Bladder control problems affect both sexes

Both men and women can experience problems with bladder control and have some degree of urinary incontinence. Urinary problems are more common in men with ageing, and in women are associated with pregnancy, childbirth and ageing. Other causes include some medical conditions and medications. Treatments can usually resolve or improve incontinence and these include pelvic floor muscle exercises, bladder training, medications and surgery. Exercise and dietary measures to prevent constipation are also important.

Normal bladder control

The body produces urine all the time. When the bladder is almost full we get the urge to empty it (urinate) via the urethra (urine tube). Normal bladder control also depends on the brain, which senses when the bladder is full. When it is time to urinate, nerves stimulate the bladder to contract, and other nerves relax the bladder opening and urethra. We learn this control early in life, so it can be a shock when accidents occur and you find you may no longer have full control. Urine leakage is also called incontinence. If you seek help, bladder control problems are often curable and certainly manageable.

Is urinary leakage common?

One in three women who have had a child and one in 10 men will have some form of problem with bladder control during adulthood. In New Zealand, it is estimated that almost 200,000 women have urinary leakage at least twice a month. Some 70% of women with leakage find they can overcome it or improve their control, but two-thirds do not seek help.

The bladder and 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 types of leakage

• Stress incontinence is urine leakage during physical exertions (eg, coughing, sneezing, laughing exercising or lifting) that raise abdominal pressure – this can force urine out of the urethra in people with weak pelvic floor and urethral muscles.
• Urge incontinence – also known as overactive bladder – 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 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.

What can cause leakage during stress?

The pelvic floor muscles may stretch, weaken or tear. If this happens, the urethra and bladder can move out of place and urine may leak out at times of physical stress. Pelvic floor muscle weakness can be caused by:

• Pregnancy and vaginal childbirth
• Constant coughing (eg, in chronic asthma)
• Straining to empty the bladder or bowel, with or without constipation
• Lots of heavy lifting
• Being overweight
• Ageing or general lack of fitness.

The urethral sphincter may also weaken with age. Lower hormone levels after the menopause, urinary infections and having diabetes or other conditions that can affect nerve function may also be involved.

Also see: Bladder control problems in women

Bladder control problems in men

Men may have any one or more of these symptoms:

• difficulty initiating the flow of urine
• slow urine stream once urination has started – it often stops and starts
• the need to pass urine more often than usual in the day (frequency) and overnight (nocturia)
• dribbling either after passing urine or between visits to the toilet
• returning to urinate within a short time after initial urination
• a feeling of urgency to urinate
• a sensation that emptying is not complete
• burning, discomfort or pain while passing urine - see doctor as may be due to infection 
• blood-stained urine - see doctor as may be due to infection.

Also see: Bladder control problems in men

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 stikes.
• Drink adequate fluids (1.5 to 2L per day, assuming you have no medical reasons not to) and 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.

More on Pelvic floor exercises for women
More on Pelvic floor exercises for men

Can you get help?

Your doctor or continence advisor (nurse or physiotherapist) can help you to learn pelvic floor exercises, advise you how to retrain your bladder and discuss absorbent products. Your doctor can also investigate and treat any infections or conditions related to your bladder problems. There are several bladder medications, depending on the type of problem. Surgery is an option for the few people who need it, if other measures have failed to improve your control.

Original material provided by everybody and reviewed in August 2003 by the New Zealand Continence Association and the Royal New Zealand College of General Practitioners. Reviewed by everybody, September 2011.