Many causes of incontinence are more commonly known, such as aging, childbirth, pelvic floor dysfunction, and Benign Prostatic Hypertension (BPH). But numerous other conditions are linked to or can cause urinary incontinence. Often, multiple factors may be at play at once, so managing and treating incontinence involves addressing all underlying conditions.
As a nurse, it has been helpful to understand what different conditions can contribute to or cause urinary incontinence and why. This knowledge can help you have informed conversations with your healthcare provider and better understand why decisions are being made about the treatment and management of urinary incontinence.
These are some of the conditions that can cause or contribute to urinary incontinence and why.
Ehler’s Danlos Syndrome
Ehler’s Danlos Syndrome (EDS) is a connective tissue disorder that can affect most parts of the body. This can include the bladder, uterus, and other pelvic ligaments that help maintain bladder control. In a review study conducted to look at urogenital symptoms experienced by people with EDS, it found that over 40% of people included in EDS studies had one or more urinary complications. The connection between EDS and incontinence is believed to stem from reduced collagen and elasticity in the pelvic floor and urinary system, which can lead to bladder control issues, such as urinary retention and incontinence.
Diabetes
Diabetes is a disease characterized by high levels of sugar (blood glucose) in the body. Over time, diabetes can damage nerves and blood vessels throughout the body, including those in the pelvic region and bladder. Nerve damage in the bladder can cause decreased sensation or nerve malfunction, disrupting the signals sent to your brain about when you need to urinate. Similarly, the blood vessels in your bladder can become damaged, causing decreased blood flow. These changes can lead to different types of incontinence.
Stroke
Strokes can cause temporary and permanent changes to the body depending on the type and severity. When a stroke affects parts of the brain that communicate with the bladder, it can cause incontinence. This can look like the brain’s inability to recognize when the bladder is full, but it can also result from a direct impact on the muscles and nerves that control the bladder. Experiencing new-onset incontinence after a stroke can be common, but for some people it will only be temporary, and they will regain control of their bladder as they recover.
Multiple Sclerosis (MS)
MS causes a range of symptoms that can vary from person to person. However, 8 out of 10 people diagnosed with MS will experience issues with bladder control. In MS, lesions form in different parts of the brain, causing symptoms. In bladder control, these lesions disrupt central nervous system signals that regulate urine flow. This can cause the bladder to become spastic and fail to fill properly, as well as create issues with urinary retention, urgency, and frequency.
Thyroid Disease
The connection between thyroid disease and incontinence is not yet fully understood. The thyroid gland’s functions do not directly affect the bladder, but they can affect kidney function. Some thyroid diseases that affect the kidneys can result in incontinence due to increased urine production.
Another connection has been made between thyroid disease, specifically hypothyroidism, and lower urinary tract symptoms such as urinary incontinence, but the exact connection has not yet been established.
Arthritis
Arthritis is a broad diagnostic term, as there are over 100 different types of the disease. Arthritis, in general, is characterized by pain and inflammation in movable joints throughout the body. Arthritis has been linked to urinary incontinence, as recent studies have shown a significantly higher prevalence of incontinence in people also diagnosed with arthritis. However, the exact cause for this connection is still not fully understood.
Parkinson’s Disease
Parkinson’s is a progressive disease where brain cells that produce dopamine are lost. Dopamine is important because it controls functions in our bodies that occur on their own, without us always being aware. One of these functions is control of our bladder. We rely on signals from the bladder to the brain when it begins to fill, letting us know to use the restroom. Without dopamine, these pathways can break down and lead to bladder control issues. As Parkinson’s disease progresses, other factors such as nerve and brain damage can contribute to incontinence as well.
Managing Urinary Incontinence
While urinary incontinence can be caused by many different conditions, managing it in the short and long term can have some similarities. As a nurse, I want first to make sure you have addressed any underlying causes of incontinence with your medical provider. For some people, treatment can include medications, surgery, pelvic floor therapy, and other treatment modalities.
When managing incontinence, no matter the cause, it is important to know how to manage leaks and care for your skin.
These are the tips I give to all of my patients when experiencing incontinence:
- Keep the skin as clean and dry as possible- this means gently cleansing the skin anytime it comes into contact with urine. You can use specially formulated wipes or no-rinse cleaners when on the go. Avoid soaps with added fragrance and do not scrub, as this can damage the skin’s natural barrier.
- Find the right product and fit- Using incontinence products can feel embarrassing, and shopping for them in the store may be overwhelming. Many manufacturers, such as LivDry, offer online product catalogs with product descriptions and sizing information. Select a product that matches your needs, such as pads for light occasional leaks or heavier overnight briefs for full bladder loss at night or during the day.
- Monitor and assess your skin daily- Incontinence puts the skin at higher risk for breakdown and infection. Looking at the skin daily can help identify reddened areas caused by excess moisture, pressure damage, or reactions to urine or skin products.
- Don’t try to manage alone- dealing with incontinence can be frustrating, especially when experiencing leaks. Reach out to a healthcare professional for help to ensure you can keep participating in activities you enjoy.
Understanding the Cause Can Change the Care
There is a common misconception that incontinence and changes in bladder control are a normal part of aging. Many causes of urinary incontinence stem from other conditions, such as chronic disease or structural changes in the body. If you begin to experience new or worsening symptoms of incontinence, it is best to work with a healthcare provider to understand the cause, as this can change how it is treated.
