Loss of bladder control – the physical background (men and women)

There are a number of reasons why men and women of all ages suffer with bladder control problems. To understand the different causes, it’s important to understand how the bladder works.

Urinary incontinence – also known as “leaking urine” or “bladder leakage” – describes the accidental and involuntary leakage of urine. It can happen to men and women of any age although different risks occur for males and females at different ages.

Different types of incontinence

ncontinence is generally categorised as:

Short term bladder
Functional Incontinence Patients with functional incontinence have mental or physical disabilities that keep them from urinating normally, although the urinary system itself is structurally intact. Conditions that can lead to functional incontinence include Parkinson's Disease, Alzheimer's Disease and other forms of dementia.

Urge incontinence
People that leak urine after a strong, sudden urge to urinate, have urge incontinence . It’s caused by an over activity of the bladder muscles and can be caused by a range of conditions like mental stress, nerve damage (from diabetes, a stroke, an infection, or another medical condition), infections, tumours or bladder stones. A thorough assessment of the underlying causes is, therefore, essential for treatment . Urge incontinence often starts with the consistent urge to urinate although the urine can be held. It progresses to the point where the urge cannot be controlled any longer. Urge incontinence can be treated with medication that helps regulate the activity of the bladder as well as Kegel exercises, to strengthen the pelvic muscles , and bladder training for the extension of urination intervals ti aid improved bladder capacity and reduced frequency.

Stress incontinence

As many as 1 in 5 women over the age of 40 have some degree of stress incontinence*. This is when urine leaks when they cough, laugh, sneeze or exercise -- or when there is pressure on their abdomen. It is almost exclusively present among women but is not linked to age -- a lot of young women and professional athletes are prone to this condition. Stress incontinence isn’t related to emotional stress, rather a weakening of the pelvic and sphincter muscles. When these are weak, any sudden pressure can push urine out of the bladder. Kegel exercises and strengthening of the pelvic muscles can help.

Overflow incontinence
Overflow incontinence is particularly common among elderly men . The cause, in most cases, is a confinement of the urethra due to an age-related enlargement of the prostate . This condition is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, it can squeeze the urethra and affect the flow of the urinary stream. The lower urinary tract symptoms (LUTS) associated with the development of BPH rarely occur before the age of 40, but more than half of men in their sixties, and up to 90 percent of men in their seventies and eighties have some LUTS. Through the blockage of the urethra, the urine is stowed in the bladder and gradually overstretches the bladder muscle . Symptoms vary, but the most common ones involve changes or problems with urination, such as a hesitant, interrupted, weak stream; urgency and leaking or dribbling; more frequent urination, especially at night; and urge incontinence. Problems with urination do not necessarily signal blockage caused by an enlarged prostate. Treatment includes the removal of the blockage via surgery , intermittent bladder depletion via catheterisation or prostate resection.