Types of urinary incontinence and what causes them

Stress urinary incontinence (SUI) is one of the most common types. It is characterised by unwanted leaks when the bladder comes under sudden pressure.

Urine leaks can be caused by:

• sneezing
• laughing
• coughing
• running
• heavy lifting
• bending over

What causes stress incontinence?

SUI happens when the muscles supporting the bladder weaken over time. Specifically, the pelvic floor muscles and the urethral sphincter muscles weaken. When the pressure in the bladder is greater than the strength of these muscles, the urethral sphincter is forced open.

The most common cause of these muscles weakening is ageing. However, menopause, pregnancy, childbirth, surgery and some medicines can also cause stress incontinence.

The next most common incontinence type is urge incontinence. It is characterised by an urgent and strong urge to urinate. It is sometimes known as having an overactive bladder (OAB).

What causes urge incontinence?

Urge incontinence happens when the detrusor muscles are overactive. These are the muscles that surround the bladder. The detrusor muscles typically relax to allow urine to fill the bladder and contract to let urine out.

In those with this condition, however, the muscles contract too often. This causes urine to leak out involuntarily. It’s not known exactly what causes these muscles to contract too much, but experts have linked it to certain risk factors such as:

• drinking too much caffeine or alcohol
• constipation
• not drinking enough fluids
• infections of the urinary system (e.g. urinary tract infections like cystitis)

Several conditions may cause frequent urination, so you must speak to your doctor before self-diagnosing.

For many, it is common to experience stress and urge incontinence symptoms.

1 in 3 women experience symptoms of both urge and stress incontinence.

This phenomenon is known as mixed incontinence. Studies estimate that 1 in 3 women with incontinence experience this type.

The cause is usually a combination of urge and stress incontinence causes.

Functional incontinence, or disability-associated urinary incontinence, is a unique type of incontinence. Unlike other types, it is not caused by a physical problem with the bladder.

This condition occurs when a person is unable to:

• recognise the need to go to the toilet
• locate the toilet
• access the toilet
• recognise the toilet
• manage their personal needs

What causes functional incontinence?

It can happen to a person for several reasons. They could have a physical disability like arthritis or cerebral palsy, where they have issues with mobility. Alternatively, it could be due to a cognitive disability such as dementia or a developmental disorder (e.g. autism).

Overflow incontinence is a rarer type of incontinence. Also known as chronic urinary retention, the condition occurs when your bladder is unable to fully empty itself.

Symptoms include:

• struggling to begin passing urine
• having a weak urine stream
• dribbling after you have finished urinating
• having involuntary leaks

What causes overflow incontinence?

One of two factors can cause overflow incontinence.

One common cause is an obstruction in the bladder. Not only does a blockage prevent you from passing urine, but it also causes excess pressure in the bladder and results in urine leakage. An obstruction can be caused by an enlarged prostate, bladder stones or constipation.

Another cause of this type is a problem with the detrusor muscles. In some people, the muscles may not fully contract, which means the bladder cannot empty. It can also stretch the bladder over time.

The main cause of this type is nerve damage, such as from an injury or surgery. It can also be a side effect of certain medicines.

The most severe type of incontinence is total incontinence, in which you cannot store any urine in your bladder. This results in passing large amounts of urine and frequent leaks.

What causes total incontinence?

Total incontinence is caused by medical conditions like:

• a problem with your bladder from birth
• a spinal cord injury
• a bladder fistula - a tunnel-like hole that forms between the bladder and a nearby area such as the vagina

It can be hard to live this condition. However, with lifestyle changes and treatment, the condition can be managed.

Keep a diary of how often you urinate and your symptoms, and bring it to your doctor's appointment. It will help them diagnose your symptoms and which type you have.

Once you have a diagnosis, they can help you decide the best treatment option. They’ll start by suggesting simple measures such as changing your diet, losing weight, doing pelvic floor exercises or doing bladder training. You can also use incontinence products like absorbent pads to help control leaks.

If that doesn’t work, your doctor may recommend prescription treatment. Medications such as tolterodine (Detrusitol) and solifenacin (Vesicare) work by helping to control the bladder muscles and reduce leakage. You can order both of these online with discreet packaging at euroClinix.

In the most severe cases, your doctor may refer you for surgery.