Urinary incontinence, or the loss of bladder control, is a common issue that greatly affects day to day life. The severity ranges from occasionally leaking urine when coughing or sneezing to having an urge to urinate that is so sudden and strong the patient cannot make it to a restroom in time. Although urinary incontinence happens more often as people age, it isn’t an inevitable consequence of aging. In some cases, it can affect children as well. Symptoms of incontinence can include occasional, minor leaks of urine, or moderate amounts of urine more frequently. There are four main types of incontinence.
Stress incontinence occurs when pressure is exerted on the bladder through coughing, sneezing, laughing, heavy lifting, or exercising. Hormonal changes and/or pregnancy and the increased weight of the fetus can lead to stress incontinence.
Urge incontinence occurs when a patient has a sudden urge to urinate followed by an involuntary loss of urine. The patient typically needs to urinate often including throughout the night. Urge incontinence may be caused by an infection or diabetes.
Overflow incontinence occurs when a patient experiences a constant dribbling of urine due to a bladder that doesn’t not completely empty.
Mixed incontinence occurs when a patient experiences more than one type of urinary incontinence. Most often, this is a combination of stress and urge incontinence.
Urinary incontinence can be temporary or persistent. Temporary incontinence can be caused by drinks, foods and medications such as alcohol, caffeine, or blood pressure medications which act as diuretics to stimulate the bladder and increase volume of urine.
Urinary incontinence may also be caused by conditions such as a urinary tract infection which irritates the bladder and causes overactive bladder and strong urges to urinate and, sometimes, incontinence. Normally when the bladder is partially full the brain sends a signal of "time to go". The urination process involves a valve called the urinary sphincter which opens to allow the bladder to drain. Muscles in the bladder wall squeeze inward to empty the bladder. In the case of an overactive bladder, the bladder muscles contract on their own, with little warning. This results in a powerful urge to urinate which could result in anything from a small leak to soaked garments if urine could not be held until reaching a bathroom.
Constipation can also cause urinary incontinence. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in the rectum causes these nerves to be overactive and increase urinary frequency.
In patients who have urinary incontinence due to recurrent bladder infections may develop interstitial cystitis. Pinpoint areas of bleeding develop in the bladder wall and scar tissue can form that causes the bladder to become stiff and less able to expand. The capacity of the bladder is markedly reduced. Irritants in the urine can leak into the interstitium through the scar tissue and irritate the nerve endings causing an abnormally high urination frequency, urgency, pressure and/or pain in the bladder, and pelvic pain. Patients may need to go to the bathroom at least once every hour. The sense of urgency can be present immediately after urination. The inflamed tissue makes it even more likely for recurrent and frequent infections to occur.
Persistent urinary incontinence can be caused by an underlying physical problem or changes which either weakens the muscle or irritates the nerve for bladder control. Pregnancy, childbirth, changes with age, or menopause can be risk factors. Vaginal delivery can weaken muscles needed for bladder control and damage bladder nerves and supportive tissue causing incontinence.
In Traditional Chinese Medicine (TCM), urinary incontinence may be attributed to a sinking of Qi. Qi is responsible for maintaining the body’s overall health and well-being. When Qi sinks, it means that it is not flowing properly through the body’s meridians and is accumulating in the lower part of the body, particularly the lower abdomen and pelvis. This can cause a variety of symptoms, including urinary incontinence.
Sinking Qi can be caused by a variety of factors, including aging, pregnancy and childbirth, trauma, chronic illness, and emotional stress. In TCM, urinary incontinence caused by sinking qi is often seen as a result of weakened or imbalanced organ function, particularly in the kidneys.
Nocturnal enuresis is the accidental or involuntary release of pee while sleeping. Bedwetting is common among children, even after toilet training. Although bedwetting isn’t a serious condition, it can cause stress for a child and family. Children who wet the bed may feel ashamed or embarrassed. They might avoid taking part in activities, such as sleepovers, because they’re worried that they might wet the bed while they’re away from home.
There are two main types of bedwetting, primary and secondary. Primary nocturnal enuresis occurs when a person has never
remained dry throughout the night for six months in a row or longer. Secondary nocturnal enuresis occurs when a person wets the bed again after not wetting the bed for six months or more. Secondary enuresis is usually the result of a medical or psychological condition. As the bladder fills with urine, it sends a signal to the brain. The brain sends a signal back to your bladder to relax so it can hold more pee. A full bladder continues to send signals to the brain so that you’ll wake up.
From a TCM standpoint, nocturnal enuresis occurs due to a Cold Kidney which causes the leakage and discharge. Cold kidneys are not able to send a strong enough signal to the brain causing poor neural function involving urine control; therefore, the patient’s bladder releases the urine.
