November is Incontinence Awareness Month
Do you leak urine when you cough, sneeze, or laugh? Do you limit your time away from home, know where all the bathrooms are in the mall, and always go ‘just in case’? Well you’re not alone. Over 3.3 million Canadians experience urinary incontinence and ½ of women will experience problems with incontinence at some point in there lives.
Contrary to popular belief, there are many ways to manage, treat, and in many cases cure incontinence. Due to embarrassment and the myth that incontinence is ‘just something you have to live with’ many people (74%!) do not seek help and are unaware of the many treatment options available. They feel bothering their doctor with something so minor is not warranted and therefore suffer in silence.
So what exactly is urinary incontinence? Well according to the International Continence Society, incontinence is defined as the, “complaint of any involuntary leakage”. Some people may think that incontinence is a disease, but it is actually a symptom of something else going on in the body. Before I get to the causes of incontinence, I feel understanding your symptoms is easier if you have an understanding of how the bladder works. So let’s take a trip back to biology class….
We’ll start our urinary tract anatomy lesson with the bladder. The bladder is the storage reservoir for urine, and like a balloon, it can expand and contract. It’s about the same size and shape of a grapefruit and can hold about 300-500 ml of fluid. The kidney’s help filter the urine and pass it onto the bladder through tubes called the ureters. Urine then leaves the bladder through another, but larger, tube like structure called the urethra.
The bladder itself is made up of 3 layers, and the thickest of these layers is called the detrusor muscle. As the bladder fills with urine, the bladder wall expands (like a balloon) and stretch receptors within the bladder are stimulated. At a certain point during bladder filling, these receptors send signals along the spinal cord to the brain, which inform us of the need to urinate. The brain then sends a signal to our detrusor muscle to contract and expel the urine.
If this were where the anatomy lesson ended, we would all be like un-potty trained toddlers. However, with further development, we cannot only perceive the need to urinate, but we can also control it until we can find an appropriate place to go. This ability is provided by the urethral sphincter, a ring of muscle that surrounds the urethra, and controls the flow of urine from the bladder. When the urinary sphincter is contracted, no urine can pass through; when relaxed, urine is released. Continence therefore depends on the proper functioning of the urinary tract system and sphincteric muscular control.
It may now be easier to understand the different causes of urinary incontinence and where in the process it occurs. The nervous system (brain + spinal cord) plays an important role in proper bladder functioning, so nerve damage caused by multiple sclerosis, stroke, Parkinson’s, brain tumours or spinal injuries may affect continence. One myth surrounding incontinence is that it’s a normal part of the aging process. This is just not so, as not all of us become incontinent as we age. However, the natural aging process may contribute to incontinence due to weakening of the bladder muscles. For men, natural enlargement of the prostate gland as they age can lead to incontinence. As women age and enter menopause they produce less estrogen, a hormone that helps to keep the urethra plump and healthy, which can also contribute to incontinence.
Another myth is that childbirth leads to incontinence, and although a majority of women will experience problems post-partum, this is not true for all. Incontinence can be caused by damage to the muscles of the pelvic floor and/or urinary sphincter (and the nerves controlling these muscles) during vaginal delivery. This damage can also lead to pelvic organ prolapse (discussed in a future blog), which can occasionally lead to incontinence. Lastly, hormonal changes during pregnancy and the added weight of a growing uterus can also contribute to incontinence. Other causes of incontinence include birth defects, side effects of medication or pelvic surgery, injuries from an accident, bladder cancer and bladder stones. I hope this information gives people with incontinence a better understanding of the condition, causes, myths and facts. Hopefully this knowledge will give others the confidence to seek help because everyone’s quality of life and psychological well-being are important and something can be done to help.
If you think you might be helped by assessment and treatment for any of the above problems you can email me at firstname.lastname@example.org or call the clinic directly to make an appointment.