By Dr. Bolanle Aderehinwo
Incontinence is lack of voluntary control over urine, when an individual can not by him or her self control the time to urinate and it seems the body dictates which time that may not be appropriate and acceptable for that individual.
In children (Infants and younger toddlers) incontinence may be allowed because they have not yet developed well their voluntary nervous system. When it happens in an adult, we raise so much eye brows and question it.
There are different categories of lack of control over urine passage (incontinence). When one cannot delay or postpone urination (urge incontinence), when urine comes out after sneezing, laughing, carrying a heavy load or coughing (stress incontinence), when one cannot even hold urine at all probably due to a dysfunction of the nerves controlling the bladder, and there are many others too.
This write up will be focusing more on stress incontinence. Let me quickly say that other types of incontinence will need expert’s opinion because of possible underlying physical (e.g diabetes, tumor or cancer, prostate pathology) Neurological ( e.g Parkinson’s disease, multiple sclerosis) or mental impairment.
However we can note that urge incontinence could be due to infection in the tract where urine passes and this can be detected by testing of urine to detect the organism which will be treated accordingly. Urge incontinence in older men could be due to disease of the prostate apart from an infective source.
Causes of stress incontinence
Before I list the causes, I want us to understand the concept behind this incontinence. If you pass urine, little or much after coughing, laughing, carrying load or sneezing, then there are 2 possibilities;
- There’s too much pressure in the abdomen causing corresponding pressure on your bladder
2. The muscles holding the bladder in its place (pelvic floor muscles) which also forms the neck of the bladder are weak. Whichever may be the reason, note the following causes of stress incontinence
- Childbirth. Vaginal deliveries can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions can be associated with incontinence. Hence women with many children by vaginal deliveries are more prone to this condition.
- Increase in Age: Usually, most health conditions are related to increase in age, incontinence may not be left out. As age increases, the bladder capacity to store urine reduces which makes it more susceptible to incontinence
- Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
- Lifting heavy loads over a long period of time. This concerns those that work in factories or construction sites for over long years and their work involves carrying heavy objects.
- Long time cough for months or years.
- Pelvic surgeries: Here there’s a possible risk of bladder injury or indirect injury from affectation of the nerves supplying the muscles of the bladder.
- Obesity. Extra weight increases pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
- Tobacco smoking. Nicotine is not tissue friendly and can predispose to this condition.
- Long term constipation.
Note that the above causes are also related to protrusion of pelvic organs (prolapse) and hernia.
How to prevent stress incontinence
One may not be able to prevent incontinence in its entirety but you can only reduce your risk of developing it and as well control and cope well with it. Here are few suggestions:
- Practice pelvic floor exercises also called kegel exercises.
- Avoid bladder irritants, such as caffeine, alcohol and acidic foods.
- Family planning for young women to avoid too many vaginal deliveries.
- Plan your pelvic surgeries with an expert who knows how to preserve organs and nervous supply.
- Treat long term cough.
- Avoid heavy lifting as much as possible.
- Eat more fruits and vegetables which can prevent constipation.
- Don’t smoke, or seek help to quit smoking
Ways Kegel exercises can be done
This is a type of exercise targeted at strengthening the pelvic floor. There are different ways it can be done.
- Via aerobics exercises. Some movements and positioning naturally involve the pelvic floor muscles.
- Voluntary tightening of the muscles. While sitting or standing or walking, focus on your pelvic muscles and tighten it without involving your abdominal, thigh and buttocks muscles.
- During sex, hug tightly the penis with your vaginal wall voluntarily.
- While urinating, release the urine gradually while tightening your pelvic floor muscles.
When it comes to coping in cases where nothing can be done, to improve quality of life and maintain personal hygiene with the use of bladder leak products like incontinence liners, pads or underpants can be considered. People with other types of incontinence will need to be evaluated by a physician for a possible way out.