If you can’t hold your pee
Many people have to deal with it: involuntary loss of urine or urinary incontinence. You can’t hold your pee properly, for example when you laugh or sneeze, or you suddenly feel the urge to pee and don’t make it to the toilet. What forms of this annoying condition are there and how do you get rid of it?
What is Urinary Incontinence?
Urinary incontinence means that you cannot hold your urine properly. About a quarter to half of all women suffer from involuntary leakage of urine and this condition is also common in men, especially in old age. Accidental leakage of urine is not dangerous, but it can be very annoying. Many people are ashamed of it and start avoiding social activities such as traveling and sports because they don’t have a toilet nearby.
There are different types of urinary incontinence:
- In stress incontinence, you lose urine during exertion (for example, coughing, laughing and jumping), without having the urge to urinate. This form of incontinence is called stress incontinence, even though it has nothing to do with psychological stress. In this case, stress means the increased pressure in your abdominal cavity caused by laughing, coughing and other sudden movements.
- Urge incontinence is when you have a sudden urge to urinate and cannot hold your urine until you reach the toilet. Your bladder muscles contract unexpectedly, forcing urine out of your bladder.
- Drip incontinence occurs mainly in men. You accidentally lose drops of urine.
- Neurogenic incontinence is the involuntary loss of urine due to damage to your nerves. Your urinary bladder therefore reacts too strongly, for example with a spinal cord injury, or not strongly enough, for example with nerve damage due to diabetes (diabetes mellitus).
Causes
Normally, your urinary bladder is filled with urine from the kidneys. When there is one hundred and fifty to two hundred milliliters of urine in your bladder, you feel the urge to urinate. You hold your pee by contracting different muscles: the sphincter that sits around the exit of your bladder and your pelvic floor muscles.
When your sphincter or your pelvic floor muscles don’t work properly, urinary incontinence can develop. Unintentional leakage of urine mainly occurs when the pressure in your abdominal cavity is higher. This is the case, for example, with sudden movements such as coughing, sneezing, lifting, laughing, jumping and running. Overweight, constipation and straining also increase the pressure in your abdomen.
Exercise incontinence can occur if the pelvic floor muscles are too weak. Your pelvic floor muscles can be weakened by prolonged coughing, pregnancy and childbirth, gynecological surgeries, aging, and the natural reduction of female hormones after menopause (menopause).
With urge incontinence, your bladder is extra irritable (overactive), for example due to a bladder infection, bladder stones or diabetes mellitus. Urge incontinence occurs more easily when you go to the toilet at the slightest urgency. Usually no obvious cause can be found.
Drip incontinence occurs when your urinary bladder is not closed properly, leaving your urethra slightly open and you lose drops of urine. In men, an enlargement of the prostate is usually the cause. The prostate may be enlarged due to benign tissue forming in the prostate (benign prostatic hyperplasia, abbreviated BPH), or an inflammation or malignant tumor (prostate cancer).
Any abnormality of the nerves to your bladder can lead to neurogenic incontinence. Examples include spinal cord injury, spina bifida (open back), brain tumors, stroke, Parkinson’s disease, multiple sclerosis (MS), diabetes mellitus, Alzheimer’s disease and HIV (human immunodeficiency virus). Surgeries in the pelvis and lower back can also damage the nerves.
Symptoms
Urinary incontinence is when you accidentally lose urine. Exercise incontinence mainly causes loss of urine with sudden movements such as sneezing, coughing, laughing, lifting, bending, running and jumping. Urge incontinence is when you have a sudden urge to urinate and cannot hold it until you reach the toilet. With drip incontinence and neurogenic incontinence, you lose urine throughout the day.
How is the diagnosis made?
You can keep a urine diary for a few days when you lose urine to get a better idea of your symptoms. Your doctor will ask what symptoms you have and when you mainly suffer from involuntary urine loss. He or she will do a physical examination of the pelvic area, including an internal examination of the vagina and rectum if needed. If necessary, your GP will refer you to a medical specialist (urologist or gynaecologist) for further examination.
Risk Factors
The risk of urinary incontinence is higher with:
- higher age
- ignoring the urge to urinate or going to the toilet extra often as a precaution
- continuous contraction of the pelvic floor muscles
- use of a lot of caffeine (coffee, tea, cola, energy drinks)
- pregnancy and after childbirth
- use of certain medications, such as diuretics and drugs for psychosis and depression
- irritation of the bladder with a bladder infection or radiation to the bladder (radiation therapy)
- mental health problems
Therapy
Check with your doctor whether the cause for your symptoms can be solved, such as with a bladder infection, enlargement of the prostate or the use of water pills. Drink one and a half liters of fluid a day and go to the toilet regularly. If you suffer from urine loss, you can wear incontinence pads or absorbent underwear.
For most types of urinary incontinence, your doctor recommends doing pelvic floor exercises. There are several tools that can support you in training your pelvic floor muscles, such as vaginal cones, elastic tape, vibrating probes and pulsating plates. A physiotherapist can help you with the exercises and aids.
Women can reduce exercise incontinence by wearing tampons or a pessary (vaginal ring). If you have serious complaints, you can consider surgery. For urge incontinence, your doctor can prescribe medication that relaxes your bladder wall.
If you are unable to empty your bladder, such as with neurogenic incontinence, your doctor may recommend a urinary catheter. Your doctor or nurse will guide you through this.
Prognosis
In about half of the cases, stress incontinence will go away on its own. With pelvic floor exercises, seventy percent of women get rid of their stress and urge incontinence within six months. Surgery is successful in 85 to 90 percent of people with exercise incontinence.
Neurogenic incontinence usually does not go away unless the cause can be remedied. Most people need a urinary catheter for life.
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