Symptoms Of Urinary Incontinence
Having urinary incontinence means you pass urine unintentionally.
When and how this happens varies depending on the type of urinary incontinence you have.
Although you may feel embarrassed about seeking help, it’s a good idea to see your GP if you have any type of urinary incontinence.
Urinary incontinence is a common problem and seeing your GP can be the first step towards finding a way to effectively manage the problem.
How Is Incontinence Diagnosed
Often, the diagnosis process for incontinence will start with a conversation with your healthcare provider about your medical history and bladder control issues. Your provider might ask you questions like:
- How often do you urinate?
- Do you leak urine between trips to the toilet, how often does this happen and how much urine do you leak each time?
- How long have you been experiencing incontinence?
These questions can help your provider figure out a pattern with your leakage, which often points to a specific type of incontinence. When your provider is asking about your medical history, its important to list all of your medications because some medications can cause incontinence. Your provider will also ask about any past pregnancies and the details around each delivery.
There are also several specific tests that your provider might do to diagnose incontinence, including:
While at home, your provider might recommend you keep track of any leakage in a journal for a few days. By writing down how often you experience incontinence issues over the span of a few days, your provider might be able to identify a pattern. This can really help in the diagnosis process. Make sure to write down how often you need to urinate, how much you are able to go each time, if you leak between trips to the bathroom and any activities you might be doing when you leak urine. Youll then bring this journal with you to your appointment and talk about it with your provider.
Causes Of Urge Incontinence
The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscle in the wall of the bladder. The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.
Sometimes the detrusor muscle contract too often, creating an urgent need to go to the toilet. This is known as having an ‘overactive bladder’. The reason your detrusor muscle contracts too often may not be clear, but possible causes include:
- drinking too much alcohol or caffeine
- poor fluid intake this can cause strong, concentrated urine to collect in your bladder, which can irritate your bladder and cause symptoms of overactivity
- conditions affecting the lower urinary tract , such as urinary tract infections or tumours in the bladder
- neurological conditions
- certain medications
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When Should I See My Doctor
Most women who leak urine after childbirth find that it goes away in the first few weeks, as the stretched muscles and tissues recover.
However, for some women it can take months while other women find their pelvic floor never recovers fully.
If you are still experiencing leakage after 6 months, talk to your midwife or doctor. Dealing with it early on can reduce the risk of it becoming a life-long problem.
Stress incontinence is common, but many women are too embarrassed to talk about it. However, doctors, midwives, maternal and child health nurses and continence nurses are used to talking about it. If you are experiencing leakage, they will have suggestions that can help.
Can Stress Incontinence Be Cured
Treatments are usually available to cure or significantly reduce the effects of stress incontinence on your life. Find a doctor whos willing to work with you to determine the best way to treat your incontinence. Choosing the right treatments for you should be a partnership between you and your doctor.
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But I Was Born This Way: Congenital Anatomic Abnormalities
The next common medical cause of incontinence is just about exclusively seen in really young dogs. Thats because they were actually born with an anatomic abnormality that contributes to leakage of urine.
The first and most well-known is called an ectopic ureter. In order to understand what an ectopic ureter is, its important to understand a little simple anatomy.
Our urinary system starts with our kidneys, which actually produce urine by filtering out things our body doesnt need. Urine then automatically travels from the kidney through a narrow tube called a ureter, where it empties into the urinary bladder. The bladder acts as a storage area, allowing urine to be held until it becomes full, at which point a signal is sent to the brain that we have to pee.
In a dog with an ectopic ureter, the ureter does not attach to the bladder in the normal location. Instead, it tunnels either through or around the bladder, emptying into the urethra, beyond where the muscular urinary sphincter is. This prevents urine from being held or sorted by the bladder, leading to continuous leaking. Either just one, or both ureters on each side can be affected.
The classic presentation for this condition is a young puppy that seems to respond to potty training techniques, but is continuously having accidents, especially when lying down or sleeping.
While male dogs can be affected, female dogs are about 20 times more likely to develop the condition compared to males, according to the ACVS.
What Can I Do To Prevent Bladder Problems After Birth
There are some simple steps you can take during pregnancy to help prevent incontinence.
- Drink 6 to 8 cups of fluid a day, unless your doctor tells you otherwise. Avoid drinks containing sugar or caffeine, as these can irritate the bladder.
- Eat a high fibre diet with 2 pieces of fruit, 5 serves of vegetables and 5 serves of cereals/bread per day.
- Make sure you have a healthy weight.
- Stop smoking.
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Most Common Risk Factors Of Bladder Leakages
Women are exposed to a high number of risk factors for bladder leaks, including:
- Pregnancy â The weight of carrying a fetus stresses the pelvic floor and can lead to stress incontinence during pregnancy and after.
- Childbirth â Tissue or nerve damage that occurs during childbirth can affect the pelvic floor.
- Menopause â Changing hormones during menopause contribute to the deterioration of the pelvic floor, as well as the lining of the bladder and urinary tract.
- Weight gain â Many women gain weight as they age due to hormonal changes and this can exert enough pressure on the pelvic floor to weaken it.
Other risk factors, not particular to women, include:
- Smoking â Smoking can cause chronic coughing that exerts undue pressure on the pelvic floor.
- High-impact activities like running or jumping over many years â Prolonged impact on the pelvic floor from these types of activities can weaken it.
What Causes Bladder Weakness
Bladder weakness usually occurs when the muscles in the pelvic floor or sphincter have been damaged or weakened.
Both men and women have a pelvic floor. It is made up of layers of muscles which hold the bladder and bowel in place and help to stop leaks. The sphincter is a circular muscle that goes around the urethra and squeezes as the bladder fills up to create a seal so that urine cant leak out.
In women, these muscles can be weakened during pregnancy by the extra weight and natural hormonal changes. Childbirth can cause more problems especially if delivery is prolonged or the baby is large. Forceps and ventouse assisted deliveries may increase the risk of damage, muscle tearing or episiotomies can cause further damage.
Some women develop stress urinary incontinence after the menopause. This is because the pelvic floor becomes weaker following hormone changes within the body. Even before the menopause, some women may notice that they have a weaker bladder than normal in the week before a period. Stress urinary incontinence may occur after a hysterectomy and also after operations on the bladder.
People who have been constipated for a long time or have a chronic cough may also be prone to stress urinary incontinence. Men can develop stress urinary incontinence if they are experiencing problems related to their prostate gland or post prostate surgery.
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You Dont Have To Be Leaking Urine In The Bedroom To Have A Problem
Maybe you arent experiencing issues with urine incontinence during sex. But youre still worried that the symptoms you experience during the day will show up in the bedroom. Maybe you are nervous about the possibility of unpredictable urine loss during sex or concerned about the odor associated with urine leaking if it were to occur. This can lead to lack of fulfillment with sexual activity or avoidance of it all together.
Bladder leaks can impact more than your sex life they have been reported to alter self-esteem and body image in women of all ages. But the thing is, we are parts of a whole. Meaning that how we are impacted by bladder leaks on our mental health can definitely impact our sexual arousal. Female sexual arousal is highly tied into our self-esteem, body image, and connection we feel with our partners. That can certainly be affected by something as jarring as leaking urine throughout the day.
How We Figure Out Whats Wrong: Diagnosing Incontinence
Fortunately, in most cases, we can narrow down urinary issues to incontinence pretty quickly, often with some good historical information.
As mentioned, dogs with incontinence characteristically leak urine without realizing it, especially when sleeping. When you bring your pup into your vet with urinary concerns, your vet will ask pointed questions about the nature of the urinary issues, when youre seeing accidents happen, and how the behavior looks.
I also typically ask a lot of questions for young puppies about how potty training and crate training are going. Puppies have to drink and pee frequently when theyre active and sometimes new pet parents will confuse this behavior with incontinence when we really just need to work on our potty schedule and training.
We always typically rule out other common medical problems like urinary tract infections, by checking a urine sample first. In many cases, well use an ultrasound to guide collection of a sterile urine sample. This also allows a look at the bladder to rule out bladder stones, polyps, and other bladder masses.
Some birth defects of the bladder can be identified with ultrasound, but not often with your regular vet. A specialist in ultrasound, like a veterinary radiologist, can sometimes diagnose ectopic ureters, a patent urachus, and other disorders of the upper urinary tract, as well as visualizing abnormalities in urine flow.
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What Are The Symptoms Of Bladder Control Problems
Signs and symptoms of urinary incontinence can include
- leaking urine during everyday activities, such as lifting, bending, coughing, or exercising
- being unable to hold in urine after feeling a sudden, strong urge to urinate
- leaking urine without any warning or urge
- being unable to reach a toilet in time
- wetting your bed during sleep
- leaking during sexual activity
How Do I Know If Its Incontinence
There can be many urinary issues that affect dogs. Well just be focusing on incontinence here, but for a good overview of some other conditions like urinary tract infections, bladder stones, kidney disease, and others, make sure to also check out Why is My Dog Peeing in the House? 8 Urinary Issues in Pets and What to Do.
Urinary incontinence is typically characterized by two main signs that separate it from other conditions.
The first is that dogs are typically dribbling or leaking urine. The second is that they generally appear unaware that accidents are occurring.
Compare this to a dog with a urinary tract infection, a common first concern among pup parents when they see their dog leaking urine, where there is a sense of urgency, repeated requests to be let outside, and frequent attempts to squat or strain to pee.
The two main presentations for incontinence, as suggested in the intro, are a dog that either appears to leak urine when shes asleep, leaving a wet spot on her bed , and/or a dog that is just dripping little bits of pee as she walks around, seemingly unaware.
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Living With Urinary Incontinence
Urinary incontinence does, unfortunately, become a long-term problem for some women. Here are some tips on living with it:
- Use incontinence pads, which are made for urine leakage, rather than sanitary pads.
- Take a change of underwear or set of clothes when you go out.
- Know where toilets are located so you can find them quickly .
- Cross your legs when sneezing or laughing.
- Modify your exercise routine to avoid high impact exercises such as jumping.
What Are Kegel Exercises
Kegel exercises, also called Kegels or pelvic floor muscle training, are exercises for your pelvic floor muscles to help prevent or reduce stress urinary incontinence. Your pelvic floor muscles support your uterus, bladder, small intestine, and rectum.
Four in 10 women improved their symptoms after trying Kegels.9 Kegels can be done daily and may be especially helpful during pregnancy. They can help prevent the weakening of pelvic floor muscles, which often happens during pregnancy and childbirth. Your pelvic floor muscles may also weaken with age and less physical activity.
Some women have urinary symptoms because the pelvic floor muscles are always tightened. In this situation, Kegel exercises will not help your urinary symptoms and may cause more problems. Talk to your doctor or nurse about your urinary symptoms before doing Kegel exercises.
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Posterior Tibial Nerve Stimulation
Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor. It is thought that stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pass urine.
During the procedure, a very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and causing your foot to move. You may need 12 sessions of stimulation, each lasting around half an hour, one week apart.
Some studies have shown that this treatment can offer relief from OAB and urge incontinence for some people, although there is not yet enough evidence to recommend tibial nerve stimulation as a routine treatment.
Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medication and you don’t want to have botulinum toxin A injections or sacral nerve stimulation.
Forms Of Urinary Incontinence That Affect Men Only
- Benign prostatic hyperplasia affects about 50 percent of men over the age of 60, and 90 percent over the age of 85 an enlarged prostate can cause sudden and frequent urges to urinate.
- Peyronies disease is the result of injury or damage to penile tissue, causing an abnormal curvature.
- Painful inflammation of the prostate gland
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What Are The Treatment Options For Pregnancy Incontinence
The first lines of treatment for pregnancy incontinence are lifestyle changes and bladder management. Here are some tips for managing your bladder:
Do Kegels: Kegel exercises to strengthen your pelvic floor. Theyre a safe and effective exercise before, during, and after pregnancy. To do a Kegel, focus on the muscles you use to hold in urine. Squeeze them for ten seconds before relaxing. Aim to do five sets of these exercises per day. Learning how to relax your pelvic floor may help during and after labor.
Create a bladder diary: Jot down when you notice the most leaks so you can plan your trips. This is also the first step to bladder retraining. Bladder retraining is about re-teaching your bladder to hold more urine by extending time between trips.
Avoid carbonated or caffeinated drinks: Avoid carbonated drinks, coffee, or tea. These beverages may make you feel like you need to use the bathroom more often. Try drinking more water or decaffeinated drinks.
Avoid drinking at night: Limit your beverages in the evening to avoid frequent trips to the bathroom and leaking at night.
Eat a high-fiber diet: Eat foods that are high in fiber to avoid constipation, which puts added stress on your pelvic floor.
Maintain a healthy weight: Extra weight, especially around your abdomen, increases pressure over your bladder. Losing weight after labor can also help with incontinence after pregnancy.
When You Should See A Health Care Professional
You shouldnt have to wear a pad to soak up urine every day. Also ask yourself these questions:
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Is the urge to urinate interfering with your work because of leaking or frequent bathroom breaks?
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Do you map out where bathrooms are when you run errands?
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Is incontinence interfering with your sex life or intimacy with your partner?
These are all signs of a problem, and that it may be time for you to talk with a gynecologist.
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Treatment For Stress Urinary Incontinence
It is important to have your symptoms assessed by a health professional who will assess your bladder behaviour and pelvic floor and confirm that you have stress urinary incontinence.
The main treatment for stress incontinence is pelvic floor exercises. Surgery to tighten or support the bladder outlet can also help. Medication may be used in addition to exercises if you do not want, or are not suitable for surgery.
There is medication available for treating women with moderate to severe stress urinary incontinence, along with pelvic floor muscle exercises. Older people with other problems in addition to their bladder may benefit from seeing a specialist in medicine for older people.