What Causes Incontinence?

Most of us have heard of urinary incontinence and it’s common to think it only happens to women who have given birth. Yet, urinary incontinence is not a one size fits all. There are a handful of causes of bladder weakness and these can differ for men and women. Urinary incontinence can happen because of lifestyle factors or underlying health conditions. Sometimes good old genetics can be blamed. For some people, all three elements are involved.

This blog explains the causes of urinary incontinence, the causes of incontinence for men and women, and the potential risks and triggers.

The urinary system and how it works

The bladder is a round, muscular organ that sits above the pelvic bone and is held in place by the pelvic muscles. As the bladder fills with urine, the bladder muscle relaxes. At the same time, the sphincter muscle keeps the bladder closed until it's time to urinate.

When the bladder is full, the nerves from the bladder send signals to the brain. The nerves in the brain then tell the bladder when it’s ready to be emptied. This is when the bladder muscles tighten and at the same time, it tells the sphincter to relax⁽¹⁾, ⁽²⁾.

Female incontinence causes

Urinary incontinence in women is common, especially during pregnancy, childbirth, and before menopause.

A poll of 1,900 women was launched by Netmums for the Chartered Society of Physiotherapy and The Royal College of Midwives (RCM). The poll revealed one out of three women developed urinary incontinence during pregnancy. And some women said the problem continued one year on from having their baby ⁽³⁾.

Pregnancy

When a woman is pregnant, her pelvic floor muscles are put through their paces. This is understandable because as the baby grows, it places pressure on the bladder. The pressure can then overwhelm the bladder’s sphincter and the pelvic floor muscles. If the pressure inside the bladder is more than the urethral closure pressure, urine will leak out (3). This is called stress incontinence and can happen when a pregnant woman exercises, coughs, sneezes, and laughs ⁽¹⁰⁾.

Also, pregnant women have an increased level of the hormone called relaxin. This hormone relaxes the connective tissues during pregnancy. After pregnancy, the hormone level may not return to normal. This can reduce the strength of the supporting ligaments around the pelvic floor and the urethra and may lead to bladder weakness ⁽¹⁴⁾.

Childbirth

• Women are also at risk of developing urinary incontinence during childbirth. There are various factors that place a woman at higher risk, such as:
• A vaginal delivery
• Having twins or multiple babies places extra pressure on your pelvic floor
• If the baby weighs over 9lbs (regardless of whether you had a vaginal or cesarean section)
• Pushing for longer than an hour during the second stage of labour
• A complicated labour or third or fourth-degree tears
• If forceps or a ventouse are used
• The extra pressure on the pelvic floor can cause a prolapse ⁽⁴⁾

Perimenopause

Stress incontinence is common during perimenopause. This is because estrogen levels start to drop causing the lining of the urethra to thin. Also, the surrounding pelvic muscles may weaken with age ⁽⁵⁾. Although urinary incontinence is common around this stage of life, it doesn’t mean that you should put up with it.

Male incontinence causes

Men also experience urinary incontinence. There a few factors that can cause bladder leaks, for example:

• It’s common for older people to experience an enlarged prostate gland. The enlarged gland places pressure on the urethra and can cause leakage or make it difficult to urinate
• Prostate surgery
• Removal of the prostate gland for cancer treatment. After the removal, the pelvic floor muscles can become weak, as can the nerves around the bladder. This can cause leakage for about half of men after they’ve had surgery. One in five men still have problems a year later ⁽⁶⁾

Temporary vs persistent urinary incontinence

There can be a range of causes for urinary incontinence in men and women. For example lifestyle, medical, or physical circumstances can all play a role. These are grouped into either temporary or persistent causes for bladder leaks.

Temporary urinary incontinence

Some of the temporary causes are:

• Eating certain foods, such as chilli peppers, chocolate, foods high in sugar or acid (citrus fruits)
• Drinking alcohol, caffeine, and/or fizzy drinks
• Some medications. For example, heart and blood pressure tablets, sedatives, or muscle relaxants
• Consuming large doses of Vitamin C ⁽⁷⁾

Persistent urinary incontinence

Persistent urinary incontinence is caused by a physical problem or medical condition. Some of the reasons include:

• Pregnancy
• Childbirth
• Bladder damage during surgery e.g. hysterectomy or prostatectomy
• Neurological conditions affecting the spinal cord and brain (e.g. Parkinson’s, Multiple Sclerosis, or stroke)
• Enlarged prostate and prostate problems
• Birth defects
• Age
• Menopause ⁽⁷⁾

Medical conditions can also cause bladder leaks such as:

• A urinary tract infection (UTI)
• Constipation

Causes of urinary incontinence

Urinary incontinence can be grouped into five categories. Let’s take a closer look at them.

Causes of stress incontinence

When the pressure of urine in the bladder is more than the strength of the urethra, the urethra can’t stay closed, which can cause leakage. If you throw in coughing, laughing, sneezing, or trying to lift a heavy object, it adds to the pressure placed on the bladder and can cause urinary incontinence.

The causes of stress incontinence include:

• Pregnancy
• Childbirth
• Being overweight
• Damage to the bladder during surgery. For example, a hysterectomy, or the removal of the prostate gland
• Neurological conditions
• Medicines
• Connective tissue disorders ⁽⁸⁾

Causes of urge incontinence

Urge incontinence happens when someone is in desperate need to go to the toilet and the bladder contracts before it's time to urinate. Urge incontinence is a symptom of a lifestyle factor, medical issue, or physical problem. It can be hard for a doctor to pinpoint the cause for incontinence, however, here are some reasons:

• Constipation
• Urinary tract infection
• Tumours in the bladder
• Bladder stones
• Neurological condition
• Certain medication
• Enlarged prostate
• Drinking alcohol and/or caffeine
• Not drinking enough fluids such as water. This can lead to strong and concentrated urine which can irritate the bladder ^{(8, 10)}

Causes of mixed incontinence

Urinary incontinence causes could be due to two or more factors. For example, it could be a medical condition or a lifestyle factor. Often it’s a mixture of stress incontinence and urge incontinence (7).

Causes of overflow incontinence

Overflow incontinence happens when there's a blockage that stops the bladder from emptying. There are a few things that can cause this, such as:

• An obstruction, such as an enlarged prostate gland, bladder stones, or constipation. The bladder may not be able to empty due to the blockage or build-up of urine. This may cause leaks and is sometimes called dribbling ⁽⁸⁾
• Damage to the nerves
• Surgery
• Certain medicines

Overflow incontinence is more common in men than women. It’s often caused by surgery on the prostate or prostate problems ⁽⁹⁾.

Causes of total incontinence

Total incontinence happens when the bladder can’t store any urine at all. This means it’s impossible to hold your urine or urine leaks regularly. Possible causes are:

• Problems with the bladder from birth
• An injury to the spine affecting the nerves between the bladder and the brain
• A hole in or around the bladder ⁽⁸⁾

Medicines that may cause urinary incontinence

Both prescription and over the counter medications can cause urinary incontinence or make bladder leaks worse.

There are four groups of medications that can cause urinary incontinence, these are:

• Diuretics (water pills). These stimulate your kidneys to get rid of water and salt from the tissues and bloodstream ⁽¹¹⁾. The most common diuretic is Furosemide, which treats high blood pressure, heart failure, and reduces a build-up of fluid in the body ⁽¹²⁾.
• Alpha blockers. Men often take alpha blockers to treat an enlarged prostate which was causing their urinary incontinence ⁽¹¹⁾. Yet, for women, alpha blockers can cause urinary incontinence.
• Antidepressants and some pain relievers. These can stop the bladder from emptying. This can be a problem if someone has already been diagnosed with overflow incontinence. These tablets can also reduce someone’s awareness that they need to go to the toilet. And they can cause constipation which then can cause urinary incontinence. However, some antidepressants can help with urinary incontinence ⁽¹³⁾.
• Sedatives and sleeping pills. These can cause a particular problem if someone already has urinary incontinence. They can reduce a person’s awareness that they need to go to the bathroom while they’re sleeping ⁽¹¹⁾.

It’s worth noting here that Hormone Replacement Therapy (HRT) can also cause urinary incontinence ⁽⁸⁾.

Urinary incontinence risk factors

There are various risk factors that cause urinary incontinence for both men and women. Women are more likely to experience stress incontinence due to pregnancy, childbirth, and perimenopause. And men are more likely to experience urge and overflow incontinence if they have prostate problems. Other risk factors for both men and women include:

• Age. As people get older the muscles in their bladder and urethra lose their strength. Urinary incontinence becomes more common during middle age and is very common in people who are 80 or older ⁽⁸⁾
• Being overweight places pressure on the bladder and other pelvic muscles
• Smoking
• Family history, especially a history of urge incontinence
• Neurological illnesses
• Diabetes (7)
• Lower Urinary Tract Symptom (LUTS) relates to problems with either the bladder, prostate, or urethra. Having these problems can cause bladder leaks (4)

Urinary incontinence causes

If you’re concerned about urinary incontinence it’s important to speak to your doctor. Often people feel embarrassed to chat to their doctor about bladder leaks. But it is something your doctor can help you with.

You can also check out how INNOVO can help reduce your bladder leaks in as little as 4 weeks. Learn how INNOVO works and discover our clinical studies today.

Sources

1. Cleveland Clinic. Pregnancy & Bladder Control. Reviewed June 2020
2. Kidney & Urology Foundation of America. Urinary System and How It Works. October 2006
3. The Chartered Society of Physiotherapy. Pregnancy Related Incontinence. Reviewed: 26/07/2017
4. Baby Centre. Will My Pelvic Floor Get Worse If I Have More Babies?
5. The North American Menopause Society. Urinary Incontinence
6. NHS. Male Urinary Incontinence. May 2020.
7. Mayo Clinic. Urinary Incontinence. May 2021
8. NHS. Urinary Incontinence Causes. November 2019
9. Urology Care Foundation. What Is Urinary Incontinence?
10. Healthline. What You Need To Know About Urge Incontinence. February 2010
11. Cleveland Clinic. Are Your Medications Causing Your Incontinence, or Making It Worse? January 2020
12. NHS. Furosemide. January 2019
13. Webmd. 4 Medications That Can Cause Incontinence. July 2020
14. Incontinence UK. Incontinence During Pregnancy. March 2018