Urinary incontinence: types, treatment, Kegel exercises

Urinary incontinence is the inability to retain urine. It occurs more frequently with age and occurs more often in women than in men. The risk factors depend on the type of urinary incontinence. What are the four main forms and how can they be treated? How can you strengthen the pelvic floor muscles with Kegel exercises?

Article content

  • Urinary incontinence
  • Types of urinary incontinence
  • What type of urinary incontinence?
  • 1. Stress incontinence/stress incontinence
  • 2. Urge incontinence
  • 3. Overflow incontinence
  • 4. Total incontinence

Urinary incontinence

Muscles in the bladder wall push urine out. Around the bladder opening and in the pelvic floor there are muscles that ensure that the urine can be held. But if there is something wrong with the muscles or the nerves that make these muscles work, a person may lose bladder control (completely or partially). Urinary incontinence is more common in older people and affects more women than men. Incontinence can occur with a stroke or dementia.

Types of urinary incontinence

There are four main types:

  1. Stress incontinence (the most common type)
  2. Urge incontinence
  3. Overflow incontinence
  4. Total incontinence

What type of urinary incontinence?

The type of urinary incontinence can be determined by means of urodynamic research (UDO) . The functioning of the bladder and the bladder outlet are examined. A catheter is inserted through the urethra into the bladder. The catheter contains a pressure gauge. The bladder fills with fluid. When coughing or urinating, the doctor receives information about: the bladder, bladder sensation, bladder outlet, type of urine loss.

1. Stress incontinence/stress incontinence

  • Stress incontinence is also called stress incontinence . It involves uncontrolled loss of small amounts of urine when someone exerts themselves, coughs or sneezes.
  • It can be caused by pelvic floor muscles that are not strong enough. The pelvic floor muscles provide support to the bladder and play a role in opening and closing the bladder neck during urination. If the muscles become weaker, the bladder neck can drop, which causes involuntary loss of urine as the pressure in the abdomen increases. If you suffer from it a little, it will happen when you are doing strenuous activities, but if you have it to a severe extent, it will also occur when coughing and, for example, lifting. Stress incontinence occurs almost exclusively in women, usually before and during pregnancy , after surgery in the pelvic area, after menopause and with aging. It can also be caused by a prolapsed uterus, prolapse of the rectum or a prolapsed bladder. You are more likely to develop stress incontinence if you are overweight and if you suffer from constant (chronic) coughing. Men very occasionally suffer from stress incontinence after prostate surgery .
  • Self-help: You can do Kegel exercises yourself . These exercises strengthen the pelvic floor muscles and are a way to combat stress incontinence (regardless of the cause).
  • Possible treatments for stress incontinence: physiotherapy, medications (including estrogens), pessary/ring or surgery. Please note that the complaints can return after an operation, there is also a small risk of complications. If you are overweight, a doctor will probably advise you to lose weight.

Kegel exercises

  • These exercises help strengthen the pelvic floor muscles and can prevent or reduce the complaints that occur with urinary incontinence.
  • You can perform the exercises sitting, standing or lying down.
  • Do the exercises as often as possible, but at least once an hour.
  • To feel what the pelvic floor muscles are, imagine that you are urinating and suddenly you have to stop. The muscles that you then feel tense are the pelvic floor muscles.
  • Tighten the pelvic floor muscles and hold the tension for ten seconds. Slowly relax the muscles and repeat five to ten times (or more if possible).
  • do the exercises while urinating ! The result may be that you pee incompletely and that is not good.

2. Urge incontinence

  • Urge incontinence is also called urge incontinence . Someone with this type of urinary incontinence feels a sudden strong urge to urinate, followed by an involuntary loss of urine. It occurs more often with age and more often in women than in men. Urge incontinence varies in severity. If it is not that bad, you can just reach the toilet before the bladder empties. But if the condition is severe then it is impossible to stop the flow of urine.
  • Irritation of the muscle that forms the bladder wall is usually the cause. If there is irritation, this muscle contracts involuntarily, urgency arises and urine may be lost. There may be inflammation of the lining of the bladder, but it can also be caused by bladder stones, a stroke, multiple sclerosis or injury to the spinal cord. However, the cause of urge incontinence often remains unclear.
  • Treatment: if the underlying cause is known, it may need to be remedied. If there is no clear cause, you can reduce incontinence by gradually lengthening the intervals between urination. You can strengthen the pelvic floor muscles through Kegel exercises (see stress incontinence). Stop smoking, because smoking irritates the bladder. Avoid drinks containing caffeine or alcohol, as they increase urine production and can worsen urges. A doctor may prescribe bladder inhibiting medication, which will reduce the activity of the bladder muscle.

3. Overflow incontinence

With overflow incontinence, the bladder cannot empty completely due to a blockage in the bladder neck or in the urethra. It may also be because the bladder muscle is no longer strong enough. The pressure in the bladder increases, causing constant dripping of urine. Bladder stones can be the cause of urine not flowing out, or a blockage in the urethra, or in men, an enlarged prostate can be the reason. The bladder muscle can become weakened by overstretching, diabetes mellitus or pelvic surgery.

4. Total incontinence

With total incontinence there is no longer control of bladder function. This is usually due to a disorder of the nervous system (for example dementia) or an injury to the nerves. Incontinence can also occur if the nerves to the bladder are damaged during surgery in the pelvic area.