Urinary incontinence: causes, types, diagnosis and treatment

Urinary incontinence, defined as involuntary loss of urine, is a common medical condition that can significantly affect quality of life. Although it can occur at any age, it is more prevalent in older people, affecting both women and men.

The Elytis Hospital, we recognize the profound impact this problem can have on your daily life and self-esteem, and we are dedicated to providing personalized solutions and high quality care to help you regain bladder control!

Why is it important to treat urinary incontinence?

Urinary incontinence is not only a physical problem, but also an emotional and social one. People with this condition can experience:

• Embarrassment and shame: Involuntary leakage of urine can create discomfort and affect self-esteem.
• Social isolation: Fear of having an accident in public can lead to social avoidance and isolation.
• Depression and anxiety: Urinary incontinence can contribute to depression and anxiety.
• Reduced quality of life: Limitation of daily activities, sleep difficulties and impact on intimacy can significantly affect quality of life.
• Health problems: urinary incontinence can increase the risk of urinary tract infections and skin irritation.

It's essential to understand that urinary incontinence is not a normal part of ageing and that there are effective solutions to treat it.

Causes of urinary incontinence

Urinary incontinence is a symptom of a dysfunction in the mechanism of urine storage and elimination. This dysfunction can be caused by a variety of factors, including:

1. Pelvic muscle factors:

• Weak pelvic muscles: The pelvic muscles support the bladder and urethra. Weakening of these muscles, caused by:
  • Pregnancy and childbirth
  • Menopause
  • Obesity
  • Pelvic surgery
  • Chronic constipation
  • Frequent heavy lifting
  • Chronic cough
  • Getting older
• Pelvic nerve damage: The pelvic nerves control the bladder and urethral sphincter muscles. Damage to these nerves, caused by:
  • Diabetes
  • Stroke
  • Multiple sclerosis
  • Parkinson's disease
  • Pelvic surgery
  • Spinal trauma

2. Bladder-related factors:

• Bladder overactivity: involuntary contractions of the detrusor muscle (bladder muscle) leading to an urgent need to urinate and leakage of urine.
• Reduced bladder capacity: The bladder may lose its ability to store urine due to:
  • Recurrent urinary tract infections
  • Radiotherapy in the pelvic area
  • Bladder tumors
• Urinary tract obstruction: Any blockage in the urinary flow path, such as:
  • Enlarged prostate (in men)
  • Kidney stones
  • Urinary tract tumors
  • Urethral strictures (narrowing of the urethra)

3. General medical factors:

• Urinary tract infections: Urinary tract infections can irritate the bladder and cause temporary incontinence.
• Constipation: Chronic constipation can put pressure on the bladder and contribute to incontinence.
• Diabetes: Diabetes can damage the nerves that control the bladder.
• Neurological conditions: Strokes, multiple sclerosis, Parkinson's disease and other neurological conditions can affect bladder control.
• Obesity: Excess weight puts extra pressure on the bladder and pelvic muscles.
• Medications: Certain medications, such as diuretics, sedatives, antidepressants and muscle relaxants, can increase the risk of urinary incontinence.
• Drinking too much caffeine or alcohol: These substances can irritate the bladder and increase urine output.
• Smoking: Smoking can irritate the blad bladder and increase the risk of chronic coughing, which can worsen incontinence.

Types of urinary incontinence

Urinary incontinence is classified into several types, depending on symptoms and causes:

1. Stress incontinence:

• Definition: involuntary loss of urine during physical exertion, sneezing, coughing or laughing.
• Cause: weakening of the pelvic muscles or urethral sphincter.
• Symptoms: leakage of urine during activities that increase abdominal pressure.

2. Emergency incontinence:

• Definition: sudden and intense urge to urinate, followed by involuntary loss of urine.
• Cause: overactive bladder, urinary tract infections, neurological disorders.
• Symptoms: Urgent need to urinate, increased urinary frequency, night wakings to urinate (nocturia).

3. Mixed incontinence:

• Definition: the combination of stress and urge incontinence.
• Cause: a combination of factors affecting both pelvic muscles and bladder function.
• Symptoms: loss of urine both during physical exertion and in emergencies.

4. Overflow incontinence:

• Definition: Involuntary loss of urine when the bladder is full and cannot empty completely.
• Cause: obstruction of the urinary tract, weakening of the detrusor muscle, neurological disorders.
• Symptoms: weak urine flow, feeling of incomplete emptying of the bladder, frequent loss of urine in small amounts.

5. Functional incontinence:

• Definition: involuntary loss of urine due to physical or cognitive problems that prevent a person from reaching the toilet on time.
• Cause: arthritis, dementia, depression, reduced mobility, environmental barriers.
• Symptoms: leakage of urine in the absence of a urinary tract problem, difficulty reaching the toilet on time.

Diagnosis of urinary incontinence at Elytis Hospital

The Elytis Hospital, the diagnosis of urinary incontinence is based on a complete and individualized evaluation, which includes:

1. History: detailed discussion of symptoms, medical history and risk factors.

2. Physical examination: Examination of the abdomen and genital area for abnormalities.

3. Voiding Diary: Monitoring frequency of urination, amount of urine output and incontinence episodes.

4. Laboratory tests: urine analysis to check for infections or other problems.

5. Imaging investigations:

• Renal-vesico-prostatic ultrasound: Imaging examination to visualize the kidneys, bladder and prostate (in men).
• Testicular/scrotal ultrasound: separate examination to evaluate the testicles and scrotum.

6. Urodynamic studies:

• Uroflowmetry: Measurement of urine flow to assess bladder function.
• Cystometry: Measurement of the pressure in the bladder during filling and emptying.
• Pressure-flow study: evaluation of the relationship between bladder pressure and urine output.
• Electromyography: Measurement of the electrical activity of the pelvic muscles.

7. Cystoscopy: minimally invasive investigation to visualize the inside of the bladder.

Treatment options at Elytis Hospital

Elytis Hospital offers a full range of treatment options for urinary incontinence, tailored to the type and severity of the condition, as well as the individual needs of each patient.

1. Non-surgical treatment:

• Lifestyle changes:
  • Reduce fluid intake: Limit fluid intake in the evening and avoid drinks that irritate the bladder (coffee, alcohol, carbonated drinks).
  • Bladder training: bladder retraining techniques that help control the urge to urinate and increase the interval between urination.
  • Pelvic muscle exercises (Kegel): Strengthening the pelvic muscles can reduce urine leakage, especially with stress incontinence.
  • Losing weight: If you are overweight or obese, losing weight can reduce pressure on your bladder and pelvic muscles.
  • Avoiding constipation: Eating fiber, proper hydration and regular exercise can prevent constipation.
• Medications: Certain medications can help relax the detrusor muscle, increase blad bladder capacity or reduce the frequency of urination.
• Medical devices: vaginal pessaries, vaginal rings or other devices can help support the blad bladder and reduce urine leakage.
• Botox injections: Botulinum toxin injections into the detrusor muscle can reduce involuntary bladder contractions and relieve symptoms of urge incontinence.
• Electrical stimulation: Electrical stimulation of the sacral nerves can help bladder control.

2. Surgical treatment:

• Minimally invasive procedures: Elytis Hospital specializes in minimally invasive interventions for the treatment of urological conditions such as:
  • Extracorporeal lithotripsy (with or without anesthesia): fragmentation of kidney and ureter stones using shock waves.
  • JJ catheter removal: ureteral stent removal.
• Surgery: In severe cases of urinary incontinence, surgery may be needed to correct the underlying problem, such as:
  • Suburethral sling: Insertion of a synthetic band under the urethra to support it and prevent leakage.
  • Colposuspension: Lifting the bl bladder and fixing it to the surrounding tissues.
  • Artificial sphincter: a surgical implant that controls the flow of urine.

Benefits of treatment at Elytis Hospital

At Elytis Hospital, you benefit from:

• Specialized expertise: our team of experienced urologists is dedicated to diagnosing and treating all types of urinary incontinence.
• Advanced technology: We utilize state-of-the-art equipment to ensure maximum precision during urologic procedures.
• Minimally invasive interventions: we prioritize modern, minimally invasive methods that reduce recovery time and postoperative discomfort.
• Multidisciplinary approach: in complex cases, we collaborate with other specialties to provide an integrated therapeutic plan.
• Personalized care: we understand that every patient is unique and we tailor treatment to individual needs.
• Comfort and safety: We provide a comfortable and safe environment for our patients.

Don't let urinary incontinence affect your life! Schedule your urological consultation at Elytis Hospital and benefit from the expertise and dedication of our team. We will help you regain bladder control and enjoy an active and fulfilling life.

Latest medical review:

17.01.2025, Dr. Anca Mihaela Mircea – Medic Specialist Urologie