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Urinary Incontinence Affects 160 Million Women Globally1

Do You Leak Urine Unexpectedly?

Urinary incontinence is the unintentional leakage of urine. For some reason, urination is happening when we are not sitting on the toilet. This can be a few drops that leak out with a cough or a sneeze, or it can be a full emptying of the bladder without even feeling an urge. There are are multiple forms of urinary incontinence. Furthermore, the causes of incontinence are varied and not always clear.

With the condition affecting ∼160 million women across the world, it should come as no surprise that an industry worth billions of dollars thrives on the back of this condition. In 2015, incontinence pads alone generated 8 billion dollars in revenue. 64% of women manage the urinary incontinence with pads alone. If you have urinary incontinence, I expect you are less concerned about the cost of pads but more on impact on your quality of life. Consequently, we have established this knowledge portal to educate you into the the condition and available treatments.

On this page, we will firstly explain how the urinary system works. Secondly, we will explore the cycle of urination as this information can give you a better understanding of your continence. Lastly, we will discuss the four main types of Urinary Incontinence; Stress Incontinence, Overactive Bladder, Mixed Incontinence and Functional Incontinence, each of which have their own page giving more information on that specific type of symptom. If you don’t find the information you are looking for, we have a search bar at the bottom of the page that will search the site including all pages and articles. You can also jump onto our community and ask questions there. As always, speak to your doctor or another healthcare professional if you have incontinence.

The Urinary System

The urinary system is the system in your body responsible for urination. Your kidneys are responsible for producing urine. The amount of urine you produce depends on how much you eat, drink and sweat. Urine is transported to your bladder through a tube called the Ureter. Your bladder is a small sack that holds the urine, which is comprised of smooth muscle called the detrusor.

The bladder acts like a balloon that expands when filling. At the neck of the bladder, you have your internal urethral sphincter, which is also composed of smooth muscle fibres. Your urethra is a small tube that leads from your bladder to the outside world. Your external urethral sphincter is located at the end of your urethra and is responsible for holding in your urine.

The workings of the lower urinary system (Bladder down) can be simplified into two stages – the storage stage and the emptying stage. These stages are broken into four steps which are shown in the image below. Your nervous system sends signals back and forth through your spinal cord to your brain to control this cycle. Your bladder has stretch receptors that sense the amount of urine in your bladder as it expands.

Urinary System

The Cycle of Urination

The Urinary Cycle of filling and emptying

When your bladder has around half full, they send a signal to your brain which triggers the guarding reflex. The guarding reflex sends signals to your external urethral sphincter to produce a stronger contraction.  The more urine you have in your bladder, the stronger this contraction. Meanwhile, the guarding reflex keeps your bladder muscle relaxed. This ensures that you maintain continence while your bladder is filling. You will feel a slight urge to urinate when the guarding reflex is activated.

When your bladder is full, the urge to urinate becomes strong. This triggers the micturition reflex. The bladder contracts while the internal sphincter muscle relaxes.  Once you relax your external sphincter, the urine can flow.

The reflexes and urges of urination are present from birth. In babies, the bladder fills and empties instinctively.  Potty-training teaches infants to become aware of the bladder signals, in particular the urge to urinate and micturition reflex. They utilise the voluntary control of the external urethral sphincter to hold it closed until a toilet is found. This whole process is a beautifully synchronised dance between voluntary and involuntary control over organs and muscles.

Urinary Incontinence Affects Over 50% Of Post Menopausal Women2

How Can I Know the Severity Of My Incontinence?

With urinary incontinence, you can leak anything from a few drops to soaking through your clothing with a full emptying of the bladder. Studies have shown the Sandvik test to be a good measure of incontinence severity. We have created an online version of the Sandvik test to help you determine your level of incontinence. This index is sometimes used by urologists to evaluate incontinence. Minimum score 0, maximum score 12. The higher the score, the higher the degree of incontinence.

What Are the Different Types of Urinary Incontinence

There are 4 main types of Urinary Incontinence: Stress Incontinence, Overactive Bladder, Mixed Incontinence and Functional Incontinence. You can read more on the different types of incontinence by clicking on the buttons below. If you don’t find what you are looking for, just use the search bar at the bottom of the page to search this site.

Stress Incontinence (SUI)

Stress urinary incontinence (SUI) is the unintentional leaking of urine upon exertion, e.g.; when laughing, coughing, sneezing or exercising. Learn more about the treatments and conditions.

Overactive Bladder / Urgency (OAB)

Overactive Bladder (OAB) is a sudden intense urge to urinate, sometimes followed by involuntary urination. It is can be accompanied by the need to urinate during the night (nocturia)

Mixed Incontinence (MUI)

Mixed urinary incontinence is a term used to describe a combination of other types of incontinence. Most typically a combination of stress and urge although it does vary

Functional Incontinence

There are multiple other forms of incontinence including Overflow, Functional and Reflex (Neurogenic). These conditions are typically connected to other conditions.

If you are suffering from urinary incontinence, please do speak to your doctor. It is really important to address incontinence early.

Treatment Options for Urinary Incontinence

Like most symptoms of pelvic floor dysfunction, the treatment for urinary incontinence falls into one of two categories; conservative (non-surgical) and invasive (surgical). Surgical options are generally only advised for once conservative options have been tried unsuccessfully for an extended period. For more information on the various treatments offered in these two categories, click on the relevant button below. If you did not find what you were looking for, you can search this site using the search bar at the bottom of the page.

References

  1. Kılıç M. Incidence and risk factors of urinary incontinence in women visiting Family Health Centers. Springerplus. 2016 Aug 11;5(1):1331. doi: 10.1186/s40064-016-2965-z. PMID: 27563526; PMCID: PMC4980849.
  2. Kołodyńska G, Zalewski M, Rożek-Piechura K. Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Prz Menopauzalny. 2019 Apr;18(1):46-50. doi: 10.5114/pm.2019.84157. Epub 2019 Apr 9. PMID: 31114458; PMCID: PMC6528037.