Incontinence - Picture Summary

Understanding urine and the bladder

The kidneys make urine all the time. A trickle of urine is constantly passing to the bladder down the ureters (tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat.

The bladder is mainly made of muscle and stores the urine. It expands like a balloon as urine comes down the ureters. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles beneath the bladder that sweep around the urethra (the pelvic floor muscles). When a certain amount of urine is in the bladder you become aware that the bladder is getting full. When you go to the toilet to pass urine, the bladder muscle contracts (squeezes) and the urethra and pelvic floor muscles relax.

Complex nerve messages are sent between the brain and the bladder and pelvic floor muscles. These make you aware of how full your bladder is and tell the right muscles to contract (squeeze) or relax at the right time.

Urinary incontinence

If you have urinary incontinence it means that you pass or leak urine when you do not want to. It is classified into different types, depending on the cause.

• Stress incontinence is usually due to weak pelvic floor muscles.
  • Urine leaks when you cough, laugh, jump, etc.
  • Treatment is mainly by doing exercises to strengthen the pelvic floor muscles.
  • A medicine caled duloxetine is sometimes used. It helps the muscles around the urethra to contract more strongly.
  • Surgery to 'tighten' the tissues under the bladder is needed in some cases.
• Urge incontinence is due to an 'overactive bladder' that contracts (squeezes) suddenly.
  • Bladder training is the usual first treatment. This trains you to 'hold on' for longer.
  • Medication can help to relax the bladder muscle.
• A combination of stress and urge incontinence commonly occur.
• Bedwetting (enuresis) occurs in many children, but some adults are affected.
• Neuropathic incontinence is due to damage to nerves supplying the bladder. For example, as a result of spinal cord problems, multiple sclerosis, etc.
• Overflow incontinence is due to a blockage of the urine outlet which upsets the normal control of passing urine. Urine pools in the bladder behind the blockage, but small amounts of urine bypass the blockage and trickle down the urethra. The most common example is incontinence caused by an enlarged prostate gland in men which partly blocks the bladder outlet.

Further help and information

Continence Foundation
307 Hatton Square, 16 Baldwin Gardens, London, EC1N 7RG
Tel (Helpline): 0845 345 0165  Web: www.continence-foundation.org.uk
A national charity dedicated to helping people who have some problem with bladder or bowel control in their adult lives. The Foundation offers information, advice, promotes advances in public and professional education, and campaigns for the improvement of continence services.

Incontact
United House, North Road, London, N7 9DP
Tel: 0870 770 3246   Web: www.incontact.org
For people affected by bowel and bladder continence problems, and their carers.

© EMIS and PIP 2005   Updated: November 2005   PRODIGY Validated