Urinary incontinence is a condition that affects over 5 million people in Australia. It becomes more common as age increases, but there are risk factors that affect younger adults as well.
It’s important to understand that there are different categories of urinary incontinence, the most common being stress incontinence (SUI) and urge incontinence (UI). Stress incontinence presents as little leaks when coughing, laughing or lifting heavy items. Urge incontinence may also be known as overactive bladder and it presents as a sudden, uncontrollable urge to urinate. It is common for bladder leaks to occur while rushing to the bathroom.
Men do experience urinary incontinence, but it more frequently affects women. According to the Continence Foundation of Australia, 80% of Australians who experience incontinence are women1. This is likely because many of the risk factors relate to the female anatomy and changes that women experience throughout life, such as childbirth and menopause. This doesn’t mean that men don’t experience incontinence, it’s just more common in women.
Pregnancy and Childbirth
Many women have incontinence during pregnancy as the expanding uterus puts weight on the bladder. Hormonal changes during pregnancy can also be a contributing factor to impaired bladder control.
In some cases, incontinence goes away after giving birth, but it’s also common to experience incontinence after giving birth. Pregnancy puts extra weight on the bladder and the muscles that hold it up. This extra weight can cause the muscles (commonly the pelvic floor muscles) to stretch and can even lead to prolapse (in which the bladder loses all support and drops down onto the vagina). Vaginal birth can also contribute to stretching of the pelvic floor muscles.
In some cases, the muscles are stretched during pregnancy or childbirth, but incontinence symptoms don’t appear until later in life with menopause or ageing.
Oestrogen keeps the tissue lining of the bladder and urethra healthy. As oestrogen levels decrease, the tissues can begin to atrophy, increasing the risk of incontinence. With the onset of menopause, the muscles around the bladder weaken and the bladder begins to lose support. Stress incontinence is more common post pregnancy and in menopause, but urge incontinence may be experienced in menopause as well.
Getting older is inevitable, and it may be another cause of muscle atrophy or loss of strength in the bladder’s supporting muscles, including the pelvic floor. Thus, the occurrence of bladder prolapse increases with age.
As muscles and other tissues get older, they also tend to lose elasticity. When the bladder tissues lose their elasticity, the bladder itself becomes less capable of stretching. This affects its ability to hold urine, which may lead to urge incontinence. It can also lead to irritation of the bladder, which causes it to contract or become overactive.
Weight gain can occur for many reasons, including hormonal changes, medical conditions, lifestyle changes and more. Excess weight can put pressure on the bladder, increasing the occurrence of urge incontinence. It can also stretch the muscles that support the bladder, increasing the risk of stress incontinence.
Some patients find that incontinence goes away after losing the weight, but not all. It depends on the condition of the muscles.
It’s important to remember that just because you may have one of these risk factors, it doesn’t necessarily mean that you will develop incontinence. It just means that incontinence is more common in patients with these factors. If you are concerned, or you experience symptoms of incontinence, you’re encouraged to speak to a doctor for diagnosis, possible causes and treatment options.