Urinary incontinence is a health issue that can be distressing and embarrassing for those affected, impacting their daily lives, mental well-being, and self-esteem. It is common among children, while in adults, it is more prevalent among women and the elderly. (1)

This article covers the main causes of urinary incontinence and its treatment options.

Causes of urinary incontinence

Urinary incontinence comes in different types, with each type having its own causes. Below is an explanation of the causes according to each type. (2)

Stress Incontinence

Characterized by involuntary urine leakage during activities that put pressure on the bladder like coughing, sneezing, laughing, or exercising.

Stress urinary incontinence occurs when the pressure inside the bladder exceeds the strength of the urethral muscle that controls urine flow. As a result, any added pressure, like from coughing, causes urine leakage.

This type usually occurs as a result of weakness in the pelvic floor muscles, and its causes includes:

• Childbirth: especially vaginal delivery, which increases the likelihood of this condition compared to a cesarean section.
• Increased pressure on the tummy: as a result of obesity or pregnancy
• Damage to the bladder area during surgery.
• Neurological diseases: such as Parkinson's disease or multiple sclerosis.
• Certain connective tissue disorders: like Ehlers-Danlos syndrome, can also contribute to this condition.
• Certain medications: Some medications can cause side effects that affect bladder control, such as certain drugs used to treat benign prostatic hyperplasia.

Urge Incontinence

Urgency incontinence, also known as overactive bladder, causes a sudden and intense urge to urinate.

This happens due to a problem with the bladder muscles. Normally, the bladder muscles relax to allow it to fill with urine and then contract to empty it. However, sometimes the bladder contracts repeatedly and intensely, making it difficult to control urination.

Causes of this type of incontinence include:

• Drinking too much caffeine.
• Not drinking enough fluids leads to highly concentrated urine accumulating in the bladder, which may irritate it and lead to symptoms of hyperactivity.
• Urinary tract infections: These can cause irritation of the bladder.
• Some issues that may affect the bladder include tumors or stones.
• Constipation.
• Nerve disorders.
• Taking certain medications.

Mixed Urinary Incontinence

This type occurs when you have both stress and urge incontinence at the same time.

Overflow Incontinence

It occurs when the bladder does not empty completely, leading to continuous or repeated urine leakage. The causes include:

• Bladder obstruction: such as an enlarged prostate or bladder stones.
• Weak bladder muscles: due to nerve damage or certain chronic conditions.

Functional incontinence

This type often affects people with a physical or mental disability, where the patient is unable to reach the toilet in time.

Medications that cause urinary incontinence

Some medications can have side effects that cause urinary incontinence, either by affecting the bladder muscles and their function or by increasing urine production. Some of the most common medications include: (3)

• Diuretics.
• Certain medications used to treat an enlarged prostate.
• Some antidepressants.
• Certain blood pressure medications.
• Some sedatives.

Treatment of urinary incontinence

There are several treatments for urinary incontinence, depending on the cause and patient condition. In general, lifestyle changes that help improve the condition can be tried first before exploring other treatments.

Below is a more detailed explanation of the methods for treating urinary incontinence: (5)(6)

Lifestyle changes

• Drink enough water throughout the day and reduce fluid intake in the evening.
• Avoid or limit caffeine consumption.
• Try to prevent constipation.
• Engage in regular physical exercise and work on reducing excess weight.
• Quit smoking.

Bladder training

This is done by setting a schedule for urination and gradually increasing the intervals between urination to train the bladder to hold urine for longer periods. A doctor can help you create a suitable schedule.

Kegel exercises to strengthen the pelvic floor muscles.

This increases the ability to hold urine and reduces leakage. Kegel exercises are among the best exercises to strengthen the pelvic floor muscles. To perform them, you must first identify the pelvic floor muscles, which are the muscles you use when trying to stop the flow of urine. Once you’ve located these muscles, follow these steps:(4)

• Lie down on a comfortable bed or couch.
• Tighten the target muscles for 3 seconds, then relax them for 3 seconds.
• Repeat the exercise for 10 cycles, and it is recommended to perform it twice a day, in the morning and evening.

Other treatments

Other treatments for urinary incontinence may include:(5)(6)

• Medications that reduce the nerve signals that trigger urination or help control the bladder muscles.
• Medical devices such as alarms that alert a person when urination begins during sleep, or the use of urinary catheters.
• Bladder neck and urethral injections: These aim to add volume to improve urethral closure.
• Electrical nerve stimulation: This stimulates the nerves that control the bladder to improve its function.
  Surgery: Generally reserved for patients whose symptoms are severe or who do not respond to conservative treatments.

Important note: It is essential to a nephrologist  to determine the cause of urinary incontinence and identify the appropriate treatment. Although urinary incontinence may seem like a challenging and embarrassing issue at times, there are various available and effective treatments.

References

1. Cleveland Clinic - Urinary Incontinence
2. NHS UK - Causes of Urinary Incontinence
3. WebMD - 4 Medications That Can Cause Incontinence: Diuretics, Blood Pressure Medicines, adn More
4. MedlinePlus - Urinary Incontinence
5. NIDDK - Treatment for Bladder Control Problems