Urinary incontinence

Stress Urinary Incontinence

Stress urinary incontinence refers to leakage of urine on exertion or effort such as when coughing, laughing, exercising, lifting heavy objects or sneezing. 

It may happen whenthe urethral sphincter muscles that act to hold in urine are working ineffectively. This may occur as a result of pelvic floor muscle weakness, low levels of oestrogen (resulting in thinning of the lining of the urethra and weakening of the pelvic floor muscles) or pelvic nerve damage resulting from surgery e.g.: hysterectomy or radical prostatectomy.

The amount of urine leakage can vary from a few drops to larger amounts, particularly if leakage occurs each time with repeated coughing, sneezing or another activity such as repeated jumping.  

Urge urinary incontinence

Urgency refers to a sudden, strong urge to pass urine. Urge incontinence occurs when the urge is so great that leakage of urine occurs before the person can reach the toilet.

Urge urinary incontinence may be caused by poor bladder habits, hormonal changes, medicines such as diuretics, diseases affecting the nervous system such as Multiple Sclerosis (MS), obstruction from an enlarged prostate, urinary tract infection, irritation from bladder stones, Painful Bladder Syndrome (Interstitial Cystitis) or other bladder problems. 

Urgency can result from having an overactive bladder. This when the bladder is contracting and trying to empty when it should still be relaxed and holding on. 

The volume of urine leakage may range from leaking a few drops on the way to the toilet or having a sudden large gush or flood of urine when large amounts or the entire contents of the bladder is emptied. 

Mixed urinary incontinence

this is a mixture of urinary stress incontinence and urge urinary incontinence symptoms.

Overflow incontinence

Overflow incontinence occurs when the bladder is full and not able to empty properly (or even empty at all). Urine may eventually leak or dribble away, or the person may strain to pass urine. 

This can result in resulting in dribbling of urine, poor stream, hesitancy (getting to the toilet and then having to wait before the urine starts to flow), nocturia (being woken at night by the need to go to the toilet and pass urine) and post micturition dribble (also known as after dribble).

It may be caused by obstruction (blockage) from an enlarged prostate, a large prolapse or narrowing (stricture) of the urethra. If there is faecal impaction or a full bowel pressing on bladder this can also stop it from emptying properly.

If the bladder becomes overly full the muscle fibres in the bladder may become overstretched and lose its ability to contract effectively and empty. This can occur with spinal cord injuries, diabetic nerve damage,

or an overstretch injury of the bladder. This loss of muscle tone in the bladder is called an atonic bladder.

Neurogenic (nerve damage) urinary incontinence 
Reflex incontinence

Reflex incontinence occurs when the bladder empties by reflex once it is full. This type of incontinence is associated with nerve damage such as some spinal cord injuries win which the person has no sensation in their bladder. 

Functional incontinence

Functional incontinence refers to passing urine in inappropriate places or incontinence due to an inability to get to the toilet. 

It may be caused by an inability to recognise the toilet (due to cognitive impairment such as dementia). This may result in other places and items such as trees, or pot plants being used in place of the toilet. 

Some medicines may make the person very sleepy so that they are unable to wake up when they need to go to the toilet and they may be incontinent.  

Functional incontinence may also occur when the person knows that they need to go to the toilet and where it is, but they are unable to get there in time. This could be due to difficulty walking (poor mobility skills) or having difficulties using their hands to manage undressing. Conditions that can contribute to functional incontinence are severe arthritis, Parkinson’s disease and strokes.  

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Testimonial image:

Kylie – parent of a child that wets the bed 

Kylie rang our service as she was concerned about her five-year-old daughter, Mia, who was wetting the bed. Kylie had tried limiting Mia’s drinks in the late afternoon and evening and was also getting up at night to wake Mia and take her to the toilet.

Our advisor explained that it may take children until they around 5 ½ years old before they gain bladder control during sleep. Kylie was advised to encourage Mia to drink well throughout the day and was cautioned against cutting out drinks in the afternoon and early evening. Kylie was discouraged from waking Mia at night to take her to the toilet. Kylie was provided with information on obtaining a referral from Mia’s doctor to a bedwetting clinic if Mia continues to wet the bed past 5 ½ years of age.

Testimonial image:

Anastasiya’s story

“As a mum of two young children, I have experienced the joys of two pregnancies and postpartum recoveries. I was shocked after the birth of my first child to discover that my pelvic floor muscles had become weak. I sought advice from Bladder and Bowel Health Australia and learnt the importance of exercising these muscles. This knowledge helped, and because I was better informed second time around, I have now fully restored the dignity of my body and truly enjoyed the changes - and my motherhood. Thank you, Bladder and Bowel Health Australia, for informing young families about bladder and bowel health issues.” 

Testimonial image:

Doreen – carer of her husband who has dementia 

Doreen was becoming exhausted caring for her husband Tom, who has dementia. Tom was not always making it to the toilet on time and needed his trousers to be changed several times a day. Every day Doreen was also washing bedlinen and the four towels that Tom was laying on at night as he was soaking through his pull-up pants. 

Tom was receiving a high-level Home Care Package, and Doreen was able to arrange with their provider for some of Tom’s package to be allocated to funding continence assessment and management.  

Our advisor went to Tom’s home and conducted a thorough continence assessment. A continence management plan was developed with input from Doreen, and appropriate incontinence aids and linen protection were organised. Doreen is relieved that Tom’s incontinence has reduced, and her washing load has lessened. Doreen is now confident that she can continue caring for Tom in their home. 

Testimonial image:

Gary – experiencing leakage after his recent prostate surgery 

Gary met with one of our Bladder and Bowel Health advisors, as he was concerned about his urine leakage that was persisting after his radical prostatectomy five weeks earlier.   

Gary discussed his concerns with the advisor and was reassured that he was making good progress towards regaining bladder control. This reinforced the information he had received from his urologist. Gary was encouraged to switch to a smaller incontinence pad rather than continuing to wear the pull- up incontinence pants he had worn since his surgery. The advisor arranged some smaller pads for him to trial and provided details on where he could buy them close to his home. 

Gary was encouraged to drink plenty of fluid (particularly water) and to increase his fruit and vegetable intake to avoid constipation. Gary was uncertain if his pelvic floor muscles were working properly and he was referred to a pelvic floor physiotherapist. Gary left the clinic in a brighter frame of mind, confident that he was improving and had clear strategies to further support his recovery.