Urinary incontinence is any involuntary loss of urine. Urinary incontinence can have a significant detrimental impact on the physical, psychological, and social wellbeing of a person. Urinary incontinence is approximately twice as common in women as in men.
There are three main subtypes of urinary incontinence:
- Stress urinary incontinence: involuntary leakage caused by effort or exertion such as sneezing, coughing or exercise
- Urgency incontinence (or urge urinary incontinence): involuntary leakage caused by a sudden compelling desire to pass urine which is difficult to defer.
- Mixed urinary incontinence: involuntary leakage associated with both urgency and physical stress (exertion or effort such as sneezing or coughing). Mixed urinary incontinence may be stress or urge dominant.
Urinary frequency is generally considered more than eight urinations during waking hours.
Overactive bladder (OAB) syndrome is defined as urgency, usually with increased frequency and nocturia (having to urinate through the night thus disturbing sleep), which may occur with or without urgency incontinence. About 20% of women aged 40 years or older have OAB and this increases to 36% of women aged 80 years or older. Prevalence rates among men range from 7% to 27%.
For this article, I will focus on OAB as it is the most common cause of urinary incontinence.
Overactive bladder (OAB)
Overactive bladder (OAB) affects approximately 350,000 people in Ireland. In simple terms, OAB is where the bladder is more active than usual. It is characterised by bladder muscle contracting frequently and spontaneously as urine fills the bladder.
Types of OAB:
Urinary urgency and urgency incontinence
Urinary urgency is when the bladder contracts causing urgent desire to pass urine giving little time to get to a toilet. This often happens with no warning. When the desire to pass urine is so extreme that some urine leaks (involuntary leakage); this is known as urgency urinary incontinence.
Urinary urgency is the desire to pass urine more often than usual in smaller volumes. Most people pass urine 6- 8 times daily though anything between 4-10 times daily may be classed as normal. Normal urine frequency depends on factors like volume drank daily and the types of fluid drank. Some medications like diuretics can make more urine pass. People with overactive bladders tend to pass urine more frequently than normal.
Nocturia is passing urine during the night and generally means having to get up more than twice per night to pass urine and is often caused by overactive bladder. We should have 6-8 hours of uninterrupted sleep and nocturia is a big cause of disturbed sleep. Urinary tract problems other than OAB can also cause nocturia (e.g.) Prostatic hyperplasia in men.
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To be continued…next week
References upon request
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