There are four main types of incontinence:
- Urge incontinence due to an overactive bladder.
- Stress incontinence is defined as the loss of small amounts of urine associated with sneezing, laughing or exercising or other movements that increase intra-abdominal pressure and thus increasing pressure on the bladder.
- Overflow incontinence due to either poor bladder contraction or blockage of the urethra.
- Functional incontinence due to medications or health problems making it difficult to reach the bathroom.
Your doctor can diagnose your specific type of incontinence, its cause, and provide possible treatment options.
Overactive Bladder & Urge Incontinence
Overactive bladder is a condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person’s life. If there is loss of bladder control then it is known as urge incontinence. While urge incontinence is a common issue and may occur in anyone at any age, it is more common in women and older adults.
Urge incontinence is a sign that there is an underlying problem. In urge incontinence, the muscles of the bladder contract with enough force to override the sphincter muscles of the urethra, causing some urine to leak through. These contractions can occur no matter how much urine is in the bladder.
- Needing to urinate suddenly and urgently.
- Having to urinate often during the day and night. Urinary frequency is considered abnormal if the person urinates more than eight times in a day.
Nocturia is a symptom where the person complains of interrupted sleep because of an urge to void the bladder, two or more times per night is considered abnormal frequency.
- Not being able to control when you pass urine.
- bladder infection
- bladder inflammation
- bladder stones
- Something blocking urine from leaving the bladder
- An enlarged prostate blocking urine from flowing from the bladder (in men)
- diseases of the nervous system (such as multiple sclerosis)
- injury to the nervous system (such as a stroke or trauma to the spinal cord)
- bladder cancer
- poorly controlled diabetes
- obesity can also contribute to a decrease in bladder control.
In many cases of urge incontinence, your doctor will be unable to pinpoint any exact cause.
Relieving Symptoms of Urge Incontinence
Most people with urge incontinence can live normally without treatment. However, the condition could affect your daily life, and you may want to consider trying some of the many treatment options for urge incontinence.
- Bladder Retraining
- Lifestyle Changes
- Dietary Changes
- Pelvic Floor Exercises
Managing urge incontinence usually begins with bladder retraining. This helps you become aware of when you lose urine because of bladder spasms. Then you relearn the skills you need to hold and release urine. While it may sound simple, training your bladder takes patience.
Two biofeedback techniques are timed voiding and bladder training.
- Timed voiding programs involve establishing a schedule for urination to reduce the frequency of accidents. To practice timed voiding, you use a chart to record the times that you urinate and when you leak urine. From the patterns that appear in the chart, you can plan to empty your bladder before you would otherwise leak. You can set a reminder on your phone or use a vibrating watch to stay on schedule.
- With bladder training, you “stretch out” the intervals at which you go to the bathroom. For instance, to start, you can plan to go to the bathroom once an hour. You follow this pattern for a period of time, and then you try to delay urinating by an extra 10 minutes and build up to 20 minutes until you can comfortably use the bathroom every three to four hours.
You may also try urinating, then going again immediately to learn how to empty the bladder completely.
Avoid going to the toilet “just in case”. This bad habit may lead to frequent urination because you will reduce the bladder’s holding capacity.
You can’t solve incontinence by severely cutting back on fluids. This can lead to dehydration, constipation, and kidney stones, which can irritate your bladder and make symptoms worse. Limiting your amount of liquid will result in less, but the smaller amount of urine is highly concentrated and irritating to the bladder. Plus if you do leak urine, drinking enough water will keep odours away. Drink more water earlier in your day to reduce the urge overnight. Sip small amounts of water evenly throughout your day so your bladder does not have to hold a large amount of water at one time.
Establish regular bowel habits.
If you are constipated, add fibre to your diet. Fluid intake also helps with constipation. Eliminating chronic constipation can also eliminate a source of signals to the brain suggesting that the bladder has an emptying problem when the source of discomfort is really the large intestine and rectum.
You should also quit smoking so that you cough less.
Some foods and beverages can be irritating to your bladder, eg. alcohol, caffeine, and foods that are spicy, acidic, or high in sugar.
Alcohol has also been shown clinically to act as a bladder stimulant, triggering symptoms of urgency. In addition, it acts as a diuretic and may induce greater frequency of urination. Alcohol inhibits arginine vasopressin, also known as antidiuretic hormone or ADH. The purpose of ADH is to conserve water in the body by reducing its loss in urine. Without ADH, the kidneys don’t reabsorb water as easily, therefore you fill the bladder quickly with water-diluted urine leading to frequency. Alcohol affecting the availability of ADH can lead to urination being induced 20 minutes after a person consumes it.
Like alcohol, caffeine acts as a diuretic, causing more frequent urination. In addition, caffeine can irritate the bladder and create stronger urges. Caffeine is found in coffee, tea, soft drinks, chocolate (white chocolate does not contain caffeine but still contains a lot of sugar), and certain over-the-counter medicines such as cold medications and diuretics for weight loss. It can have effects on the body’s metabolism, including stimulating the central nervous system and increasing bladder activity. Consuming caffeine may result in urgency, frequency, and/or incontinence. Studies have demonstrated that individuals with bladder symptoms who have reduced caffeine intake to less than 100mg/day noted improvement in symptoms. If you choose to limit products containing caffeine, do so slowly over a period of several weeks as strong headaches may result during the withdrawal period.
Soft drinks, soda water, and energy drinks. These drinks usually have caffeine, as well as carbonation, which should both be avoided. In addition, many of them contain artificial sweeteners. Champagne, has carbonation and bladder-stimulating alcohol.
When there is excess sugar in the blood the kidneys work harder to remove the glucose. The brain gets the signal that water is needed to dilute the blood. If the kidneys cannot filter all the glucose, then excess glucose gets dumped into the urine. Fluid is taken from bodily tissues to help move the sugar to the urine. This leads to dehydration and thirst. As water is consumed to quench the thirst, urination happens more frequently. Drinking more water is good and helps the kidneys remove the sugar. Control of blood sugar levels can help prevent any of this from happening.
Spicy foods can irritate the bladder and increase symptoms of OAB and incontinence. Test how much heat you can handle without affecting your bathroom habits.
Acidic foods.Increased acid in things like citrus fruits (oranges, grapefruits, clementines, lemons, and limes), tomatoes, pineapple, vinegar and cranberries can worsen bladder control.
Many processed foods contain artificial flavours and preservatives that can irritate the bladder and worsen incontinence symptoms. Artificial sweeteners (sodium saccharine, acesulfame K, and aspartame) have been shown to affect bladder function in limited animal studies. They have been found to cause bladder irritation in people with interstitial cystitis (IC) or chronic bladder inflammation. Additionally, they are known to aggravate symptoms in someone with a urinary tract infection.
However, if caffeine, alcohol, artificial sweeteners, or spicy food is a regular part of your diet, try eliminating them for a week to see if your symptoms improve. Then gradually, every one to two days, add one food/drink back into your diet, making note of any changes in urinary urgency, frequency, or bladder control loss. There may be individual circumstances that cause an individual’s bladder to spasm.
Pelvic Floor Training:
Kegel exercises aim to strengthen the muscles of the pelvic floor. These are mainly used to treat stress incontinence. However, these exercises may also help relieve the symptoms of urge incontinence.
Always practise when you have an empty bladder. Ensure you are keeping the muscles of the abdomen, buttocks and legs relaxed.
- Focus on the pelvic floor region, between the tailbone and pubic bone. On an exhale contract the muscles of your pelvic floor, imagining pulling the pubic bone and tailbone together. On an inhale aim to fully relax your pelvic floor.
- Keep your breath slow, even and without strain.
- Repeat this breath plus contraction sequence for as many repetitions as you can three or more times per day.
When to Seek Medical Treatment
If you have a serious case of urge incontinence, you will want to seek treatment right away. Your symptoms could be signalling a bladder infection, inflammation, obstruction, or stones in the bladder or kidney. Infection could spread to the kidneys or other areas of the body. Rarely, this condition can cause severe increases in bladder pressure, which can lead to kidney damage.
Some symptoms to watch out for are urge incontinence together with:
- pain in the pelvic region (lower stomach)
- burning or pain with urination
- symptoms that continue for several days
For many people, urge incontinence is merely an inconvenience that does not require a doctor visit. However, if urge incontinence is impeding on your daily activities, visit your doctor to discuss treatment options, such as medication or surgery to help with muscle strength and sphincter functioning. There are many surgical options your doctor can discuss with you.
If you are not seeing improvement after three or more months or if you are frustrated with the treatments that your doctor is providing, request a referral to a specialist such as a urologist, gynaecologist, nurse specialist, physical therapist, or occupational therapist or seek a second opinion from another doctor.
I hope you have found the information presented here useful. It is not a replacement for medical counselling. Post any questions you may have in the comments below.
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