Incontinence

Over 600,000 adult New Zealanders, both men and women, do not have full bladder control, but with the right advice and treatment the majority of those affected can have significant improvement.

Approximately 1 in 3 women who have had a child and 1 in 10 men will have some form of problem with bladder control during adulthood.

• In women, bladder control problems are associated with pregnancy, childbirth, menopause and ageing.
• For men, urinary problems are most commonly related to ageing.
• Other causes include some medical conditions, medications, obesity, chronic cough, constipation and inappropriate exercises.

The following article provides general information on bladder control and associated problems. For gender-specific information see bladder control problems in men and women.

Normal bladder control

The production of urine is not under our voluntary control. However, as adults, we have developed the ability to recognise when our bladder is full, and to be able to hold on to urine until we reach a toilet. This means we have control over when and where we will pass urine.

This control is possible because of messages passing between the brain and the bladder, and our ability to interpret these messages. We can learn to use this mechanism to delay passing urine.

The bladder & the urethra

Two structures that help keep urine in the bladder are the pelvic floor muscles and the urethral sphincter.

The pelvic floor muscles help hold all of the pelvic organs in place. When the pelvic floor muscles are strong, the urethra and bladder cannot move out of place. This helps keep the urethra closed, so urine cannot leak from the bladder.

The urethral sphincter is a band of muscles around the urethra. When these muscles are strong, they squeeze tightly and keep urine in the bladder. When you want to urinate you can relax these muscles.

Common urinary problems

Stress incontinence: this is urine leakage during physical exertions (eg, coughing, sneezing, exercising or lifting) that raise abdominal pressure. This can force urine out of the urethra in people with pelvic floor and urethral muscles.
Urge incontinence: also known as overactive bladder. It means a person has a sudden, strong urge to urinate if bladder emptying is delayed, which results in uncontrolled leakage. This is often due to involuntary bladder overactivity.
Overflow incontinence: this occurs when the bladder cannot empty properly. This causes it to become too full, overflow and then leak regularly in small amounts, with no real trigger or warning.

Some people can have a combination of these types of incontinence.

Treatment of bladder control problems

Incontinence can usually be stopped or improved by treatments such as pelvic floor muscle exercises, bladder training, medications and surgery. Exercise and dietary measures to prevent constipation are also important. 

How the problem affects you depends on what is causing it. For this reason, it is important to seek professional help from your doctor or continence adviser so the cause can be found and appropriate treatment given.

For gender-specific information see bladder control problems in men and women

Self care

Tips for improving your bladder control

• Try to ‘be the boss’ of your bladder, not the other way around – adults usually pass urine four to six times in a day and maybe once during the night. Bladder retraining techniques can help people with urge incontinence to lengthen the time between toilet visits and ‘buy more time’ when the urge strikes.
• Assess how how much fluid (such as water, juice, coffee, tea, fizzy drinks) you drink in total each day. Usually 5 or 6 drinks a day in total is enough. There is no ‘right amount’ to drink – frequently people think they should drink a lot more than they need. Reduce drinking in the evening if going to the toilet at night is a problem.
• Eat a diet with plenty of fibre to help avoid constipation (and consequent straining during bowel motions).
• Avoid bladder irritants, such as alcohol and caffeine-containing beverages, if they irritate your bladder.
• Check all of your medications with your doctor – some can affect bladder control.
• Keep to a healthy body weight – it puts less strain on your pelvic floor muscles.
• Do exercises to strengthen your pelvic floor muscles.

Daily pelvic floor muscle exercises

Men and women can strengthen their pelvic floor muscles. Over weeks or months this can improve bladder control. To activate these muscles, while sitting, tighten the muscles of the bladder outlet (urethra) and anus (not buttocks) as if trying not to pass wind, ‘lift up’ inside and hold. Contract these muscles strongly while sitting, lying or standing (do not strain by bearing down), hold for five to 10 seconds (keep breathing), rest, then repeat several times – perform this a few times a day.

If you are still unsure which muscles to use, try to stop or slow your urine midstream; this engages the right muscles, but do not make this a regular exercise. Try to get into the habit of tightening your pelvic floor muscles immediately prior to any activity such as lifting, leaning forward or laughing.

Read more about pelvic floor training in men and women

Learn more

Continence information – adults NZ Continence Association, 2015
Promoting good bladder and bowel health  NZ Continence Association, 2015