Urinary Control Disorder

Overview

Urinary Control Disorder (UCD) or Urinary incontinence is the loss of bladder control and is a common and often embarrassing condition. While UCD occurs more often as people get older, it is also common after pregnancy and childbirth.


Symptoms

Common symptoms include occasionally leaking urine when you cough or sneeze, having the urge to urinate and not being able to get to a toilet in time, or frequent urination. Types of urinary incontinence include:

Types of Incontinence Orchard Clinic
  • Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. ‘Stress’ here refers to the physical strain associated with leakage and although it can be emotionally distressing, the condition has nothing to do with emotion. Often, only a small amount of urine leaks and it could occur even though the pelvic floor muscles are not contracting and there is no urge to urinate.  
  • Urge incontinence or Overactive Bladder. This condition occurs in both women and men. You have a sudden, intense urge to urinate followed by an involuntary loss of urine even when your bladder isn’t full. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as a neurologic disorder or diabetes. Even if you have never had an accident, urinary urgency and frequency can interfere with work and social life with a constant need to use the bathroom. 
  • Overflow incontinence. This condition happens in both women and men. If you feel like your bladder never completely empties or if you experience frequent or constant dribbling of urine, you may have overflow incontinence. Men are more frequently diagnosed with overflow incontinence than women often due to prostate-related conditions. 
  • Functional incontinence. This is a case where a physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to undress yourself quickly enough to get to the toilet. 
  • Mixed incontinence. It is possible to have more than one type of urinary incontinence which is called Mixed Incontinence.

Causes

UCD occurs when the pelvic floor muscles are weak and are unable to support bladder control. This often occurs due to childbirth, aging, hormonal changes, surgery, chronic cough or prostate-related issues.

UCD and Pelvic Organ Prolapse are two conditions that often occur together. The weakening of the pelvic floor muscles and supportive tissues that cause prolapse can also cause stress incontinence. When Pelvic Organ Prolapse occurs, one often feels a feeling of pressure of fullness in the pelvic area and often face painful intercourse, constipation and lower back pain.

Postnatal or Postpartum Incontinence

Incontinence or UCD is common during and following pregnancy. During pregnancy, hormonal changes coupled with the growing weight of the uterus place significant stress on the pelvic floor muscles, causing these muscles to weaken.

It is common for mothers to continue to face urinary leakage or incontinence after childbirth. These muscles do not get stronger on their own and will continue to weaken over time if no proper care is taken to re-engage or retrain these muscles.

About Postnatal Incontinence
Hear Fannie share about her experience with postnatal incontinence

Other underlying physical problems or changes could also lead to UCD:

  • Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
  • Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to UCD. 
  • Pelvic Organ Prolapse. When Pelvic Organ Prolapse occurs, one often feels a feeling of pressure of fullness in the pelvic area and often face painful intercourse, constipation and lower back pain. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Pelvic Organ Prolapse and UCD are two conditions that often occur together. 
  • Aging. With age and inactivity of the pelvic floor muscles, contractions are often weaker and one may feel an inability to hold their bladder well. 
  • Menopause. Post menopause, women produce less estrogen, a hormone that lubricates and keeps the lining of the bladder and urethra healthy. When these tissues deteriorate, UCD is aggravated. 
  • Hysterectomy. In women, the bladder and uterus are supported by many of the pelvic floor muscles. Any surgery that involves a woman’s reproductive system including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.
  • Enlarged prostate. The prostates naturally enlarge as men grow older, and UCD often stems from the enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
  • Prostate cancer. UCD is a common side effect of treatments for prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. 
  • Constipation. Chronic constipation and UCD often occurs together causing significant stress on the pelvic floor muscles.  
  • Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.


Risk factors

Factors that increase the risk of developing UCD include:

  • Gender. Women are twice as likely to have stress incontinence. Pregnancy, childbirth, menopause and the natural female anatomy lead to higher occurrence of stress incontinence in females. However, men with prostate gland problems are at increased risk of urge and overflow incontinence.
  • Age. The muscles in your bladder and urethra will weaken as one gets older. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release.
  • Overweight. Carrying extra weight increases pressure on your bladder and the surrounding pelvic floor muscles, weakening them and causing urinary leakage when you cough or sneeze.
  • Chronic Cough. Persistent coughing will place significant stress on the pelvic floor muscles, causing them to weaken over time and increasing the chances of UCD.
  • Weight Lifting, Running or Impact Sports. Weight lifting, running and other high impact sports with weight pressure or jumping actions will place stress on the pelvic floor muscles and causing them to weaken. 
  • Other diseases. Neurological disease or diabetes may increase your risk of incontinence.

Aging & Incontinence

Like any muscle that weakens in strength and laxity with age, the occurrence of incontinence increases with age as the muscles in the bladder and urethra weaken.

For women, this is made more difficult with pregnancy, childbirth and menopause. With pregnancy and childbirth, the weight of the growing baby stresses the pelvic floor muscles causing it to weaken. The hormonal changes that occur with menopause also causes laxity in the muscles.

About Aging and Incontinence

Complications

UCD can cause other complications that could worsen over time if left on its own and possibly lead to surgery.

  • Pelvic Organ Prolapse: UCD and Pelvic Organ Prolapse are two conditions that often occur together. The weakening of the pelvic floor muscles and supportive tissues that cause prolapse can also cause UCD. Cystocele, Rectocele & Uterine Prolapse are different types of Pelvic Organ Prolapse. When Pelvic Organ Prolapse occurs, one often feels a feeling of pressure of fullness in the pelvic area and often face painful intercourse, constipation and lower back pain.
Pelvic Organ Prolapse Diagram

A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman’s bladder bulges into her vagina.

A rectocele is a herniation (bulge) of the front wall of the rectum into the back wall of the vagina.  This is usually caused by thinning of the rectovaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles.

A uterine prolapse is when the uterus descends toward or into the vagina. This happens when the pelvic floor muscles become weak and are no longer able to support the uterus. In some cases, the uterus can protrude from the vaginal opening.

  • Skin infection. Rashes, skin infections and sores can develop from constantly wet skin, reliance on adult diapers or poor toilet hygiene.
  • Urinary tract infections. Incontinence increases your risk of repeated urinary tract infections.
  • Constipation: Chronic stress on the pelvic floor muscles can lead to constipation
  • Social Withdrawal. UCD can affect your confidence and strain social, work and personal relationships.

Prevention

Most of the time, UCD is not easily prevented. However, the following will help to decrease the risks:

  • Practice pelvic floor exercises
  • Maintain a healthy weight
  • Avoid bladder irritants, such as caffeine, alcohol and acidic foods
  • Eat more fiber, which can prevent constipation, a cause of urinary incontinence
  • Avoid smoking
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