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Bladder Weakness/Incontinence?

Bladder Weakness (or urinary incontinence) is passing urine when you don’t mean to because of partial or total loss of bladder control.

If everything is working normally, when your bladder is full it sends a signal to your brain. Your brain then tells your pelvic floor muscles to relax and the opening at the neck of your bladder to open. Your bladder muscle tightens (contracts) and pushes the urine out.

If you have bladder weakness then it could be due to a number of different factors connected with either the muscles or the nerve supply to control your bladder.

How common is it?
If you experience any degree of bladder weakness or incontinence then you aren’t alone! In the UK today there are up to six million people who experience these symptoms. The most important thing to realize is that the symptoms can be treated with professional help and the problem can often be cured.

Although the incidence of bladder weakness and incontinence does increase with age, surveys show that 6% of women aged 15-44 have the condition so it is far more common than you might think.

Bladder weakness is often considered a female problem, but this is only partly true. Although in younger age groups, more women than men experience this condition, the differences are equalized around the age of 70, so in later life, almost as many men as women suffer from bladder weakness.

What can cause it?
If you've noticed that you leak when you cough, laugh or move it's worth talking to your doctor or surgery practice nurse about what to do next. Although bowel and bladder weakness becomes more common as we get older, it is not an inevitable part of ageing. Because bladder weakness is not a distinct disease, it is often difficult to determine a definite cause.

There are a wide variety of reasons why you may experience bladder weakness or faecal incontinence:

Weakened Pelvic Floor Muscles - The bladder and outlet passage are supported and held in place by a sling of muscles called pelvic floor muscles that keep the bladder closed. If these muscles lose their strength and/or flexibility (often caused by trauma to the entrance to the bladder, 'pelvic floor' or bowel during childbirth) then even everyday activities such as coughing may cause leaking.

Being overweight can also put an added strain onto pelvic floor muscles.

Birth Defect - You may have been born with a defective bladder or sphincter, which means you've always leaked or start to leak once other factors add to the problem.

Menopause -With the menopause, due to the reduction in the quantity of oestrogen many women notice that their bladder becomes lax, with leakage of urine.

Illness - Kidney or urinary tract infections can cause temporary bladder weakness or incontinence. Severe constipation can also cause these conditions to occur.

Nerve Damage - It can be caused by nerve damage, such as spinal cord injury, or with nerve diseases like multiple sclerosis.

Other - Surgery, Medications, or an oversensitive bladder can also lead to bladder weakness.

What types of Bladder Weakness/Incontinence are there?
Stress
This is by far the most common type and is common in women after childbirth or after the menopause. Usually only a small amount of urine leaks out but this can be enough to cause embarrassment or concern. This often happens due to physical exertion (i.e., at the gym or whilst lifting) but can be triggered by something as ordinary as sneezing, laughing or coughing. This is because your pelvic floor muscles are weakened. This is often caused during pregnancy and childbirth by the pressure on the bladder during later stages.

Urge
Urge is the second most common type of incontinence. It is also referred to as an overactive bladder. With this type of bladder weakness, the bladder contracts involuntarily, leading to the release of large amounts of urine. This is caused by a problem with the messages between the bladder and the brain. The bladder may tell the brain it is full too early, the bladder muscle squeezes and empties the bladder completely - often before you have a chance to get to a toilet.

Urge incontinence may happen at any time, even when you’re sat still. It can be triggered by a sudden change of position, and is worse in times of stress. It can happen during sex, particularly during orgasm. Another symptom of urge incontinence is a need to go to the toilet a lot during the night.

Overflow (or Drip)
This is most common in older men who often have a slightly enlarged prostate gland, which is situated just underneath the bladder. The urine outflow tube passes through the middle of the prostate, and any enlargement of this gland presses on the urethra (urine tube). This makes it difficult for the bladder to empty and fill up completely, and a pool of urine constantly remains in the bladder. The area behind the obstruction is tense and highly pressurised and the bladder regularly releases a small involuntary dribble of urine. This condition is also known as incomplete bladder emptying and is rarer in women.

Reflex
Having no control over their bladder at all is called reflex bladder. Some people have it all their lives or it can develop after injury or illness.

Mixed
Some people experience mixed symptoms at the same time.

Faecal
Faecal incontinence is more common than you probably think, but people do not talk about it. Faecal incontinence is the involuntary leakage of faecal material from the back passage. The substance that leaks away may be semi-solid or liquid. This type of incontinence may occur only occasionally or it may be a persistent problem of many years' duration.

Only a professional trained in these symptoms can truly diagnose and treat your condition. A GP will often refer you to a specialized Continence Advisor for assessment to ensure you receive the right help and treatment to improve your symptoms.

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