What’s causing your bladder weakness?

According to the NHS, between three and six million people in this country have some degree of incontinence problem. We look at the things that increase your risk of bladder weakness and what you can do about it

If you have a weak bladder, chances are you’ll know all about embarrassing leaks. But instead of feeling uncomfortable about it, it’s important to remember that bladder weakness – or incontinence – is a very common problem.

Indeed, the type of person affected by bladder weakness may surprise you. For instance, the Leicestershire Medical Research Council Incontinence Study suggests almost four out of 10 women aged 40 report significant symptoms of incontinence, while a survey by incontinence experts at Tena claims one in nine men experience bladder weakness at some point in their life.

But what exactly is incontinence? The two most common types of urinary incontinence – which is when you leak urine after losing control of your bladder – are called stress incontinence and urge incontinence (according to the NHS, more than nine out of every 10 cases of incontinence are stress or urge incontinence):

  • Stress incontinence: Triggered by exercise, coughing, sneezing and laughing, this is the most common type of incontinence in women. Stress incontinence can happen when your pelvic floor muscles and/or your urethra – the tube that carries urine out of your body from your bladder – become weakened or damaged.
  • Urge incontinence: This is when you experience a sudden and intense urge to pass urine or when you need to urinate frequently, including during the night. It can happen when the muscles in the walls of your bladder – called the detrusor muscles – contract more often than normal.

There are other types of incontinence too, including:

  • Overflow incontinence: Also called chronic urinary retention, overflow incontinence is when you cannot empty your bladder completely.
  • Overactive bladder syndrome (OAB): Like urge incontinence, OAB makes you want to go to the loo suddenly and frequently, but you may not lose control of your bladder.

What causes it?

Certain medicines can affect the way your bladder stores and passes urine, or even make you produce more urine than usual. According to the NHS, these medicines include:

  • ACE inhibitors
  • Diuretics
  • Some antidepressants
  • Hormone replacement therapy (HRT )
  • Sedatives

There may be several different reasons why someone has incontinence, and the reasons tend to differ between the different types.

Stress incontinence can be caused by damage to the nerves of the urethra that happens during childbirth. If you’re pregnant or very overweight, the increased pressure can also weaken your urethra, as can a lack of the hormone oestrogen in
women (in post-menopausal women, for example).

Possible causes of urge incontinence, on the other hand, include conditions that affect the lower urinary tract, such as urinary tract infections or bladder tumours.

Drinking too much alcohol or caffeine can also lead to urge incontinence, as can constipation. Some people with neurological conditions – that is, conditions that affect the brain and spinal cord, such as multiple sclerosis or Parkinson’s disease – may also develop urge incontinence.

Like urge incontinence, overflow incontinence can also be caused by problems with the detrusor muscles. But while urge incontinence can be a result of the muscles contracting too often, with overflow incontinence it can be that they don’t contract fully, which means your bladder doesn’t empty completely when you urinate.

This can happen if you have nerve damage, such as that caused by surgery to part of your bowel or a spinal cord injury.

Often, however, overflow incontinence is caused by a blockage or an obstruction to your bladder, which means it becomes difficult or even impossible to empty your bladder completely. The things that can obstruct your bladder include bladder stones, constipation and – in men – an enlarged prostate gland.

Meanwhile, it’s not clear exactly what causes OAB. However, the Bladder & Bowel Foundation believes things that irritate the bladder may include too much caffeine and fizzy drinks, not drinking enough fluids and urinary tract infections.

Are you at risk?

Aside from the causes of incontinence, there are also several risk factors – in other words, things that make the development of bladder weakness more likely. Some of these factors are the same in men as in women, such as:

  • Getting older (urinary incontinence is more common in older people).
  • A family history of incontinence, especially if it’s stress incontinence.
  • A disability such as a condition that affects your brain or spinal cord.
  • Having symptoms that affect the bladder and urethra called lower urinary tract symptoms (LUTS).

According to the NHS, LUTS are thought to affect six out of 10 people aged 60 or older and include problems with storing or passing urine, as well as problems after you’ve passed urine (for example, feeling that you haven’t emptied your bladder completely). LUTS can also be caused by problems with the bladder or the prostate gland in men, but can often be treated.

Women, however, can have a higher risk of incontinence if they developed stress incontinence while they were pregnant or during the six weeks after the birth (according to the NHS, this can make you more likely to suffer from stress incontinence for up to five years after having a baby). Having a vaginal birth – as opposed to a C- section – is also associated with a higher risk of stress incontinence.

For men, having an operation to remove the prostate gland – called a prostatectomy – may also increase the risk of incontinence.

Getting help

If you have the symptoms of any type of incontinence, your GP can offer general advice and, if you need it, prescribe any relevant medicines that may offer relief. You may also be referred to a continence advisor or a hospital urologist or urogynaecologist.

If you don’t feel comfortable discussing it with your GP, there are also more than 360 NHS continence clinics in the UK that are manned by specialists in bladder weakness. To find the nearest clinic to where you live, call the Bladder and Bowel Foundation on 0845 345 0165.

Meanwhile there are several incontinence products you can use that are designed to make your life easier. Many incontinence products are also available in many pharmacies – just ask your pharmacist to tell you what they have in stock (find your nearest pharmacy by using the Pharmacy Finder tool.

Healthy bladder tips

There are other ways your pharmacist can help you to keep your bladder as healthy as possible too. For instance, they can offer lifestyle tips that could help keep your bladder healthy, which may include the following:

  • Keep drinking – you may feel that drinking less may help if you suffer from bladder weakness, but not drinking enough fluids may actually aggravate your bladder and make the problem worse.
  • Do, however, drink less tea, coffee and alcohol, as these all increase the amount of urine you produce. Try alternatives such as water, juices and non-caffeinated hot drinks, such as herbal teas. Around eight glasses of fluids a day is considered normal.
  • Avoid constipation by eating a high- fibre diet (constipation can put a strain on your bladder). Eat plenty of fresh fruit and vegetables, plus other high- fibre foods such as wholemeal bread and pasta, brown rice, beans and pulses.
  • Lose weight if you need to, as being overweight is associated with bladder control problems. Ask your pharmacist for advice about weight management as well as products that may help support your efforts to lose those excess pounds.
  • If you smoke, make the decision
to quit now. Smoking itself isn’t thought to cause incontinence problems, but a smoker’s cough can put pressure on your bladder. Again, your local pharmacist can help support you by recommending stop- smoking products that could make giving up easier.
  • Cut down on jogging and take up Pilates. Why? Because certain types of high-impact activities, such as jogging or aerobics, can put stress on your pelvic floor muscles. Strengthening your pelvic floor muscles can really help to improve your bladder function – and one of the best exercises for concentrating on these muscles is Pilates. Ask at your local gym or leisure centre if they offer Pilates classes, or check with your local library. You can also do pelvic floor exercises at home.