Stress Incontinence vs. Urge Incontinence

By Emily Quinn PT

What is Urinary Incontinence?

Urinary incontinence is the involuntary loss of urine and affects approximately 3.3 million Canadians. Incontinence is not a normal part of any phase of life, but the good news is that help is available. In this blog, I will review the role that pelvic floor muscles play in urinary incontinence, the risk factors, the 3 most common forms of incontinence and what treatment options are available.

What is the role of the pelvic floor in urinary incontinence?

The pelvic floor is comprised of a group of muscles that support and protect the organs in our pelvic region (including the bowel, bladder and uterus) against changes in intra-abdominal pressure. When working optimally, these muscles work in a coordinated manner with the muscles of the bladder to keep the urethra closed when it is not appropriate to empty the bladder and help keep the urethra open when it is appropriate to empty.

Who is at risk of urinary incontinence?

There are many risk factors that increase an individual’s susceptibility to developing urinary incontinence. Some of these factors include trauma to the pelvic floor muscles as well as substances that are irritating to the bladder. Moreover, certain factors cause an increased intra-abdominal pressure, thereby increasing bladder pressure and making it more difficult for the pelvic floor muscles to keep the urethra closed and prevent unwanted leakage. Some of the risk factors include:

• Females are at a greater risk than males
  -Pregnancy, delivery and obstetrical trauma
  -Gynaecological and/or urological surgery
  -Post-menopause

• Obesity

• Chronic and/or recurrent cough

• Alcohol and other bladder irritants

• Long-standing bowel and bladder habits including straining

• Some forms of medication

What are the 3 main types of urinary incontinence?

1. Stress Incontinence is the most common form of urinary incontinence, followed by 2. Mixed Incontinence and 3. Urge Incontinence. Stress incontinence is the involuntary loss of urine following a rise in intra-abdominal pressure. This can occur during laughing, coughing, sneezing and with physical activity. Urge incontinence is the involuntary loss of urine following a sudden, strong urge to urinate. As you might guess, mixed urinary incontinence is a combination of both stress and urge incontinence.

What treatment options are available?

Management of urinary incontinence first involves a detailed history and hands on evaluation from a trained healthcare provider. Regardless of when or how urinary leakage occurs, conservative management is the first line of treatment for all forms of urinary incontinence, prior to medical and/or surgical interventions.

The first line of treatment for stress incontinence is pelvic floor muscle training with qualified health care providers, including pelvic floor physiotherapists. Lifestyle modification including fluid intake, voiding habits, smoking cessation and weight loss may be considered. The use of pessaries, a customized removable internal vaginal device may also be used for some women. Individuals who are not successful with conservative management may explore medical or surgical solutions.

Conservative management of urge incontinence typically involves lifestyle modification such as bladder re-training, scheduled voiding and cessation of bladder irritants (including caffeine). Similarly to the management of stress incontinence, pelvic floor muscle training has been demonstrated to be effective at reducing the amount of leakage with urge incontinence. For some individuals, the addition of a pharmaceutical agent may be considered to supplement conservative management.

Management of mixed urinary incontinence involves a combination of the strategies identified above. The first step to managing mixed incontinence, therefore, is to identify the predominent form of urinary leakage in a given individual.

Urinary incontinence is not the norm and help is available! Pelvic floor muscle training is effective at improving symptoms associated with stress, urge and mixed incontinence. If you are experiencing unwanted urinary leakage, book an appointment with one of our pelvic floor physiotherapists today to learn more!

References:

1. Bettez, M., Tu, L. M., Carlson, K., Corcos, J., Gajewski, J., Jolivet, M., & Bailly, G. (2012). 2012 Update: Guidelines for Adult Urinary Incontinence Collaborative Consensus Document for the Canadian Urological Association. Canadian Urological Association Journal, 6(5).

2. The Canadian Continence Foundation: (https://www.canadiancontinence.ca)