Symptoms and causes

When to see your doctor

You should make an appointment to see your doctor if you experience one or more of the following symptoms:

• I feel that I cannot fully empty my bladder
• I need to get out of bed at night to pass urine
• I leak urine during my sleep
• Urine comes out in a weak stream
• I often suffer from urinary tract infections
• I need to pass urine more frequently than I used to
• I feel an urge to pass even small amounts of urine
• I feel an urge to pass even small amounts of urine and sometimes I do not make it to the toilet
• I leak urine when I am physically active, laugh or sneeze

These symptoms can be caused by many different medical conditions and may be treated accordingly.

Bladder problems can - whether you’re unable to empty your bladder or to hold urine in the bladder (leaks) - have a significant impact on your health and quality of life.

People who experience bladder problems are often hesitant to do something about it, because they find it embarrassing to talk about or simply consider it a sign of ageing.

"Over 20% of people over the age of 40 experience some kind of urinary disorder." 

The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study P. Boyle1, C. Robertson1, C. Mazzetta1, M. Keech2, F.D.R. Hobbs3, R. Fourcade4, L. Kiemeney5, C. Lee6 and the UrEpik Study Group1

If you have urinary retention, you might experience one or more of the following symptoms:

Not being able to urinate
Discomfort
Urgent sense to urinate but weak flow
Dribble due to overflow incontinence
Bloated lower abdomen

Why does it happen?

Urinary retention can be caused by an obstruction in the urinary tract, a bladder muscle weakness or by damage to the nervous system caused by e.g. multiple sclerosis, spinal cord injury or spina bifida (neurogenic conditions).

People with nerve damage may experience that their bladder muscles don’t get the message that it is time to release urine or the muscles are too weak to empty the bladder completely.

Urine that stays too long in the bladder may lead to an infection and urine may back up, leading to pressure and damage to the kidneys.

Urinary retention may also lead to overflow incontinence.

Consult your doctor if you experience one of the symptoms of urinary retention.

If you have urinary incontinence, you might experience one or more of the following symptoms:

• Small or large amounts of urine leaking without warning or without feeling the urge to go to the toilet
• Involuntarily leakage when sneezing, coughing, laughing or exercising
• A sudden urge to rush to the toilet to urinate
• The need to get up to pass urine two or more times a night (nocturia)

Are you experiencing any of these issues? Then you could be suffering from one of the following conditions:

Stress incontinence

Occurs when the muscles in the pelvic floor, under sudden, increased pressure(stress), are too weak to hold the urethral sphincters closed. This results in an involuntary leakage of urine during everyday activities such as sneezing, coughing, laughing or exercising.

Urinary problems can be age related or result from an underlying physical disease.

Medical conditions causing urinary issues:

Weakening of the pelvic floor due to childbirth or surgery
Enlarged prostate (BPH)
Prostate or bladder surgery
Bladder cancer
Damage to the nervous system (neurogenic conditions)

Changes with age

Ageing of the bladder muscle can decrease the bladder's capacity to store urine. Ageing of the pelvic floor muscles may lead to a weak pelvic floor and incontinence.

Menopause

After menopause women produce less oestrogen, a hormone that helps keep the lining of the bladder and urethra healthy.

Pregnancy

Hormonal changes and the increased weight of the uterus can lead to stress incontinence.

Childbirth

Vaginal delivery can weaken muscles needed for bladder control and can be associated with incontinence.

Post surgery

Any surgery that involves the reproductive system, may damage the supporting pelvic floor muscles, which can lead to incontinence.

An enlarged prostate (BPH) is common among men above the age of 40 and can have an impact on daily life, as urinary symptoms may become more frequent as the prostate grows.

Cancer

A tumour anywhere along the urinary tract can block the normal flow of urine, leading to overflow incontinence.

Urinary stones

Hard, stone-like masses that form in the bladder — sometimes cause urine leakage.

Neurogenic conditions

Urinary symptoms vary depending on where the neurological damage occurs and how severe it is.
Neurogenic conditions include:

• Spinal cord injury
• Multiple sclerosis
• Spina bifida
• Type 2 diabetes
• Stroke
• Parkinson’s disease
• Brain tumours 

Even if your bladder problem is age-related and not coming from an underlying disease, you should still see a doctor about it.

A bladder that has lost function due to damage to its nerve supply is called a ‘neurogenic bladder’.

Neurogenic bladder may occur as a consequence of:

• Spinal cord injury
• Multiple sclerosis
• Spina bifida
• Type 2 diabetes
• Stroke
• Parkinson’s disease
• Brain tumours

Although the nerve damage does not influence how the kidneys produce urine, a major consequence of the damage can be impaired functionality of the bladder-like storage capacity and coordination between bladder contraction and sphincter relaxation.

There are two main categories of dysfunction associated with neurogenic bladder – reflex bladder and flaccid bladder:

Overactive (reflex) bladder

When the bladder muscles contract spontaneously as it begins to fill with urine, causing incontinence (i.e. accidental emptying) because the person is unaware of when the emptying will occur.

Underactive (flaccid) bladder

When the bladder can’t release urine because it tends to lose muscle strength and cannot contract properly for emptying. Without appropriate management, a flaccid bladder is at risk of overstretching and becoming damaged or infected because the person may be unable to feel when the bladder is full. Bacteria, therefore, will not be removed through urination and can spread into the bladder.

This means that the bladder can act like a flaccid bladder or a reflex bladder and may, therefore, have more varied and unpredictable symptoms.

The symptoms of a neurogenic bladder must be properly managed. If the bladder has lost its inherent ability to empty, the preferred method is intermittent self-catheterisation (ISC).

What is spinal cord injury?

Typically, the injury is caused by broken bones in the neck or back pressing on the spinal cord. Most spinal cord injuries cause some degree of permanent disability or loss of sensation in parts of the body below the site of injury.

What causes spinal cord injury?

Spinal cord injury is most often the result of some sort of trauma, most commonly car accidents, falls, violence or sports injuries. However, it can also result from infection of the spinal cord and certain medical conditions.

Why does a spinal cord injury cause bladder issues?

The bladder, which stores urine, is controlled by the nervous system. When you have a spinal cord injury, it is likely that the nerves controlling your bladder are damaged. As a result, the bladder may become overactive or underactive.

The spinal cord forms a vital link between the brain and the rest of the body and is part of the central nervous system.

The spinal cord is protected by the bones of the spine and is cushioned by a clear fluid called cerebral spinal fluid. Nerves enter and exit the spinal cord at different points to control the various parts of the body including the bladder.

The stretch receptors of the bladder are connected to nerves, which send signals up through the spine to the brain that now is the time to urinate. If it’s convenient for a person to do so, then the brain sends the message back that it’s OK to release urine.

If the spinal cord is damaged, this messaging system will not work, resulting in bladder problems.

What is spina bifida (SB)?

Spina bifida means ‘split spine’. People with spina bifida were born with a spine and central nervous system that have not developed properly. The reason why this happens remains unclear. The severity of SB varies – in severe cases some of the spinal cord tissue penetrates the skin leaving it exposed outside the body.

Why does SB cause bladder problems?

As the bladder and bowel are controlled by the nerves in the lower part of the spinal cord, a spinal cord that is damaged will lead to bladder and/or bowel dysfunction in different degrees depending on the severity of the nerve damage. What kind of bladder problems? Most people with spina bifida will experience bladder dysfunction known as neurogenic bladder, which means they have difficulties controlling their bladder. A neurogenic bladder can lead to either overactive (reflex) bladder and or underactive (flaccid) bladder, which is why people with spina bifida need help to manage their bladder.