Living with
Urinary Incontinence & Overactive Bladder Syndrome

What is urinary incontinence and overactive bladder syndrome?

Urinary incontinence is any involuntary leakage of urine. While it is rarely life-threatening, it may have a profound influence on the physical, psychological, and social wellbeing of individuals living with the condition. 

Although there are various causes, urinary incontinence can be divided into five main types, namely urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and total incontinence. 

1. Urge incontinence is the involuntary leakage of urine accompanied or immediately preceded by a sudden compelling desire to void. This means that, while someone is experiencing a strong desire to urinate, the person is unable to keep urine from leaking. The person is often unable to reach the bathroom in time and the amount of urine leaked can vary from a little to a greatly embarrassing amount. 

2. Stress incontinence refers to the leakage of urine when the intra-abdominal pressure is increased, such as with exertion, coughing, sneezing, or laughing. 

3. Mixed incontinence is characterised by a combination of the two so that the leakage of urine is associated with both urgency and exertion, effort, sneezing, or coughing. 

4. Overflow incontinence stems from chronic urinary retention, where someone is unable to fully empty the bladder which causes frequent leaking when the bladder’s capacity to hold urine is exhausted. 

5. Total incontinence is when someone’s bladder cannot hold any urine at all so that urine is leaked constantly or very frequently. 

Overactive bladder syndrome is a condition that is characterised by urinary urgency, in other words a frequent and sudden urge to urinate that is difficult to control. It may be with or without urge incontinence. It is usually associated with frequency (having to pass urine often) and nocturia (the need to pass urine during the night). 

How do you know you have overactive bladder syndrome? 

While the diagnosis of urinary incontinence is generally straightforward, overactive bladder syndrome is characterised by more than just the involuntary leakage of urine. A person suffering from overactive bladder syndrome may: 

• Experience a sudden urge to urinate that is difficult to control 

• Unintentionally leak urine immediately after an urgent need to urinate (urge incontinence) 

• Have to urinate frequently, usually eight or more times over a 24-hour period 

• Wake up more than two times in the night to urinate (nocturia). 

Although not everyone with overactive bladder syndrome also suffers from urinary incontinence, unexpected frequent urination and night-time urination can be very disrupting. People living with this condition often feel embarrassed, isolate themselves and limit their work and social life. 

When to see a doctor 

Anyone suffering from any type of urinary incontinence should see their general practitioner without delay. This also holds true for anyone suffering from urinary frequency or frequent night-time urination. Urinary incontinence and overactive bladder syndrome are common problems and help is available. 

What causes urinary incontinence and overactive bladder syndrome? 

The different types of urinary incontinence mostly have different causes. 

Stress incontinence mostly results from damage to the sphincter that closes the urethra (the small tube that takes urine from the bladder to its opening just above the vagina or at tip of the penis) or from damage to the pelvic floor muscles. When there is overactivity of the muscles that control the bladder, known as the detrusor muscles, urge incontinence may be the result. Anything that prevents the bladder from emptying completely through obstruction or blockage, may be the cause of overflow incontinence, while total incontinence may be caused by a birth defect, spinal cord injury or a fistula. A fistula resembles a small tunnel between the bladder and a nearby area, such as the rectum. 

When the detrusor muscles of the bladder start to contract involuntarily even when the volume of urine in the bladder is low, the person will experience an urgent need to urinate, and overactive bladder syndrome may ensue. There are four components to overactive bladder syndrome, namely urgency, frequency, night-time urination (nocturia) and urge incontinence. The International Urogynaecological Association (IUGA) and International Continence Society (ICS) defines overactive bladder syndrome as the presence of “urinary urgency, usually accompanied by frequency and nocturia, with or without urge urinary incontinence, in the absence of a urinary tract infection or other obvious pathology.” The diagnosis of overactive bladder syndrome is therefore only made if there is no other, obvious pathology that may better explain the symptoms. 

Risk factors 

Risk factors for the development of urinary incontinence include: 

• Pregnancy and vaginal birth 

• Obesity 

• A family history of incontinence 

• Ageing (however, bear in mind that incontinence is not an inevitable part of ageing). 

How is the diagnosis made? 

During the initial assessment by the general practitioner or urologist, urinary incontinence will be categorised as stress incontinence, urge incontinence, mixed incontinence or overactive bladder syndrome based on the symptoms present. It is mostly not necessary to do any special investigations at this stage, although your doctor may want to do a urinary dipstick test to rule out the presence of a urinary tract infection or diabetes. 

To accurately assess urinary frequency and incontinence episodes, your doctor may ask you to complete a bladder diary for 3 days. Your history, physical examination and bladder diary will mostly be sufficient for treatment to be initiated. Special investigations, including ultrasound, cystometry and urodynamics, will mostly be reserved for patients with overflow or total incontinence, or for those who do not respond to conservative or medical management and/or who are candidates for surgery. 

What treatment is available for urinary incontinence and overactive bladder syndrome? 

Treatment for urinary incontinence can be divided into three main categories, namely conservative treatment, medical treatment, and surgical treatment. 

Conservative management may incorporate lifestyle changes, such as losing weight and reducing caffeine and alcohol intake, with pelvic floor exercises to strengthen pelvic floor muscles by squeezing them. Patients may also benefit from bladder training exercises (such as timed voiding and bladder-holding techniques) and from the use of incontinence products (such as absorbent pads and handheld urinals). 

If conservative management fails to adequately address the problem, medical management will be offered. Available medicines include anticholinergic medicines that help to control detrusor muscle spasms, such as solifenacin and oxybutynin. These are not the only medicines available and your doctor will choose the one most appropriate for you. 

If incontinence continues despite the use of conservative measures and medicines, there are several surgical options available. The type of incontinence will determine the most appropriate procedure. For example, a sling procedure that aims to reduce pressure on the bladder or to strengthen the muscles that control urination may be the most appropriate option for stress incontinence. Urge incontinence may require procedures to enlarge the bladder or the implantation of a device that stimulates the nerve that controls the detrusor muscles. 

Living and managing

While it may not always be possible to prevent the development of urinary incontinence, there are certain steps one can take to reduce the risk thereof or to improve the symptoms once present. These include: 

• Maintaining a healthy weight 

• Avoiding or cutting down on alcohol and/or caffeine 

• Remaining active with a particular focus on keeping the pelvic floor muscles strong 

• Quitting smoking 

• Managing chronic conditions, such as diabetes, that may also cause symptoms such as frequency and nocturia. 

What to eat 

People with urinary incontinence and overactive bladder should limit their consumption of alcohol and caffeine. Other dietary recommendations include the elimination of foods or beverages that may worsen bladder symptoms such as: 

• Tea 

• Chocolate 

• Caffeinated soft drinks (even decaffeinated coffee and tea contain some caffeine) 

• Citrus juices and fruits 

• Tomatoes and tomato-based products 

• Spicy and acidic foods and drinks 

• Foods and drinks that contain artificial sweeteners. 

It also important to prevent constipation as a full bowel may put added pressure on the bladder and negatively influence bladder function. One can keep your bowel regular by increasing your intake of fibre through foods such as beans, pasta, oatmeal and bran cereal as well as fresh fruit and vegetables. Regular exercise will also help to maintain regular bowel movements. 

It is important to drink plenty fluids, but these should be non-irritating beverages. If one suffers from incontinence or overactive bladder syndrome, one may be tempted to cut down on liquids to reduce the need to pass urine or to try and prevent leakage. However, drinking too little fluid can lead to dehydration, which will produce highly concentrated (dark yellow, strong-smelling) urine. Highly concentrated urine may irritate the bladder and may exacerbate frequency and urgency. 

Conclusion 

Urinary incontinence and overactive bladder syndrome are highly prevalent conditions. Although mostly not life-threatening, these conditions may severely impact one’s social and work life. Everyone suffering from these conditions should seek medical help without delay, because there are several treatment options available that may vastly improve one’s quality of life.