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The discovery of incontinence problems often occurs in an everyday situation, it can be a cough in the grocery store, a brisk walk to the bus or a sudden need to urinate that cannot be stopped.
Incontinence can feel both disturbing and embarrassing, but even though this is usually not something you talk about with others, it is a common medical problem - at the same time it is not something you should have to accept as "normal". There is often a clear explanation for why urine leakage occurs - and in many cases it can be treated or at least alleviated.
Incontinence - why it happens and what you can do
Incontinence simply means that you leak urine without wanting to, this is a symptom and not a disease in itself. To find the right treatment, you first need to understand what type of leakage it is.
The most common form of incontinence is stress incontinence. This means that it leaks when the pressure in the abdomen increases, for example when you cough, sneeze, laugh, jump or lift heavy objects. This is often because the support around the urethra and pelvic floor is not enough to hold it tight.
Another common form is urge incontinence. This is when you have a sudden, strong urge to urinate and you don't always have time to get to the toilet. This is often associated with an overactive bladder, where the bladder muscle contracts too early. Some people have a combination of both exercise incontinence and stress incontinence, which is called mixed incontinence. Furthermore, there is also another form called overflow incontinence, where the bladder does not empty properly and therefore leaks, as well as continuous leakage that may be due to more unusual anatomical or neurological causes.
Why do some people suffer from incontinence more often than others?
There are often several factors that together cause the bladder, urethra or pelvic floor to function worse, so it is not possible to point to a single cause of incontinence. Some causes of the discomfort that are worth highlighting are the following:
- Pregnancy and vaginal delivery – these can stretch and strain the pelvic floor, which in turn increases the risk of stress incontinence in particular.
- After menopause, lower estrogen levels affect the mucous membranes and tissues in the lower abdomen, which in some people can contribute to dry mucous membranes, irritation and poorer support around the urethra.
- Excess weight increases pressure on the pelvic floor and bladder.
- Constipation can also play a role, partly through mechanical pressure and partly through the pelvic floor being strained when you strain repeatedly.
- Caffeine and alcohol can increase the amount of urine and irritate the bladder, which can worsen urges and leakage.
- Prostate enlargement and problems after prostate surgery are important causes in men.
- Both women and men can experience incontinence due to neurological diseases, diabetes, recurrent urinary tract infections or after pelvic surgery.
- Age does matter, but incontinence is not an inevitable part of getting older. That's an important difference. The risk increases over time, but the symptoms should still be assessed and treated based on the cause.
What can I do as someone who suffers from incontinence?
For many, treatment begins with various measures that you can do yourself or with the help of healthcare support.
Pelvic floor training
For stress incontinence, pelvic floor training is the first-line treatment. Here, you focus on strengthening the muscles that support the urethra, bladder and rectum. If the pinch becomes stronger, the urethra can hold tight better when abdominal pressure increases, for example when coughing or exercising.
Bladder training
For urge incontinence, bladder training often helps. This form of training involves gradually increasing the time between toilet visits, so that the bladder gets used to holding larger volumes without signaling an acute urge immediately. Bladder training often needs to last at least six weeks to have a clear effect.
Lifestyle changes can also reduce symptoms:
- reduce large amounts of coffee, energy drinks, tea and alcohol
- treat constipation
- lose weight if overweight
- quit smoking if coughing worsens leakage
- drink moderately, but avoid both overdrinking and drinking too little
The last point is easy to miss. Many people drink too little in the hope of leaking less, but concentrated urine can irritate the bladder and instead of reducing discomfort, the urges are made worse.
Auxiliaries can be a good support while you seek treatment. Absorbent protection, incontinence protection and in some cases uridom or other aids can improve everyday life, but they do not replace an examination when the problems are recurring.
How the examination and treatment are carried out in healthcare
If your incontinence problems affect your everyday life, you should seek care and be offered a simple examination, which is often enough to move forward with treatment. During such an examination, you will often be asked to share when the leakage occurs, how often you urinate, how much you drink, what medications you take and whether you have other symptoms such as burning, a feeling of prolapse or difficulty emptying your bladder.
You will often be asked to make a voiding list, sometimes this is also called a bladder diary. There, you note for a few days how much you drink, how often you urinate, whether you leak and in what situations it happens. This can provide a clearer picture than memory alone.
The assessment may also include a urine sample, gynecological examination, prostate assessment or checking remaining urine after a visit to the toilet. The aim is to distinguish between different types of incontinence and to find things that can be treated, such as urinary tract infection, constipation, prolapse or obstruction to bladder emptying.
If self-care and exercise are not enough
If self-care and exercise are not enough, there are other options to try. In the case of an overactive bladder, medications that reduce urges and the need to go to the toilet can be used, examples of which are antimuscarinic medications or so-called beta-3 agonists. However, the benefits of using them need to be weighed against side effects such as dry mouth, constipation or the effect on blood pressure in some people.
In the case of stress incontinence that does not improve with pelvic floor training, surgery may be considered. This often involves procedures that improve the support under the urethra. For men with incontinence after prostate surgery, there are specific treatment options, sometimes including pelvic floor exercises, sling surgery, or an artificial urethral sphincter.
When incontinence may be a sign of something else
Urinary leakage can sometimes also be a result of another medical problem, in which case it is not enough to just treat the leakage itself. If you also have problems with burning when urinating, blood in the urine, fever, pain in the lower abdomen or back, or sudden new incontinence, you need to be evaluated. The same applies if you have difficulty emptying your bladder, feel a clear feeling of heaviness in the lower abdomen, or have neurological symptoms such as numbness, weakness, or decreased sensation.
Certain medications can also contribute to the problem. Diuretics increase the amount of urine, and other medications can affect bladder emptying, alertness, or constipation. Therefore, the entire list of medications is relevant when investigating incontinence.
When should you seek help – and what might be good to check?
If your incontinence recurs, disrupts your everyday life or causes you to change the way you live, you should seek medical attention to get an assessment and the right help. You should also seek medical attention if the symptoms come on suddenly, worsen quickly or are combined with other urinary tract symptoms.
If you also feel unusually tired, thirsty or urinate a lot, it may be wise to check your blood sugar, as diabetes sometimes contributes to frequent urges and urinary problems. In the case of repeated urinary tract problems, urine tests and sometimes kidney function tests may also be relevant. In people after menopause, pregnancy, childbirth or prostate treatment, a broader medical assessment can provide an explanation for why the symptoms have arisen at this time.
There is therefore rarely a single standard solution. But there is almost always a next step: the right diagnosis, the right exercise, the right treatment or the right sample.
