Introduction :
Incontinence is the loss of urine from the bladder and bowel at times when such loss is not desirable.

Types :
Incontinence can vary from constant bed wetting, to the occasional dribble when the woman jumps, coughs or laughs. Incontinence of faeces may also occur.

Cause :
The most common cause of urinary incontinence is the damage done to the genitals during child birth, and this is the reason for women being the victims far more frequently than men. Other causes include urinary infections, strokes, confusion in the elderly, bladder injury, epilepsy and damage to the spinal cord in paraplegics and quadriplegics. The urethra is the tube that carries urine from the bladder to the outside of the body. In women it is only one centimetre long. It leaves the bladder at an acute angle, and this angle causes the pressure of the urine inside the bladder to keep the urethra closed. It requires a voluntary muscular effort to open the urethra, and allow the urine to escape. The stretching that occurs during childbirth, can cause this critical angle to be lost, and the urethra becomes a straight tube leading from the bladder to the outside. Any pressure put on the bladder, or any significant volume of urine, can then cause incontinence. Unfortunately the reverse is also true, and this straightened tube can allow bacteria and infection to enter the bladder more easily, and cause the pain and discomfort of cystitis. Because the bladder is controlled by nerves, damage to the nervous system by a stroke or the cutting of the spinal cord in paraplegics may also lead to incontinence.

Incidence :
Incontinence is usually associated with the old man lying semiconscious in a nursing home bed, but it is far more common in women, and many relatively young women in their thirties or earlier can be victims.

Prevention :
Exercises to strengthen the muscles of the pelvic floor should be undertaken by all women immediately after childbirth.

Investigations :
Urine tests to detect infection are routinely performed. Special x-rays and ultrasound examinations can determine the cause of the incontinence.

Course :
Embarrassing, unpleasant, uncomfortable, distasteful, offensive, distressing, intolerable and very annoying. Incontinence is all these things, and more, but it is a topic that is never discussed with friends or family, and often only mentioned to doctors after many visits for other more socially acceptable diseases. The problem usually slowly worsens over many years unless medical treatment is sought.

Treatment :
As with most diseases, the earlier incontinence is treated, the better the results. Prevention is even better than cure. Exercises to strengthen the pelvic floor can be done in the early stages of incontinence, to help control the bladder function as normally as possible. You can start by practising stopping and starting your urinary stream several times whenever you go to the toilet. Physiotherapists can teach you the finer details of these exercises. If your problem has progressed beyond control by exercises alone, the options are rather limited. In younger women, an operation to correct the abnormal bladder/urethra angle is usually successful. In older women, a specially shaped rubber ring may be worn inside the vagina to put pressure on the urethra and prevent urine from escaping. These rings must be fitted, and regularly checked, by a doctor. Men can also have an operation, but it is not as successful as in women. In elderly and paralysed men, it is often more practical to use a collecting bag, as this can be easily attached to the penis.

Complications :
Urinary infections, that may spread to the kidney, are the main complication of incontinence. A woman’s concern about incontinence can become a significant mental problem, and a social barrier. Please don’t be delayed by embarrassment, talk to your doctor.

Outcome :
Most people with this distressing problem can be adequately assisted by some form of medical or surgical intervention.

Further information:
The Continence Foundation of Australia can provide information, liaison and support services. There are branches in every state.

Related conditions :
Cystitis. Bowel Incontinence