incontinence, where the bladder is unable to empty completely.
- Hormonal changes: A decrease in testosterone levels can affect the balance of other hormones, such as oestrogens, which are also present in the male body in smaller amounts. These changes can affect bladder and urethral function, leading to incontinence.
- Weakening of nerve function: Andropause can be associated with a decline in nervous system function, which can affect bladder control. Neurological changes can lead to difficulty in controlling urination, which can contribute to incontinence.
Statistics on urinary incontinence dysfunction
there are statistics on urinary incontinence that show how common the problem is, especially among older people. These data are often collected in population-based surveys and include different demographic groups to identify which groups are most at risk of this dysfunction.
For example, a study in Europe found that around 10-20% of adult men over the age of 60 experience some form of incontinence. Among women, this percentage is even higher and can reach 30-40% in the same age group. In men, the prevalence of incontinence increases after the age of 70, particularly for prostate problems.
The table below shows examples of incontinence data in different age and sex groups:
| Age group | Prevalence in women | Prevalence in men |
|---|---|---|
| 20-40 years | 5-10% | <5% |
| 40-60 years | 15-30% | 10-15% |
| 60-70 years | 30-40% | 10-20% |
| Over 70 years | 40-60% | 20-35% |
As can be seen from the data, women are more likely to suffer from incontinence, especially in older age, due in part to the weakening of the pelvic floor muscles after childbirth and hormonal changes associated with the menopause. Men are more at risk of incontinence as a result of prostate problems, which become more common with age. The group most at risk are those over 70 years of age, both men and women, highlighting the importance of monitoring and treating this condition in older age.
Bibliography
- Abrams, P., Cardozo, L., Wagg, A., & Wein, A. (Eds.). (2017). Incontinence. International Continence Society.
- Haylen, B. T., de Ridder, D., Freeman, R. M., Swift, S. E., Berghmans, B., Lee, J., … & Schaer, G. N. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics, 29(1), 4-20.
- Sokol, E. R., & Karram, M. M. (2010). Pelvic Floor Disorders: a Surgical Approach. Elsevier Health Sciences.
- Hammarsten, J., & Högstedt, B. (2001). Clinical, anthropometric, metabolic and insulin profile of men with high-stage and high-grade clinical prostate cancer. Blood, 67, 1159-1167.
- Kumar, R. J., Barqawi, A. B., & Crawford, E. D. (2006). Adverse events associated with hormonal therapy for prostate cancer. Reviews in Urology, 8(Suppl 2), S41.