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Types, symptoms and causes of urinary incontinence

Urinary incontinence is the involuntary and uncontrolled leakage of urine from the bladder.
The severity ranges from a few drops to complete enuresis; frequency also varies from occasionally to several times a day.

female and male pelvis and pelvic floor

Schematic view of the female and male pelvis and pelvic floor

When voiding urine the bladder contracts and the sphincters surrounding and compressing the urethra relax. The pelvic floor which supports the pelvic organs and bladder sphincters also relaxes. Urine can now be voided via the urethra.

There are many causes of urinary incontinence which can disturb the coordination of the involved muscles and nerves. Types and symptoms of urinary incontinence depend on the underlying cause.

What are the most common types and causes of urinary incontinence?
What symptoms are observed?

Stress incontinence

Stress incontinence is usually caused by weak urethral sphincters and pelvic floor. The pressure in the abdomen increases with physical, mechanical stress or exertion (e.g. laughing, sneezing, coughing, jumping or lifting). This pressure overstrains the closure of the urethra causing involuntary urine leakage, usually without a previous urge to urinate. The loss of urine can vary between a few drops to a large amount.

Causes of this insufficient closure mechanism include:

  • Pelvic surgery and accidents
  • Strained pelvic floor after pregnancy, hormonal changes in menopause, connective tissue weakness in women
  • Pelvic injury or surgery (e.g. in cases of prostate cancer) in men

Beside conventional pelvic floor exercises, electrotherapy in combination with biofeedback can be used to strengthen the pelvic floor muscles.

Urge incontinence

Urge incontinence occurs when there is a sudden urge to urinate although the bladder is not yet completely filled. The bladder muscle contracts involuntarily. It is characterized by an involuntary loss of urine. Urge incontinence is subdivided into sensory urge incontinence (disturbed sense of bladder filling) and motor urge incontinence (disorder of nerve impulses leading to bladder contraction).

  • In sensory urge incontinence hypersensitive receptors send false messages to the brain about the filling level of the bladder. The body responds by involuntarily contracting the bladder. This usually leads to the loss of a small amount of urine. Sensory urge incontinence is caused by, e.g., chronic bladder infection, bladder stones, urethral stenosis.
  • In motor urge incontinence (or overactive bladder) signals between bladder and brain are not inhibited. The muscle responsible for micturition contracts uncontrollably. The immediate pressure on the bladder causes a sudden urge to urinate which cannot be suppressed. Causes are often neurological disorders such as stroke, multiple sclerosis, traumatic brain injury (tbi), nerve irritation or damage after surgery.

Pelvic floor training with biofeedback trains the voluntary contraction and relaxation of the pelvic floor (as a support of the sphincters).

Mixed incontinence

Patients suffer from symptoms of stress and urge incontinence. One type is usually more prominent. Physical pressure (e.g. laughing, sneezing) leads to the involuntary loss of urine while at the same time the patient has an intense urge to urinate. Causes of mixed incontinence are the same as in stress and urge incontinence.

Overflow incontinence

The bladder cannot be completely voided due to obstructions (e.g. enlarged prostate, urethral stenosis) or neural lesion. This leads to chronic overexpansion of the bladder, constant “dribbling” of urine accompanied by a permanent urge to urinate.

Reflex incontinence

Affected people do not realize when their bladder is full and cannot voluntarily void it. The bladder voids involuntarily. Signal transmission from the brain and spinal cord to the bladder is disturbed due neural lesions. Involuntary micturition occurs often without the previous urge to urinate.

  • In spinal reflex incontinence (e.g. in cases of incomplete tetraplegia, multiple sclerosis) the bladder reflexively contracts but the patient feels no urge to urinate because the neural connection between spinal cord and brain is severed.
  • In supraspinal reflex incontinence the disorder is located in the brain (e.g. after stroke, in cases of Alzheimer’s disease, dementia, Parkinson’s disease). The brain cells controlling the bladder have been damaged. Voluntary bladder control by the brain is not possible.

The treatment of reflex incontinence focuses primarily on protecting the kidneys. Complete voiding of the bladder is reached via a catheter. Electrotherapy can be used in addition.

Other types of urinary incontinence are extraurethral incontinence and enuresis.

Being overweight, constipation, chronic cough, anxiety and nervousness, medication, alcohol, diabetes, urinary tract infection can negatively affect the bladder. The risk of urinary incontinence increases with age.

Women suffer from stress incontinence more often and also from urge incontinence with increasing age. Men suffer more often from urge and overflow incontinence.

Persons suffering from repeated involuntary loss of urine (and/or the symptoms described above) should seek medical advice. Individual and targeted treatment and therapy of urinary incontinence require the exact diagnosis of the underlying causes.

Important:

This article contains only general information and must not be used for self-diagnosis or self-treatment. This information does not replace medical advice.