Causes of incontinence

Incontinence can be caused by:

Urinary tract infections (UTI)
UTIs are common and develop when the urinary tract becomes infected, usually by bacteria. Most symptoms tend to be mild and pass within a few days. UTIs are more common in women than men due to the length of the female urethra and its proximity to the anus. If urge or frequency of urination develop then a GP or nurse should be consulted. (Men with recurrent urine infection should be investigated by their GP.)

Constipation
Straining during bowel movements can weaken the pelvic floor muscles or a full bowel can press against the bladder causing the urgent need to urinate or having to pass urine more frequently.

Constipation can be treated by:

  • drinking more water
  • eating foods rich in fibre
  • doing regular exercise
  • practising pelvic floor exercises
  • not ignoring the urge to pass stools
  • checking the side effects of medications. Iron supplements, calcium supplements and opioids such as morphine can cause constipation.
  • discussing any concerns with a health care professional and not stopping medication without seeking advice first.

Medications
Some medications can disrupt the normal process of storing and passing urine or increase the amount of urine produced. However, medication should not be stopped without consulting a GP or consultant.

Diuretics (water tablets) such as thiazides and furosemide increase urine production.

Opioids such as morphine can interfere with bladder contraction and cause or exacerbate constipation.

Angiotensin Converting Enzyme (ACE) inhibitors such as Ramipril and Captopril are usually used to treat high blood pressure. However, they can cause a cough and worsen stress incontinence.

Antidepressants such as citalopram are used to treat mood disorders and can interfere with bladder contraction and make constipation worse.

Sedatives such as diazepam and lorazepam can slow the reflexes, affecting the ability to recognise the signal that the bladder is full.

Hormone replacement therapy (HRT) – the lower urinary tract is sensitive to the effects of oestrogen and during the menopause levels naturally decline. There is conflicting advice and evidence about whether or not HRT affects bladder control.

Alcohol and caffeine are diuretics that can increase urine production. Caffeine can cause irritation of the bladder lining.

Nicotine is thought to irritate the detrusor muscle and trigger urge incontinence. Smoking can also cause a cough, which can lead to urine leakage.

Ketamine is a drug used medically in anaesthesia and as a pain killer but has been used as a recreational drug due to its hallucinogenic and euphoric properties. In large and repeated doses it has been found to cause shrinkage and fibrotic changes to the bladder. It can cause frequency, bleeding and pain on passing urine.

Surgery on the lower abdomen can cause the bladder to tilt leading to incontinence or damage to the sphincter.

Pregnancy and childbirth – it is common for women to experience incontinence during pregnancy and following childbirth.

Excess weight – excess weight causes pressure on the bladder and makes incontinence worse.

Additional causes of incontinence in men

Prostatitis – an inflammation of the prostate gland

  • Benign Prostatic Hyperplasia (BPH) – a common condition that can cause the urethra to close off or become narrowed, thus restricting the flow of urine from the bladder.
  • Prostate cancer is treatable when identified early.

The prostate is approximately the size of a walnut and surrounds the urethra just below the bladder. Its main function is to secrete prostate fluid, one of the components of semen. The muscles of the prostate gland also help propel this fluid into the urethra during ejaculation.

  • men can suffer from prostatitis, an inflammation of the prostate gland
  • symptoms can include pain in pelvis, genitals, lower back and buttocks
  • frequency of urination
  • pain when urinating
  • difficulty urinating and “stop-start” peeing
  • pain when ejaculating
  • tiredness, aching joints, chills and fever

It is important a GP is consulted if these symptoms are experienced.

Benign Prostatic Hyperplasia (BPH)
The prostate gland often enlarges as men get older and, in some cases, it can become problematic. As the prostate enlarges it may cause narrowing of the urethra. The bladder then needs to contract harder to squeeze urine out. This can cause the bladder to weaken and lose the ability to empty completely, causing overflow incontinence.

BPH can be managed with lifestyle changes, medication and sometimes surgery.

Symptoms

  • the need to urinate more frequently, often at night
  • difficulty starting to pass urine
  • weak flow
  • feeling the bladder has not emptied
  • taking a long time to urinate.

A GP will take a full history of symptoms and perform an examination. They will request a PSA blood test (prostate specific antigen) and carry out a digital rectal examination.

Other factors

Functional incontinence is where a person is usually aware of the need to urinate, but for one or more physical or psychological reasons they are unable to get to the toilet.

People with dementia may be aware of the need to go to the toilet but may not be able to express this need. There could be a noticeable change in behaviour, such as agitation or restlessness. They may have forgotten where the toilet is or be in unfamiliar surroundings.

Physical problems such as poor eyesight, mobility or dexterity can all lead to difficulty accessing the toilet. Fear of falling, depression and anxiety can also be factors, as well as environmental factors, such as poor lighting, low chairs, stairs or steps and unusual surroundings. Inadequate toilet facilities or a person's fear of using them can also contribute to someone being incontinent.

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