About Bladder Health
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Proper bladder function
Urinary Incontinence and bladder weakness can have many causes, understanding your bladder control and leakage symptoms is easier if you understand how the normal bladder works.
The bladder is the sac where urine is stored. It’s the size and shape of a grapefruit and can hold about 300–500 ml of fluid. Urine is filtered by the kidneys and drains into the bladder through two tubes called ureters. From the bladder, urine leaves the body through the urethra. Together, this group of organs and tubes is called the urinary tract.
The wall of the bladder is made of several layers. The thickest of these layers is called the detrusor muscle. As the bladder fills up, the bladder wall expands. When it’s time to urinate, the detrusor muscle contracts to push the urine out.
The urethral sphincter is a ring of muscle that surrounds the urethra and controls the flow of urine from the bladder. When the urinary sphincter is contracted, urine can’t pass through; when it relaxes, urine is released.
It is important to maintain optimal bladder health to ensure that it functions as intended and to maintain healthy bladder control.
Incontinence is not a disease.
Incontinence is a symptom of something else going on in the body, and should be discussed with a healthcare professional who is interested in and knowledgeable about incontinence. Incontinence can always be either cured, treated, or managed successfully. There is help available – see your healthcare professional.
What is Urinary Incontinence?
Urinary incontinence, the involuntary loss of bladder control and general bladder weakness can have a dramatic impact on one’s life!
Did you know there are over 3.3 million Canadians experiencing at least one of the different types of urinary incontinence?
Imagine not being able to travel, enjoy a movie and dinner with your partner, work out at your gym, lift your child or groceries, as you may have an accident. You can not be away from home any length of time, you absolutely must know where the bathrooms are located in the shopping mall, you are embarrassed to have intimate relations with your mate and in some cases individuals have quit their jobs.
There are ways to manage incontinence, and in many cases cure it. Due to embarrassment many people do not seek help and therefore are unaware of the many treatment options that are now available This web site is intended to give you some facts on incontinence – what it is and what it is not, and why it occurs. Most importantly, this information strives to give you the confidence of knowing that something can be done and you are not alone. This is the first step in preparing you to become an educated partner with an interested and knowledgeable healthcare professional.
General Facts
Some Causes of Urinary Incontinence
Weakening of the Pelvic Floor Muscles and Urethral Sphincter
Weakening of the pelvic floor muscles may occur as a result of trauma of vaginal childbirth, disease process affecting the brain and spinal cord such as multiple sclerosis, Parkinson’s disease, diabetes mellitus and stroke; birth defects, injuries from an accident usually with fracture of the pelvic bones, or a consequence of medications or after surgery such as removal of the prostate gland.
Obesity
Obesity and overweight increase the risk of having incontinence because the accumulation of fat increases the abdominal pressure. This overcomes the ability of the urethral sphincter to keep the urethra closed during activities that increase the abdominal pressure like walking, lifting, coughing, sneezing and sports.
Different Types of Urinary Incontinence
Click on each type of incontinence to expand more information.
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Stress incontinence refers to the leakage of urine when coughing, sneezing, laughing, lifting, jogging, or doing anything that causes the abdominal pressure transmitted to the bladder pressure to be stronger than the bladder’s closure mechanism (urethral sphincter).
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Urge incontinence is caused by sudden involuntary contraction of the bladder muscle and is associated with a strong desire to urinate and the inability to delay voiding long enough to get to a toilet. For this type, there is usually a small amount of urine loss at one time.
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Overflow incontinence is the frequent leakage of urine without the urge to void or the inability to urinate normal volumes. The amount of urine that exceeds the bladder’s capacity leaks out, but the bladder remains full.
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Total incontinence is the complete absence of control, either continuous leakage or periodic uncontrolled emptying of the bladder’s contents.
OAB: Is the medical term denoting a group of symptoms resulting from involuntary bladder spasm that includes frequency of urination especially at night and urgency with or without involuntary leakage. It may occur without an obvious cause or secondary to nervous diseases affecting the control of urination.
Mixed: Is a combination of the symptoms of stress and urgency incontinence
Functional: Those immobile who are not originally incontinent fail to get to the toilet on time and are placed in absorbent products and therefore are considered incontinent
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Enuresis is the term most widely used to describe bedwetting in children who are old enough to be "potty trained", and adults who experience loss of bladder control at night.
There is much you can do to help your healthcare professional determine the type and cause of your incontinence.
Before your visit, prepare a list of all prescription and non-prescription medications which you are taking, or bring them with you. Also briefly describe your medical history, including information on any surgeries you may have had.
In addition, your healthcare professional will ask you questions about how much fluid you drink, and how, when and how many times you lose urine.
Once a complete history has been taken, you may find that special diagnostic studies, including urodynamic tests, are in order. The type and the cause of your incontinence will determine the appropriate treatment options.
Did you know that urinary incontinence means a loss of bladder control? If you did not, you are not alone. Almost half the Canadian population does not know what the word "incontinence" means, despite the fact that 3.3 million Canadians experience it!
Incontinence affects over 3.3 million Canadians including men and women of all ages.
Incontinence means the involuntary release of urine at the wrong time and/or place.
The number of people experiencing incontinence will rise dramatically over the coming years due to the aging "boomer" population.
Incontinence is not a disease. It is a symptom of something else going on in the body, and should be discussed with a healthcare professional who is interested and knowledgeable in the area.
In one study, 74.5% of respondents reported that day-to-day activities had been modified at least a little because of urine leakage.
People suffering with incontinence experience various emotions during. incontinence—84.3% reported feeling embarrassment, 73.4% reported feeling discouraged, and 83.1% reported feelings of frustration.
Incontinence can be caused by a weakening of the pelvic floor muscles as a result of vaginal childbirth, the result of a disease process such as multiple sclerosis or Parkinson’s disease, birth defects, injuries from an accident, or a consequence of medications or surgery.
Incontinence is not caused by aging. However, changes which occur with the natural aging process may contribute to incontinence. For example, the natural enlagement of the prostate gland as men age, or the progressive decrease of estrogen which women experience with aging and after the menopause, and child birth can lead to incontinence.
Since there are so many possible causes of incontinence, bladder weakness or bladder problems, it should be diagnosed by a physician in order to ensure that this is not a symptom of another medical problem, and so that the correct treatment options can be discussed and selected.
Sources
Some Therapies for Urinary Incontinence
Kegel exercises or pelvic floor muscle training — Regular daily exercises of the pelvic floor muscles .May be done with or without Biofeedback equipment and electrical stimulation, which help identify the right muscles to contract.
Bladder training — Teaches people to resist the urge to urinate and to gradually expand the interval between urinating.
Diet — Helps people by avoiding foods and/or fluids which can irritate the bladder, like caffeine and excessive alcohol.
Medications — One type can calm bladder spasms.
Hormone replacement — Estrogen treatments to assist in improving stress incontinence in post-menopausal women
Injections — These involve injections of a substance into the urinary passage (urethra) to improve its strength and resistance.
Surgery — The most frequently performed one is a repositioning the neck of the bladder. There is also an artificial sphincter implant, which can be helpful for men who have incontinence after prostate cancer surgery. Sacral nerve stimulation device, an option for some adults, involves a device which can be implanted in the body to help stimulate nerves in the pelvis and improve bladder function.
Menopause and Old Age
Changes which occur with the menopause in women and natural aging process in the urinary bladder, urethra and pelvic floor muscles and sphincters may contribute to incontinence by interfering with the normal process of urination. For example, the natural enlargement of the prostate gland as men age or the presence of a prolapsed vagina or uterus that is common in old women may cause obstruction or abnormal descent of the urethra. The progressive decrease of estrogen after the menopause and aging which women experience, CAN lead to weakness of the pelvic floor muscles and sphincters.
It is important to note here that having incontinence in old age is NOT normal and needs consultation with a health care provider.
Chest Infections and Constipation
Chest infections such as bronchitis, flu or common cold and chronic constipation increase the risk of incontinence because repeated coughing and straining significantly increases the abdominal pressure.
Urinary Tract Infections
This is a common cause of incontinence. Infection in the urinary bladder (Urinary Tract infections/cystitis) increases the sensitivity of the bladder muscle and its liability to contract inappropriately causing incontinence.
Other Causes
Smoking increases the risk of chest infections and coughing. Nicotine and excessive alcohol have a stimulant effect on the bladder muscle that leads to inappropriate contractions causing incontinence.
Experiences, Perceptions and Needs Among a Large-scale Canadian Population Experiencing Incontinence: A Quantitative Study Report, by Malvina Klag, Executive Director, The Canadian Continence Foundation, March, 1999
Angus Reid Poll, Unpublished, 1997
Angus Reid Poll, The Canadian Continence Foundation, 1998
Myth vs. Fact
Click the myth to expand each section and read the facts.
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FACTS: Incontinence, the loss of bladder and/or bowel control, affects over 3 million Canadian men and women of all ages.
Incontinence affects the following groups of people:
10% of six-year-olds
One in four women middle-aged or older
15% of all men aged 60 years and over
Many individuals with neurological disorders and spinal cord injuries
Over 90% of those affected by incontinence live at nursing homes
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FACTS: Incontinence is a symptom of something else going on in the body, and should always be assessed and diagnosed by a healthcare professional interested and experienced in incontinence care.
Incontinence has many causes, including:
Conditions that affect the nervous system and therefore the communication between the brain and the bladder/sphincter or bowel, e.g. stroke, multiple sclerosis, Parkinson's disease, or spinal cord injury.
Consequences of surgery, e.g. prostate surgery.
Side effects of medications e.g. anti-depressants, sedatives, diuretics, or muscle relaxants.
A birth defect of the urinary system.
Weakening of the pelvic floor muscles which may occur, for example, after vaginal childbirth or menopause and aging.
Changes that occur with the natural aging process, such as enlargement of the prostate in men, or the loss of estrogen and weakness of the pelvic floor and urethral muscles in women.
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FACTS: Incontinence can almost always be cured, improved or at least successfully managed. There are many treatment or incontinence management options depending on the nature and cause of the incontinence. Time-scheduled toileting routines, diet/fluid intake changes, or exercises, with or without biofeedback and/or electrical stimulation equipment, may help. For some, medications can help to increase the bladder's ability to empty, to relax the bladder and decrease urgency, or to tighten the sphincter to prevent urine leakage from the bladder. Other options such as surgery, an artificial sphincter, or an injection of a substance into the urethral sphincter muscle, may be recommended.
In the case of people who are physically or cognitively challenged, there are often potential options that can restore or improve continence, such as assistance with toileting, or by devices such as mobility or communication aids. If incontinence products are required, choosing the most appropriate conduction or containment product can make a world of difference in one's quality of life.
Awareness that incontinence is abnormal and that there are treatment and management options is the first step. You can help your clients with incontinence by either directly providing the treatment/management services, or by ensuring your client has access to a healthcare professional with a special interest and expertise in incontinence care. If you require a list of specialists in your area who have a particular interest in incontinence, please see our Locate a Professional page.
Causes of Incontinence
Hereditary
Incontinence tends to run in families and there is a genetic component involved in the weakness of the pelvic floor muscles and urethral sphincter.
Smoking and Alcohol
Smoking increases the risk of chest infections and coughing. Nicotine and excessive alcohol have a stimulant effect on the bladder muscle that leads to inappropriate contractions causing incontinence.