Incontinence

Stress Incontinence
Stress incontinence is urine leakage in connection with physical activity, coughing, sneezing, laughing and lifting heavy objects. This increases pressure in the abdominal cavity, and thus on the bladder. If the pelvic floor musculature or the sphincter muscle around the urethra is too weak to resist the pressure, urine will be squeezed out. The causes include pregnancy and childbirth, hormonal changes with age, tissue wear due to aging, stretching of connective tissue, and surgery. Stress incontinence is the most common form of urinary incontinence among women.


Overactive Bladder or Urge Incontinence
With urge incontinence you feel an intense, uncontrollable urge to urinate that results in involuntary and frequent emptying of often large amounts of urine if you cannot get to the toilet in time. This is usually due to uncontrolled contractions in the musculature of the bladder wall. The cause may be damage to the nervous system, urinary tract infections, or age-related hormonal changes, but often the cause of this condition is unknown.
Some people experience this strong urge to urinate without the resulting urine leakage. It is associated with diseases of the nervous system, but may also be present with other diseases.

Mixed Incontinence
Comprises a combination of stress incontinence and overactive bladder, and is especially common in women.

Functional Incontinence
Functional urinary incontinence is involuntary urine leakage due to physical problems or cognitive difficulties. For example, a person who uses crutches or a wheelchair may not be able to move fast enough to reach the toilet in time. A person with Alzheimer's disease or psychiatric disorders may have problems in reasoning and planning, and is therefore unable to use the toilet despite urination functioning properly.

Overflow Incontinence
A full bladder will run over, and this is called overflow incontinence. The bladder is not properly emptied, and this may be due to weaknesses in the muscles in the bladder wall or a blockage in the passage of urine from the bladder. Weaknesses in the bladder wall may be caused by peripheral nerve damage, due to diabetes or other illnesses. An enlarged prostate gland or growths may squeeze the urethra and block the normal flow of urine through the urethra. This type of incontinence is most common in men.

Anal Incontinence
Faecal leakage is very common in elderly people. This problem is often due to intestinal disorders, which must be eliminated in examination by a specialist. The condition may result from complications during childbirth or rectal surgery. Damage may cause defects in the sphincter - the ring of muscle that closes the anus - or injury to the nerves that control the sphincter. Normal tone in the rectum is created by the smooth muscles in the inner sphincter, which is an involuntary (automatic) muscle. The ability to squeeze and keep the stool from coming out is controlled by the outer sphincter, a voluntary muscle. The degree of leakage varies. In many people, simple advice about diet, pelvic floor training, electrical stimulation, will help in the treatment of this condition, as long as there is no serious defect of the sphincter or nerve damage.

Temporary Urinary Incontinece
Temporary leakage may be related to various types of infections, medication, immobility or serious constipation. When the underlying cause is treated, the involuntary urine leakage disappears.

Hereditary Causes
A large Norwegian study shows that heredity is a factor in the development of urine leakage. Comparing the mother, daughter and grandmother indicates a higher risk when other women in the family are incontinent.
The Norwegian study EPINCONT (Epidemiology of Incontinence in the County of Nord-Trøndelag) investigated the extent to which women who are related to each other suffer from urinary incontinence. The figures show that the problem may to a great extent be hereditary.
The researchers recruited 8771 mothers and 2866 daughters (including sisters and granddaughters) who each received a questionnaire about incontinence. The responses were then collected and entered for analysis of the data.

Clearly higher risk
The figures shows that daughters of mothers with urinary incontinence have a 30% greater risk of incontinence. If the mothers had very serious incontinence, the daughters had twice the risk of suffering from the disorder compared with other women. The study also compared the extent to which sisters were affected by incontinence. It showed that if an older sister suffered from incontinence, the chances of a younger sister having the same problem were 60% higher. The increased risk applied to both stress incontinence and urge incontinence.

Does heredity mean everything?
Heredity is probably part of the explanation for the occurrence of the same problem in one family. There are also other risk factors that must be taken into account – overweight, how many times the woman has given birth, and advanced age all increase the likelihood of developing urinary incontinence.

Who can you ask for help?
In most cases, it would be natural to discuss the problems with your regular GP, who can refer you to
a specialist if necessary - a urotherapist (specially trained nurse), a gynaecologist, a urologist, a gastrologist, or a physiotherapist.