Adult Incontinence Part 2

Common types and gender differences

Note: the following is not intended as professional medical advice. Always consult your medical professional if you suspect you are experiencing urinary incontinence.

Welcome back to our 5-part series on incontinence. In our last article, we discussed the need to talk about this important issue. Now, let’s take a look at how incontinence relates to gender, and the several different forms of urinary incontinence (UI) that affect both men and women.

While both men and women can experience urinary incontinence (UI), more women than men are affected. When men face urinary incontinence, it is often due to the enlargement of the prostate gland, as they age. However, prostate cancer, constipation, and urinary tract infections can also contribute to the condition. Women can experience UI due to a number of factors including a decline in estrogen levels during menopause. This decline reduces the strength and tone of the pelvic floor muscles which control the ‘shut off mechanism’, halting the flow of urine. Changes in hormone levels around the time of menopause also reduce the ability of a woman’s bladder to stretch so it cannot hold as much urine as it once did. Pregnancy can result in weakened pelvic floor muscles due to hormonal changes, and pressure on the pelvic floor. Urinary tract infections also contribute to UI, and although these can affect both men and women, women are around 30 times more likely to experience them.

While the reasons for UI may be specific to gender, the different types of UI tend not to be. Whether it is stress, urge, overflow, or total-urinary incontinence, both men and women are affected, and it is possible to have more than one type of UI at any given time.

Stress incontinence (sometimes referred to as ‘leaking’) occurs when we laugh or cough, sneeze, or exercise. It occurs when our pelvic floor muscles are weakened or damaged (and, yes, men have a pelvic floor, too). Obesity can also contribute to stress incontinence.

Urge incontinence, on the other hand, is caused by over-, rather than under-active, muscles. It is characterised by a sudden, urgent, need to pass urine several times during the day and night. The intensity of the urge can be so great ‘leakage’ can occur before there is time to reach the toilet. Contributing to urge incontinence can be other health issues such as stroke or MS, urinary tract infections, ageing, or an over active bladder (the urgent need to urinate even when the bladder is not full).

Overflow incontinence (where the bladder doesn’t empty completely) occurs more frequently in men than in women, with the result ‘dribbling’ or leaking can be experienced. Some medicines can affect the ability of the bladder to fully empty.

Total UI is the most serious form of bladder incontinence, resulting in continuous and uncontrollable leakage. Some types of nerve damage can cause total UI as can congenital issues and injuries. As well as individual forms of UI, it is also possible to have ‘mixed UI,’ a situation where several issues contribute to the leakage of urine. For example, you may have both stress and overflow incontinence.

Whatever form your UI takes, it will vary from person to person. If you’re talking to a friend who has stress incontinence, for example, and you also suffer from this, don’t be surprised to find your friend experiences only light leakage when they laugh or exercise, while you experience a significant amount of leakage in the same situations.

Although UI can arrive in several different forms, and for very different reasons, one thing we can be sure of is there is an increased likelihood of experiencing it after the age of 50. If you think you have a problem with UI, don’t keep the information to yourself. Visit your GP right away, and encourage your friends and family who may be in the same situation, to do likewise!