How Incontinence is for Males vs. Females
Urinary incontinence (UI) refers to the involuntary loss of urine. It is a significant health problem that has many implications both socially and economically. There are many types of UI with varying degrees of severity, frequency, and prevalence among the general population.
In men, the prevalence of UI is about half as much as in women. About 3-11% of men have urinary incontinence with urge incontinence being the most common type.
Due to differences in the structure of urinary organs between men and women, the prevalence of UI in women is higher, and also increases with childbirth and age-related muscle tone weakness. However, note that UI happens to both men and women, and becomes more common as part of ageing.
Males
Oftentimes, urinary incontinence in men is often caused by underlying medical conditions such as benign prostatic hyperplasia (BPH). This condition is commonly faced by men past the age of 50, where the prostate gland becomes enlarged blocking the flow of urine through the urethra, causing overflow incontinence.
Females
As with men, there are certain causes of urinary incontinence unique to women. These are usually related to hormonal differences caused by pregnancy, childbirth or menopause, which affect muscles and nerves.
Other than certain physiological differences between genders, stress incontinence is generally related to pelvic floor muscle weakness, i.e. weakness of the structures that support the urethra and the muscles that control the release of urine (urinary sphincter).
Types of Incontinence
There are many types of UI with different etiologies, disease courses, and complications. Broadly, UI can be divided into 4 types:
Stress incontinence
Stress UI refers to the involuntary loss of urine when there is a raised intra-abdominal floor, and most commonly occurs in those with pelvic floor weakness, leading to loss of urethral support and an opening of the bladder neck. Actions/movements that cause stress UI include laughing, sneezing, coughing, or lifting.
Urge incontinence
Urge UI refers to the involuntary loss of urine that is preceded by a strong urge to urinate. This can be due to an overactive bladder (OAB), which causes the bladder muscles to contract more frequently than normal, resulting in a frequent urge to urinate even though the volume of urine in the bladder may be low. Causes of urge UI include bladder cancer, bladder inflammation, bladder infection (cystitis), bladder outlet obstruction, infection, and spinal cord injury.
Overflow incontinence
Overflow UI, in contrast to urge UI, occurs when the bladder is underactive, or when there is an obstruction to the urethra, which carries urine out from the bladder. This results in difficulty emptying the bladder, resulting in dribbling of urine, or an ‘overflow’ of urine in-between visits to the toilet. Causes for overflow UI include dementia, previous stroke, spinal cord injury, diabetes, pelvic organ prolapse, and surgical complications.
Mixed incontinence
Mixed UI is when someone suffers from a combination of different types of UI. The most common combination is that of stress UI and urge UI.
Lifestyle activities that worsen this condition
There are many risk factors that may worsen UI. Lifestyle factors include:
- Smoking
- High alcohol intake
- High caffeine intake
- Chronic cough
- Obesity
- Menopause
Medical conditions that may worsen UI include:
- Frequent urinary tract infections (UTI)
- Constipation
- Certain medication
- Cancer
- Family history of UIs
- Past pelvic or prostate surgery
- Diabetes
Signs and Symptoms
Symptoms of UI depend on the type of UI the patient suffers from. These include:
- Involuntary leakage of urine (main symptom)
- Urgency – increased urge to urinate, even when the bladder is not full
- Frequency – urinating more often than usual
- Dysuria – pain on passing urine
- Enuresis – bed-wetting during sleep
- Nocturia – waking up to urinate, more than 1 time a night
- Overflow – this typically affects the elderly and results in frequent urination or constant leakage of urine
When should you seek help?
Urinary incontinence is a significant medical condition that can cause complications to your health, lifestyle, and overall well being. While it is not life-threatening, leaving UI untreated for prolonged periods can lead to an increased risk of several complications such as more frequent UTIs, developing mixed UI, increased risk of infection, and emotional distress.
As such, it is important to seek medical advice if you experience UI symptoms. UI is a treatable condition and options for treatment for female urinary incontinence include conservative lifestyle measures and surgical interventions to help pinpoint and treat the anatomical cause of UI.
