Urinary incontinence

What is it?

Incontinence refers to the involuntary loss of urine. This is a frequent and sometimes highly disruptive issue. Although the symptom for you, as a patient, is always the same (urine loss), for the urologist it is important to distinguish between two types of incontinence, namely ‘stress incontinence’ and ‘urge incontinence’. If both problems are present at the same time, it is called ‘mixed incontinence’.

• Stress incontinence is caused by a loss of urethral support. This is a result of damage to the pelvic floor, as can happen during childbirth, for example. With stress incontinence, urine loss occurs when the pressure in the abdomen increases: typically with coughing, sneezing, picking up something and lifting. ‘Stress’ here does not mean nervousness but rather pressure (in the abdomen).
• Urge incontinence is so called because of its urgent or pressing nature. There is too little warning time: before you feel the need to urinate, it is often too late to reach the toilet in time, and this results in an uncontrollable urine loss.

Risk factors

• Excessive fluid intake (drinking) can play a role in some forms of urine loss.
• Caffeine stimulates the bladder, which can exacerbate urge incontinence.
• In men, an enlarged prostate can play a role in the development of incontinence.
• Some medications may cause or exacerbate incontinence; some neurological conditions typically involve urine loss (e.g. multiple sclerosis, spina bifida, Parkinson's disease, spinal lesions).

Diagnosis

• Urine analysis to rule out urinary infection
• Ultrasound imaging
• Urodynamic testing to measure the bladder activity

Treatment

Stress or urge incontinence is treated through:

1. Medication
   • Female hormones: this medication is particularly effective in the treatment of stress incontinence. Female hormones increase the blood flow in the urethra so that the closing pressure increases. This way, the sphincter has less difficulty countering the pressure of the bladder. This medication is combined with personalised sphincter training.
   • Anticholinergic medication: anticholinergic medication controls bladder spasms and is typically used as a treatment for people who have urge incontinence.
   • Antibiotics: if there is a persistent urinary inflammation (which can be both a cause and a consequence of incontinence), this infection will first be treated with antibiotics.
2. Strengthening of the pelvic floor muscles. This treatment leads to the reduction or disappearance of the symptoms in the case of urine leaks.
3. Two surgical procedures that can provide a solution for incontinence.

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip