Urinary Incontinence

While urinary incontinence (UI) is more common in women, it also affects men. According to the Australian Institute of Health and Welfare, up to 13 per cent of men have symptoms of UI. Because UI generally affects older men, they often consider it a normal sign of ageing. It isn’t.

Symptoms

During urination, the neck of the bladder opens, the sphincter (a circular muscle that wraps around the urethra) relaxes and the bladder muscle contracts. UI occurs when any of these muscles react involuntarily.

Types of incontinence

• Stress incontinence occurs when the bladder neck doesn’t close properly. Everyday physical activities, such as bending, lifting, sneezing or coughing, put pressure on the bladder and cause leaking.
• Urge incontinence (overactive bladder) is triggered when bladder muscles contract involuntarily, triggering an immediate urge to urinate.
• Mixed incontinence is a combination of urge and stress incontinence.
• Overflow incontinence occurs when the bladder doesn’t fully empty during urination. As more urine is produced, the bladder cannot hold the excess, resulting in frequent but insufficient urination or dribbling.

What causes UI?

The cause of UI is often unknown. In other cases, causes or triggers range from medical problems to poor health habits.

Medical problems

UI may be caused by medical problems, such as

• enlarged prostate, prostatectomy*
• hernias
• diabetes
• bladder infection or cancer, kidney stones
• stroke, high blood pressure
• Parkinson’s disease
• back problems
• spinal cord injury

* Prostatectomy (prostate removal) is the major cause of male stress UI. Up to 90 per cent of men have leakage in the first weeks after surgery. After a year, this drops to between 5 and 20 per cent.

Medications

• diuretics
• tranquilisers
• antidepressants
• antihistamines
• heart medication

Other causes

Smoking, obesity and constipation can also play a role in the development of UI.

To help your health care practitioner determine the cause and most effective treatment, log when you urinate and note any leaking. Track what activity you were doing—sneezing, coughing or lifting something. Also track how much and what you were drinking or eating.

Medical treatments

Medications can reduce urge UI by relaxing the bladder’s muscle or by blocking nerve signals that make the bladder contract inappropriately. Mouth dryness, constipation or changes in vision are common side effects. Other drugs shrink an enlarged prostate.

Surgical options exist for stress incontinence that doesn’t respond to other treatments. These include a male sling, an implanted artificial sphincter and cuff and a bladder pacemaker that stimulates nerves to relax. Injecting bulking materials to improve the urethra’s ability to close is less invasive and results are temporary.

Lifestyle options

Healthy lifestyle habits also lessen the discomfort of UI.

Diet

Drinking too much liquid stresses the bladder, but caffeinated, carbonated and acidic drinks irritate the bladder’s lining, resulting in frequent urges to urinate. Alcohol has a double effect. It increases urination while interfering with the brain’s signals to the bladder, causing the bladder to release prematurely.

Do not overly restrict liquids. Dehydration concentrates urine, and can result in urinary problems such as bladder infections which worsen UI.

There is no one-size-fits-all UI diet. A variety of foods such as spicy and acidic ones as well as chocolate, artificial sweeteners or dairy products can all contribute to an overactive bladder. Pay attention to how liquids and foods affect your symptoms, so you can make appropriate changes.

• Use a food diary to track possible triggers.
• Reduce or eliminate the item for at least a week. If there is no effect, reintroduce it and look for another trigger.
• If the food or drink worsens UI, you may not have to give it up completely. Reintroduce it in small amounts to see how much you can tolerate.

Healthy habits

Improving overall health can also reduce the symptoms of UI.

• Lose excess weight to decrease abdominal pressure, thus lessening stress and urge UI.
• Boost dietary fibre through food or fibre supplements, rather than relying on laxatives which may worsen UI.
• Quit smoking. Nicotine affects the bladder muscle wall, while smoker’s cough stresses the urinary sphincter, causing involuntary bladder contractions—another reason to quit.

Relaxation techniques

To cope with or control symptoms, practise techniques that help you relax or become more aware of your body’s muscle contractions. Breathing exercises and meditation are good stress relievers, while biofeedback monitors allow you to see, in real time, how your bladder’s muscles are contracting.

Behavioural techniques

Train your bladder with frequent toilet breaks, whether you feel the urge or not. Gradually increase time between urination. As your body becomes used to the rhythm, you may be able to go three or four hours without the urge to void.

Another technique to try is double-voiding. Urinate, wait a moment, and try again to reduce dribbling.

Kegel exercises strengthen pelvic muscles to help your bladder hold urine. Isolate the muscles (the ones you use to stop yourself passing wind or interrupt a flow of urine), tense them, hold and release. Repeat 10 to 20 times, three to five sets daily.

For additional information, check out the Continence Foundation of Australia (continence.org.au).

Herbal remedies for UI relief

Herbal preparations have traditionally been used to treat UI. They generally contain several herbs to address different aspects of UI. Although there is currently little scientific research to back their claims, several appear promising.

Buchu (Barosma betulina)

Its anti-inflammatory, antibacterial and diuretic properties may improve bladder tissue suppleness.

Saw palmetto

An ability to fight inflammation, plus its effect on testosterone levels, may help enlarged prostates.

Antioxidants

Vitamins C and E and alpha-lipoic acid may decrease the oxidative stress that irritates nerves surrounding the bladder.

Always consult your health care practitioner about herbal remedies you wish to take to prevent drug interactions with other medications.