Incontinence - Causes and Types

Updated: Feb 28

Most cases of incontinence are treatable!

Urinary and bowel incontinence as well as bladder weakness is rarely life threatening. However, it will have a hugely negative impact on the affected persons's quality of life; often leading to depression, anxiety and social isolation. It can also significantly affect the lives of those around them.

There are many treatments available for incontinence, however only 60% of suffers seek treatment, and 50% of those continue to suffer from incontinence as a result of not wanting to return to their GP for further support when initial treatments fail.

There are many conservative and non-surgical medical options, to help treat the symptoms and the cause of the incontinence, before looking to a surgical solution. There are also a number of things that can be done to make it easier to live with incontinence, whilst the sufferer undergoes treatment.

Leaking/incontinence can be a precursor or symptom of a more dangerous condition. Therefore, please speak to your GP or other healthcare professional if you are suffering.

The bladder sits in the pelvis, supported by the pelvic floor muscles and surrounding ligaments, holding it in a naturally elevated position. The bladder constantly fills with urine, and can hold 1.5 - 2 cups before giving you the urge to urinate. The muscles around the bladder remain relaxed until you are able to reach a toilet, at which point they contract in coordination with the relaxation of your urethral sphincters (which are otherwise unconsciously contracted) to allow urine to flow out of your body in a steady stream.

Urinary incontinence (UI) can occur for a huge number of reasons, including;

  • if your kidneys produce more urine than normal

  • your urethra is blocked

  • your bladder or urethra experience nerve damage

  • you are psychologically unable to urinate when you feel the urge

  • urine is constantly present in the urethra stimulating the urge to go

  • you have inadvertently trained yourself to empty your bladder when it is not yet full

A GP or specialist will diagnose the type of UI you are suffering from by its causes and when it occurs. This leads to a specific treatment plan being developed, which looks to resolve issues permanently by amending your lifestyle alongside any conservative therapy's.

In some cases there may be an easily resolvable cause of your UI, such as a urine infection, which can be treated quickly.

As with most medical issues, the earlier you seek treatment, the quicker the resolution.

However, many men and women who suffer from a degree of UI do not report their symptoms to their doctor, whether for fear of embarrassment or being seen as inevitable with age or childbirth.

Consequently, although studies reveal that up to 55% of women suffer with urinary incontinence, it is suspected that the true figure is much higher.

Even though UI is rarely life threatening, it can be much more than an inconvenience, severely effecting your quality of life, and the life of those around you.

Causes of Reversible (Transient) Incontinence

Reversible incontinence is incontinence that occurs suddenly and has been present for less than 6 weeks. Your doctor will look to determine whether it was caused by:

  • An infection - Such as a urinary tract infection (UTI), irritating your bladder and/or urethra leading to urge or frequency incontinence, which can last after the UTI has cleared.

  • Atrophic vaginitis - Vaginal dryness, usually associated with menopause.

  • A psychological disorder - Especially depression and anxiety which can make it hard to relax your muscles.

  • Hyperglycemia, associated with diabetes - High blood sugar level, leading to excessive urine output.

  • Diarrhoea - Loose and wet stools more easily leak from even tight anal sphincters.

  • Diuretics - This includes any food, drink or medication which increases the production of urine or stimulates the sensation to urinate. Including caffeine and spicy food.

  • Medications - Never stop taking a prescribed medication without first consulting your GP. Medications such as diuretics, opiods (e.g. morphine), blood pressure medicines, antidepressants, sedatives and hormone replacement therapy drugs can:

  • increase the amount of urine your kidneys produce

  • remove the sensation to urinate

  • interfere with the the ability to store and pass urine correctly

  • cause constipation

  • impair the function of the muscles and nervous system

Please note, these are only a few of the factors which can cause temporary incontinence.

Causes of Gradually Developed Incontinence

Once your doctor has determined that your incontinence is not temporary, they will look to determine the gradual or irreversible cause(s):

  • Genetic predisposition - Certain ethnic groups are more likely to develop a form of urinary incontinence as they have a smaller amount of urethral muscle. Afro-Caribbeans are thought to have the lowest risk of developing urinary incontinence because of this.

  • Pregnancy and vaginal childbirth - Even uncomplicated pregnancy and childbirth (even caesareans) weaken your pelvic floor. It is very common for women to suffer from a degree of incontinence due to the damage that occurs to the pelvic floor from the weight of the baby and the hormones the body produces to relax and loosen the muscles in preparation for labour. The risk of developing a form of incontinence increases with a larger baby (over 4000 g), complicated vaginal delivery (where forceps or a vacuum where used) and multiple births. You can suffer from a sphincter or perineum tear, and your bladder and urethra can receive direct trauma.

  • Age - Your muscles become weaker with age. Your urethra and sphincter muscles will no longer contract as tightly, allowing leaks to occur. In women, the hormonal change associated with menopause can be a further factor affecting muscle strength.

  • Pelvic surgery - Any surgery that you undergo in the pelvis and lower abdomen, can cause nerve damage to the organs and tissue that are required for the normal storage and passing of urine and faeces. Your pelvic floor muscles can become temporarily bruised and sore, or suffer lasting damage. The surgery can even inadvertently alter the position of the organs.

  • Treatment for cancer - Alongside the risk of surgery, radiation treatment can lead to temporary or permanent incontinence as it effects the cells.

  • Obesity - If you carry around excess weight, which is the case if you have a BMI greater than 30, your pelvic organs and pelvic floor muscles will be under greater pressure consistently. These can lead to incontinence and make any existing incontinence worse.

  • Smoking and having a chronic cough - Suffering with a chronic cough can weaken your pelvic floor by often putting it under strain.

  • Chronic constipation - When you are constipated you will find yourself straining to empty your bowels. This weakens the pelvic floor and anal sphincter, and the full bowel can push against the bladder. This can cause urge urinary incontinence and the sensation to urinate often. Your body will also produce more liquid to soften stools, often resulting in soft orange/light brown diarrhoea which can easily leak.

  • High impact exercise - Taking part in high impact exercise can weaken your pelvic floor. To learn more, visit our page on Exercises Which Damage Your Pelvic Floor.

  • Prostatis (only in men) - Prostatis is the inflammation of the prostate gland, and can occur as a result of suffering from prostate cancer or benign prostatic hyperplasia (BPH). Prostatis causes your urethra to narrow and even close off which reduces the flow of urine.

  • Disability and reduced mobility - Functional incontinence occurs where you experience the sensation to urinate, but cannot reach a bathroom. This may be due to a physical reason such as an issue with mobility or eyesight, or a psychological reason, such as an anxiety to go or depression.

  • Fibroids - Fibroids are non-cancerous tumours that grow in or on the wall of the womb, mostly in premenopausal women. They can range from the size of a walnut to larger than a grapefruit and they grow and shrink according to hormone levels. It is estimated that as many as 3 out of 4 women have uterine fibroids sometime during their lives and whilst some women do experience pelvic pain, heavy, painful and irregular periods with fibroids, many do not even realise they have them. However, if the fibroids press on the bladder or bowel, the potential for suffering with urinary incontinence and complete loss of bladder control increases.

  • Pelvic organ prolapse - Pelvic organ prolapses often occur gradually, and tend to cause urinary incontinence as they develop (60% of women with a prolapse also suffer from urinary incontinence). The prolapsing organ can cause dysfunctional voiding and irritate the bladder, urethra and/or bowel.

Please note, these are only a few of the factors which can cause incontinence to gradually develop.

Once your GP has diagnosed what caused your incontinence, and what form of incontinence you are suffering from, they can begin to design a treatment plan.

Types of Bowel Incontinence

Faecal Incontinence - When you uncontrollably pass gas, and leak liquid and/or solid faeces occasionally, or multiple times a day.

Flatus Bowel Incontinence - Is being unable to restrain the passing of wind. Frequently results from injury to less visible internal sphincter muscles during delivery. These muscles make the rectum a high-pressure area, giving you the ability to sense the presence of gas and appropriately control the passing of it.

Types of Urinary Incontinence

Urinary incontinence (UI) can be diagnosed specifically, by the reason or event that leads to it occurring:

Coital UI - Urinating during sex due to pressure on the bladder.

Functional UI - When you are physically or mentally unable to go to the bathroom to empty your bladder.

Giggle UI (Laughter Leaks) - When you urinate as you giggle or laugh, as a result of relaxing your muscles.

Stress UI - The most common form of UI. As a result of a physical movement such as heavy lifting, exercise, sneezing or coughing. Women are more likely to experience stress UI than men.

Urge UI - Sudden and urgent desire to empty your bladder. Women are more likely to experience urge UI than men.

Mixed UI - When you suffer from both stress and urge incontinence.

Nocturia - Excessive night time urination; getting up more than twice a night to go to the bathroom.

Overactive Bladder (OAB) - Sudden urge to urinate which may be difficult to stop in time to reach a bathroom. Women are more likely to experience an OAB than men.

Overflow UI - Where you do not feel any urge to urinate and therefore your bladder overflows. Men are more likely to experience overflow UI than women.

Double Incontinence - Due to both bladder and bowel incontinence having many of the same causes, you can also experience double incontinence (also known as combined incontinence), where urine, stool and gas all involuntarily leak.


Original articles: Kegel8 Website

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