Causes of urinary incontinence

I am Fiona Saunders. I am a nurse and I have worked for a number of years in neurology, then community nursing for about the last 20 years in continence care. Particularly with the elderly but also a little bit with children. Anybody who has got a problem with their bladder control, there will be a cause for it or a combination of causes. For some people the cause can be very simply. It could be that they cannot actually physically get to the toilet in time. For others, it can be a bit more complicated. Two main causes affect the bladder muscle and the other main causes affect the urethral sphincter.

The main causes that affect the bladder muscle is that it can become overactive or underactive. An overactive bladder is where somebody cannot empty the bladder effectively, they cannot squeeze the urine out. So, it might be lady who goes the toilet but only passes a small amount of urine and leaves residual urine in her bladder. If that residual urine increases, which it will do over time, then she will start having problems with overflow incontinence which is very distressing. The other problem affects the bladder muscle in a different way. The bladder muscle or detrusor muscle becomes overactive and it squeezes during the filling stage when it should not do.

This causes problems with frequency and urgency where somebody suddenly needs to go to the toilet. For example, a lady that came to clinic recently, she was going to the toilet eight or nine times a day and having to get up once up at night. When she went to the toilet it was always urgent, always had to rush to the toilet and often did not get there in time, wetting herself and if it was really bad it used to run down her legs. This is what we call an overactive bladder, and this can be very easily treated. The other problems affect the urethral sphincter. The urethral sphincter can become obstructed.

We see this particularly in men who have prostrate problems where they have to go to the toilet frequently. When they go they have trouble to pass urine often with hesitancy and poor stream. This again results in the bladder not emptying properly and residual urine and again, they can get this overflow incontinence. A second problem we see with the urethral sphincter is what we call stress incontinence. This very often happens following childbirth. It is damage to the pelvic floor muscles and the urethral sphincter. It is a very common problem particularly if women have large babies, but it can also happen with activities if you put a lot of impact onto the pelvic floor.

What happens if somebody has stress incontinence is when they do activity like jumping, laughing, running they leak urine because the urethral sphincter cannot squeeze tight enough to keep the urine in the bladder. If somebody becomes poorly or ill often you see this when they go in hospital, they can suddenly start to have problems with urinary incontinence. It could be caused by an infection or they get confused or a change of medication could cause that, or even if they feel very anxious and upset, it could be due to anxiety. Things like urinary tract infection, that can often cause somebody become incontinent of urine. Illnesses or conditions like endocrinal conditions like diabetes, that can affect the blood sugars can affect the urine.

If you get glucose in your urine it can cause irritation to the bladder and cause you to become incontinent. A lack of antidiuretic hormone can cause you to produce large volumes of urine, so you could get problems with passing a large amount of urine at night rather than in the day and that is what we see as nocturia or polynocturia and that can be a cause of urinary incontinence. And mobility, somebody could have a difficulty stepping up and down a step. Or dexterity, so they could not actually undo their clothing and get to the toilet in time. How they feel as well can make a difference.

If they get depressed, that can significantly affect their motivation to get to the toilet as well. So, it can actually be quite complicated, but if we do a clear and good assessment then we can identify these causes, then a lot of people can be very affectively helped with treatments.