What causes urinary
incontinence?

Primary causes

1. “Natural” causes

Pregnancy

In the last few months of pregnancy and during labour there is a lot of pressure inside your abdomen. This can cause some women to leak urine or stools. In most cases these problems are temporary and can be treated simply by pelvic floor exercises.

The menopause

The hormonal changes that occur with the menopause can contribute to urinary incontinence. In particular, they mean that the bladder wall and the muscles of the lower abdomen, which control continence, become less elastic. Many women have urinary problems (usually reversible) at this time of their life.

Ageing

As you get older, so too do the body’s cells. This means that the various systems for maintaining the body gradually become less effective. The bladder and its sphincters are themselves affected by natural ageing: they don’t work quite as well with the passage of time. This is why elderly people aren’t as good at sensing when they need to urinate, which often leads to urinary incontinence.
What is more, the body produces a hormone that concentrates urine during the night, so that the bladder fills up more slowly when we’re asleep. After the age of 50, less of this useful hormone is produced. The bladder then fills up more rapidly overnight, and you may sometimes have an extremely pressing urge to urinate at night.

2. Pathological causes

Neurological and degenerative illnesses

The bladder and the muscular sphincters are controlled by the nervous system, so a neurological disorder can cause urinary incontinence.

Surgery on the lower abdomen

This can cause the bladder to tilt, leading to urinary incontinence or damaging the sphincters. You are at greater risk of urinary incontinence if you have had several operations of this type.

Gynaecological problems

Infections of the vulva and vagina sometimes occur at the same time as a urinary tract infection and lead to urination problems.

Urological disorders

Prostate problems are sometimes accompanied by urinary retention.

Urinary tract infections

These can cause women to leak urine, particularly if they already suffer from urinary incontinence.

3.Iatrogenic causes

The term “iatrogenic” refers to harmful effects that may be caused by medical treatment.

A catheter that is left in place for too long can irreparably damage the urethra.

Multiple medication or self-medication: sometimes the interaction between several different drugs or inappropriate treatment can trigger urinary problems. Some drugs that treat one form of incontinence can also contribute to another one.

Factors contributing to urinary incontinence

Sedentary lifestyle

The muscles of the lower abdomen support the sphincters, which helps to keep the bladder “locked”. These muscles need to have good tone for the sphincters to work properly. Lack of physical exercise can allow this muscle group to relax, increasing the risk of urinary incontinence because the sphincters are not strong enough.

Sources of irritation

Persistent pain in the lower abdomen caused by wounds, sores or hardened stools in the bowel can affect how you sense the need to urinate and how well your bladder and sphincters work.

Physical or psychological trauma

Major physical or psychological trauma can sometimes trigger urinary problems. Healthcare workers often see this when an elderly person is moved to residential care at short notice. The change can be traumatic and can cause urinary problems, which are often a symptom of “failure-to-thrive syndrome”, depression etc.

Drinking too much or too little

The general advice is to drink 1.5 litres of water a day, and more if it is very hot or you have a fever. With this amount the whole body, and particularly the kidneys, can work properly. If you don’t drink enough your bladder will adapt to this: it will shrink and trigger the need to urinate sooner. It’s not a good idea to do without water in order to go to the toilet less frequently. Drinking too little each day can contribute to constipation, which can itself lead to urinary incontinence. On the other hand, drinking too much water can overstretch the bladder. It becomes less elastic and less able to contract. The process of getting rid of urine is disrupted and the risk of urinary incontinence increases.

Smoking

Nicotine irritates the bladder and makes the tissues age faster. This includes the tissues of the urinary system. As they become less elastic the bladder and sphincters also become less effective. What’s more, smoking also frequently causes chronic coughing, which puts pressure on the lower abdomen and weakens it.

Wearing high heels too often and for too long

This alters the relative position of the internal organs in the anatomy.

Inadequate or excessive personal hygiene

Wash your private parts once or twice a day using a suitable soap-free cleanser. Rinse with fresh water and dry with a clean towel.

Poor hygiene habits

Wiping from back to front or not changing sanitary protection frequently enough can expose you to the risk of vaginal or urinary tract infections, which can lead to urinary incontinence.

Working conditions that make it difficult to go to the toilet

Working men and women cannot always get to the toilet as soon as they sense the need, because they work at a workstation or they are too busy at work. This means that they:
  • either hold on – a bad habit that can make the bladder unstable;
  • or drink less, with the risk of developing a urinary tract infection leading to an unstable bladder.

Stress

A third of young women who suffer from urinary incontinence have an overactive bladder.

Too many “stimulating” drinks (tea, coffee or cola)

Drinks containing caffeine can irritate the bladder.

Excessive alcohol consumption

Alcohol is also considered to be an irritant for the bladder. What’s more, it tends to increase how much urine is produced and affects how well you sense the need to urinate.

Constipation

The rectum is located behind the bladder: a blockage of stools can put pressure on the bladder and lead to urinary incontinence. Straining only makes the pelvic floor weaker.

Obesity

Being overweight increases pressure on the pelvic floor. When your ligaments and muscles are stretched they are no longer able to support the organs in your lower abdomen properly.

Some types of sport

Physical exertion increases pressure on the pelvic floor. Although sport is good for your health, doing a lot of high-impact activities can weaken your pelvic floor. These are the “riskiest” activities: aerobic training, tennis, squash, athletics, body building, handball, basketball, gymnastics and – to a lesser extent – skiing, running, skateboarding etc. This means it is better to choose other activities that gently tone your pelvic floor (as long as you maintain good posture, keeping your tummy held in): swimming, walking, cycling, stretching, golf, roller-skating etc.

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