Urinary incontinence is any unwanted or involuntary loss of urine from the bladder that cannot be controlled at will. It is considered a health problem if it occurs regularly. Statistically, women are more likely to develop the condition than men.

The condition affects more than 200 million women worldwide. It is a misconception that urinary incontinence is an inevitable consequence of ageing. The risk of developing it increases with age, but it can also occur in young people.

Urinary incontinence can have serious consequences for a patient’s emotional, psychological and social well-being. Nevertheless, it is almost always the result of an underlying condition that can be successfully controlled or treated.

The specialists at the largest private clinics in Switzerland have many years of experience and highly specialised expertise in treating urinary incontinence in men and women. CorSwiss arranges treatment in Switzerland.

Causes of urinary incontinence

Causes in women

The disorder is more common among women, owing both to the anatomy of the urinary tract and to hormonal effects.

Several scientific studies have shown that pregnancy and childbirth (by caesarean section or vaginal delivery) can increase the risk of urinary incontinence. In such cases the muscles and ligaments of the pelvic floor are weakened, causing a condition known as urethral hypermobility (the urethra does not close properly). Around 20–40% of women experience urinary incontinence after giving birth; in most cases it is temporary (disappearing spontaneously within a month or so) and, as we will see later, mainly of the “stress” type. Uterine prolapse can also cause incontinence. This condition occurs in around half of all women who have given birth. During the menopause, women may experience urine leakage owing to falling oestrogen levels; interestingly, oestrogen replacement therapy did not help to control the symptoms.

Causes in men

Men generally experience urinary incontinence less often than women. Benign prostatic hyperplasia (enlargement of the prostate) is the most common cause of urinary incontinence in men over 40. Prostate cancer and some medical treatments are sometimes associated with the condition. Surgery or radiotherapy, for example, can damage or weaken the muscles that control urination.

In both men and women, the ageing process causes a general weakening of the urethral sphincter muscles and a reduction in bladder capacity.

Some cases of urinary incontinence are temporary and are often linked to lifestyle. Drinking alcohol, caffeinated drinks or any fluid in excessive amounts can lead to a loss of bladder control. Some medicines can also cause a short period of incontinence: diuretics, oestrogens, benzodiazepines, antidepressants and laxatives. In addition, certain health conditions are associated with the disorder: diabetes, high blood pressure, back problems, obesity and Alzheimer’s disease. Urinary tract infections can increase the need to urinate. Conditions such as multiple sclerosis, spina bifida, Parkinson’s disease, stroke and spinal cord injuries can also disrupt the nerve function of the bladder.

HOW IS FEMALE URINARY INCONTINENCE DIAGNOSED?

In women, medical responsibility for the disorder is shared between the gynaecologist and the urologist. In fact, for several years now the role of the urogynaecologist has been developing – the reference specialist in cases that call for a complex diagnostic and therapeutic approach.

In other words, patients can be divided into two categories:

  • simple incontinence, in which women mainly suffer from stress incontinence, urge incontinence or mixed incontinence,
  • and a second category, in which patients have urinary incontinence together with other significant symptoms that require more targeted diagnosis and therapy.

Accordingly, there are two types of diagnostic pathway recommended by the society of urologists:

  • the first, simpler pathway can safely be carried out by a gynaecologist or urologist, as it is non-invasive,
  • the second, by contrast, is more invasive (also referred to as surgical treatment) and should be carried out by a urogynaecology specialist or a urologist with the relevant specialisation.