By Madia Rehwald
UBC Pharmacy Student
Up to 29% of females and 5% of males in Canada experience symptoms that relate to urine retention or incontinence. The symptoms can be debilitating and embarrassing, yet up to 80% of Canadians with urinary incontinence do not seek treatment. Achieving bladder control or improvement is possible for most people. In this article, we will discuss the more common types of urinary incontinence, as well as some of the treatment options and products that are available.
Types and causes of incontinence
Urinary incontinence can happen to anyone, though it is more commonly experienced by older adults, particularly females. This is due to a combination of anatomy, pregnancy/childbirth, and hormone changes (with increased rates after menopause). Sometimes incontinence results from anatomical abnormalities, injury, or neurogenic causes, which may require surgery to correct, but in most cases, incontinence is treatable with lifestyle modifications and/or medications. Children can also experience incontinence, but the usual causes and treatment are different and will not be discussed in this article. Regardless of the cause, it is important to get assessed by a healthcare practitioner if you are experiencing urinary incontinence.
Let’s look at the most common types of incontinence.
Stress incontinence, which is most common in females, is caused by weakened pelvic floor muscles. Incontinence occurs when intra-abdominal pressure increases pressure (stress) on the bladder. This pressure overcomes the ability of the weakened muscles to keep urine inside the bladder. Some examples of things that increase the intra-abdominal pressure are laughing, coughing, and exercise. Carrying more weight in your midsection (e.g., during pregnancy) can also increase intra-abdominal pressure.
Urge incontinence is defined by an overwhelming urge to urinate (also referred to as “overactive bladder”), followed by leakage of moderate to large volumes of urine if a toilet cannot be reached in time. The cause may be related to muscle overactivity or result from neurological disorders or injuries.
It is possible to have symptoms of both stress incontinence and urge incontinence. This is known as mixed incontinence.
Some other types include overflow incontinence (leakage due to a distended bladder) and functional incontinence (leakage when unable to get to the toilet due to mobility issues, cognitive impairment, or lack of access to a bathroom). Males may more commonly experience a form of overflow incontinence, experienced as hesitancy or poor urine flow, when an enlarged prostate prevents easy flow of urine.
Ask for help to treat incontinence
If you are experiencing incontinence, please see a healthcare practitioner for assessment. It may be helpful to keep a diary of your symptoms and episodes of incontinence. You will likely be asked about your symptoms in the past few months and what the impact is on your life. For example, having to get up frequently at night to urinate can be a significant problem for older adults. Standing up quickly from a lying position can lead to postural hypotension, which may increase likelihood of falling, possibly leading to fractures.
Certain medications could also be contributing to incontinence symptoms. Pharmacists can review your medications and make recommendations for medication changes, if appropriate.
Once diagnosed, your healthcare provider can suggest non-drug measures alone or in combination with a medication used to treat incontinence. Non-drug measures are just as effective as medication options, and combining them offers improved efficacy over either alone.
Prescription medication options
There are several types of medications that can be used to treat incontinence. These include antimuscarinic medications (e.g., oxybutynin, solifenacin) and beta-3 agonists (e.g., mirabegron), which are commonly used for urge incontinence. They work by relaxing the bladder, which allows it to hold more urine, thus decreasing the urgent need to urinate. Botox injections are another option to reduce urge and frequency of urination. Vaginal estrogens are most useful for stress incontinence in post-menopausal women, though they have also shown benefit in urge and mixed incontinence for some women.
While these medications can be effective, they are not without risks, especially in older adults. Please ask your pharmacist about these medications, including their benefits, risks, and side effects.
Non-drug treatments
Now let’s explore some non-drug approaches you can try to help alleviate your symptoms:
- Fluid restriction and timing: Reducing the amount of water you consume each day and/or avoiding water after 6 pm may help reduce symptoms. It is important to consider whether this is safe for you, as decreasing your water intake can contribute to dehydration and constipation. This method is cautioned during pregnancy and when breastfeeding, as it could reduce production of breastmilk. Also, some medications require ample water intake, so this is not a viable option for everyone.
- Weight loss and exercise: Losing weight can help reduce intra-abdominal pressure and thus decrease incontinence symptoms. Again, this may not be a safe choice for everyone. If you are pregnant or breastfeeding, weight loss and some types of exercise may not be advised. Many people who experience urinary incontinence during pregnancy have a reduction or resolution of symptoms after childbirth.
- Dietary changes: Reducing intake of caffeine, alcohol, carbonated drinks, and nicotine may help. Some of these have diuretic effects, meaning your body produces more urine. Diet changes that reduce or manage constipation can also improve symptoms, as constipation increases intra-abdominal pressure.
- Pelvic Floor Muscle Training: This is very effective for all types of incontinence for females, but it requires time and consistency. Kegel exercises can be effective whether self-taught or guided by a physiotherapist. HealthLinkBC offers simple instructions on how to perform kegel exercises. About 25% of women will achieve a perceived cure after 8 to 12 weeks.
Other supportive measures
After diagnosis, when the reason for incontinence is understood and treatment is in place, there are still times when additional incontinence products can be helpful. For example, absorbent, wearable products — disposable underwear, pads, and liners — are useful in coping with bladder leaks. As well, reusable (washable) and disposable underpads can be used to protect mattresses and other furniture.
With these products, hygiene is imperative. If urine sits against the skin for an extended time, it can lead to irritation, skin burns, and potentially infection. Regular bathing and the use of adult wipes can help keep the area clean. Applying barrier creams (silicone- or zinc oxide-based) will help to protect the skin, especially when used in conjunction with good hygiene and keeping the area as dry as possible.
Please do not be embarrassed to speak with a member of our staff if you are experiencing urinary incontinence. A private consultation room is available to go over your concerns with a pharmacist. Treatment is not only possible, but effective — you do not have to suffer in silence.