Urinary Incontinence

Definition:

 

A storage symptom defined as the complaint of an involuntary loss of urine that is a social or hygienic problem

 

Common Missconceptions:

  • It is a misconception to think that it is normal to have urinary leakage after childbirth
  • It is a misconception to think it is normal to have urinary leakage as you age
  • It is a misconception to think there is nothing you can do about urinary leakage
  • See Myths About Incontinence For Women for more information

Prevelance in Canada:

  • 3.3 million Canadians suffer from incontinence
  • 1 in 4 women are incontinent
  • 1 in 9 men are incontinent; the most common cause of male incontinence is a radical prostatectomy
  • 1/6 children under the age of 17 struggle with incontinence
  • Only 1 in 12 people seek out treatment because they are embarrassed to talk about it, or don’t know that help is available

Female Prevalence:

  • Young adulthood women is 20-30%
  • Middle age women is 30-40%
  • Elderly women is 30-50%

Incidence:

  • 50 % of women at some point in their life cycle experience some urinary incontinence
  • 33 % will develop regular problems
  • 50% of nursing home residents are incontinent (male and female)

Social Consequences:

  • Decreased self esteem
  • Depression
  • Isolation
  • Impedes social activity
  • Impedes physical activity
  • Incontinence is the number one reason for nursing home admission
  • Heavy economic burden on patients, families and society (it costs far less to invest in some pelvic floor physiotherapy than to pay for the ongoing costs associated with incontinence)
  • Canadian Urinary Bladder Survey (CUBS 2003) estimates that the cost of urinary incontinence in Canada is 1.5 billion dollars per year
  • On a personal level, for the average person living in their home, the Canadian Continence Foundation estimates that incontinent products cost an average of $1000/year
  • Pelvic Floor Physiotherapy for Incontinence costs an average of $500/patient; if you do not have any coverage, this is still an excellent investment of your resources, which will pay financial dividends in one year, and emotional dividends for a lifetime.

Risk Factors:

  • Female
  • Obesity
  • Post menopause (hormone changes)
  • Over 40 (1 in 3)
  • Pregnancy and Childbirth
  • Multiparous: having had more than one child
  • Obstetric trauma (forceps, suction, tearing)
  • Gynaecological or Urinary surgery
  • Chronic Illness
  • Medication
  • Smoking
  • Chronic straining
  • Radical Prostatectomy for men
  • Prostate enlargement

Three Functions of the Pelvic Floor Muscles:

  • Acts as a sphincter: prevents urinary and fecal leakage
  • Provides support: supports our internal organs
  • Provides stability: stabilizes our back and pelvic girdle
  • Sexual function: increases satisfaction in your sex life
  • Sump pump action: assists the lymphatic system and veins in bringing blood back to the trunk

Five Main Types of Incontinence:

 

Stress Incontinenece (SUI):

  • Involuntary loss of urine secondary to an increase in intra-abdominal pressure (coughing, sneezing, laughing, lifting, exercise or transitional movements)
  • Usually only a small volume of urine loss
  • Increased mobility of the urethra: research has shown that along with decreased urethral closure pressure, increased urethral mobility is the best diagnostic tool of Stress Urinary Incontinence (SUI)
  • This type of incontinence is generally caused by a weak pelvic floor. Doing Kegels and working on Pelvic Floor
  • Physiotherapist in order to determine if your pelvic floor is tight or weak; an internal exam is the only way to tell how to treat this type of incontinence

Urge Incontinence or Overactive Bladder:

  • Urge incontinence is defined as the sudden loss of bladder control secondary to a strong and overwhelming urge to go to the bladder
  • You will get urine loss before you are able to make it to the toilet
  • There can be a small amount of urine loss or a complete emptying of the bladder as a result of urge incontinence
  • Urge incontinence or Overactive Bladder (OAB) is often caused by: Detrusor (bladder muscle) instability, weak or tight pelvic floor muscles, or an upregulated sympathetic nervous system
  • OAB is often worsened by depression and anxiety
  • OAB is often treated medically with anti-cholinergic medication such as detrol or vesicare
  • OAB is very successfully treated without medication with appropriate treatment for the weak or tight pelvic floor as well as cognitive behavioural strategies for learning to manage the urgency

Overflow Incontinence:

  • The bladder doesn’t empty normally and becomes very full (distended bladder)
  • Constant loss of small amount of urine (dribbles)
  • The bladder may also never feel completely empty

Functional Incontinence:

  • Urinary leakage which is associated with impairment of cognitive or physical function (broken hip), psychological unwillingness or environmental barriers to the toilet
  • Occupational therapists are very helpful with this type of incontinence
  • Little changes can make a big difference (Velcro fasteners on pants instead of buttons)

Mixed Incontinence:

  • Urine loss associated with increases in intra-abdominal pressure (stress incontinence) and with an intense urge to void (urge incontinence)
  • It is very common to have mixed incontinence instead of just pure stress incontinence or urge incontinence

For more information, please go to www.canadiancontinence.ca