In the UK 8.3% of the population have bladder problems, a leakage of urine that occurs more than twice a month without control at an appropriate time or place.

One in three women and one in ten men suffer some degree of urinary incontinence - this may increase to 50% in the over-50s. 

Only 2% of cases get reported; the number of people seeking help to overcome the difficulties being the tip of the iceberg.  The extent of the problem is masked by embarrassment and lack of awareness of the support available.

Incontinence is a deeply personal condition that is rarely talked about.  It presents practical, emotional and personal hygiene difficulties that can affect our quality of life.

It can cause difficulties at work and in both our private and social lives, often making us opt out of activities that might provoke an incontinence episode.

Feelings of low self-esteem, despair and shame are common, compounded by a constant fear of odour and need for protection.

Many people accept the condition as normal, particularly when the leakage is small, and they cope with it as best they can.  Incontinence can be successfully treated and managed; it should not be a hindrance to leading a full life.

Women and incontinence

Female sufferers often feel they have lost their femininity, and that the problem is something they have to 'put up with'.

Up to 10% of all women over the age of 25 years wear some type of pad or protection at all times, the proportion increasing during sporting activity, as an increase in pressure on the pelvic floor can be the stimulus for leakage.

Women are at a higher risk of developing stress incontinence than men due to the damage caused to the pelvic-floor muscles during pregnancy.

Men and incontinence

A major cause of incontinence in men aged 50+ is due to an enlarged prostate - with 350,000 men visiting their GP each year due to the resulting condition, overflow incontinence.

Urgency or urge incontinence affects approximately a quarter of men in their sixties, and over a third of men between the age of 70 and 85.

Overcoming the stigma

The title for this health topic has been extensively debated - incontinence or bladder problems.

Even today, in the new millennium, continence remains the last taboo - never to be discussed openly, and barred from TV health issues for fear of offending the viewers (except in programmes discussing disability). 

Incontinence is perceived to be an embarrassing condition of ageing or of disability but never is it seen as a common problem that affects the whole spectrum of the population.

If we are to 'free' those suffering from incontinence we need to rid ourselves of the taboo by openly discussing it. 

This will inevitably raise its profile and hopefully encourage research into the causes and subsequent treatment.  As long as it remains a hidden problem, many will have their quality of life severely affected when successful treatment is available on the doorstep.

Types of incontinence

The condition can be caused by a number of factors such as muscle weakness, muscle over-activity and disease or congenital abnormality.  There are different types of incontinence, the main three being stress, urge, and overflow.  It is not unusual to have more than one type.

Urinary incontinence is the focus of the information provided.

So what happens when the urinary system starts to falter?

The difficulties encountered in incontinence arise due to weakening and stretching of the various muscles in the urinary system, the pelvic-floor muscles, and the urethral sphincter muscles.  These changes cause stress to the bladder and a comprehensive weakening of the bladder support.

The most common form in adults is stress incontinence, where a small amount of urine is passed when pressure in the abdomen increases, i.e. through sneezing, coughing, laughing, or exercising.  It is caused predominantly by a weakness of the pelvic-floor muscles.

Urge incontinence becomes more common as people age.  However, it is not exclusive to the problems of ageing - children can also have urge incontinence. 

Urgency is caused by an alteration in bladder pressure initiated by a muscle contraction (the detrusor muscle).

Reflex incontinence is how a baby's bladder empties.  Patients with spinal injuries may also suffer from reflex incontinence.

Incontinence can also be due to damage of the nerves controlling the bladder - caused by stroke, cancer, tuberculosis, multiple sclerosis, or prostate enlargement.  In some cases, the cause is unclear.  Senile dementia may create the loss of normal voluntary control.

Management and treatment

It is understood that only 10% of people with incontinence have an intractable condition i.e. one that cannot be cured.  The majority of sufferers can be successfully treated or effectively managed.

Pelvic-floor exercises and bladder retraining are simple, effective means of regaining control.  For others, medication and, as a last resort, surgery may be the treatment of choice.

Today we have an ever-increasing range of products aesthetically designed to manage incontinence effectively.  Incontinence pads are manufactured to meet a quality specification; they are made of wood pulp and contain polymer to ensure that no leakage will occur.

Written by Janet Blannin and K Mellish. 

20/05/2009