Bladder Control

What is Bladder Control?

It is well-known that the polio epidemics of the mid-20th century left many young people with sequelae in the form of second neurone paresis and that, after rehabilitation and a stable period of muscle strength, these people once again experience muscle weakness, a condition known as post-polio syndrome (PPS) or the Late Effects of Polio (LEoP)

It is, however, less well-known, that reports from the time of the polio epidemics  also described that patients with acute polio had bladder symptoms. In one study 42 out of 199 surviving patients had disturbances of the bladder, while another found  65% of the adults had urinary tract symptoms.

From a theoretical view, these problems may return with the decline of function experienced by the polio patients in the long run. Furthermore, the acute polio and subsequent rehabilitation may have had an influence on upbringing, habits and physical ability/disability of the patient; factors that are also important in relation to the occurrence of bladder symptoms.

Bladder symptoms, especially incontinence, are known to have major influence on quality of life  thus, it is of relevance to the rehabilitation of polio survivors to address their bladder symptoms.

Urge incontinence  where you may feel the need to go so often it interferes with living

Stress incontinence due to a poorly functioning urethral sphincter muscle

Overflow incontinence due to either poor bladder contraction or blockage of the urethra


Mixed incontinence involving features of the different other types


How the bladder works

The bladder is a hollow organ in the lower abdomen. It stores urine, the liquid waste produced by the kidneys. Urine passes from each kidney into the bladder through a tube called a ureter. Urine leaves the bladder and exits the body through another tube called the urethra.

As the bladder fills with urine, pressure is exerted on its walls, which you experience as the need to urinate. This triggers the brain to send a message to the layer of muscle that surrounds the inner lining of the bladder, forcing the muscle to contract (tighten) and the urine to flow out of the bladder.

At the same time, the sphincter muscle that surrounds the urethra relaxes, letting the urine flow out of the body. This process requires both nerves and muscles working together to prevent urine leakage. Damage, weakening or injury to either muscles or nerves can result in incontinence.

Common symptoms of Bladder Control :

Leaking urine during everyday activities, such as lifting, bending, coughing, or exercising

Feeling a sudden, strong urge to urinate right away

Leaking urine without any warning or urge

Being unable to reach a toilet in time

Wetting your bed during sleep

Changes in Bladder Control

A weakening detrusor muscle, a smooth muscle found in the wall of the bladder, may cause incomplete voiding. In this case voiding becomes more frequent and overflow incontinence may result.

A weak sphincter/pelvic floor can lead to stress incontinence or urine leakage.

An autonomic nervous system imbalance can give rise to urge incontinence difficulty inhibiting the desire to void or difficulties initiating a void.

Functional incontinence may occur due to being unable to reach the toilet in time as a result of restricted mobility.

Oedema in the legs, causing nocturnal and urinary incontinence, are  common in those with lower limb paralysis. Fluid accumulates in the legs during the day and mobilizes at night when the person lays down in the bed, resulting in a larger urine production at night.

Problematic voiding habits, such as suppressing the need to void, leading to an overstretched detrusor muscle.

Hundreds of people in this photo will have issues with bladder control. It is more common than we think because few people talk about it.

What can I do to improve my Bladder Control ?

While incontinence may not be a life-threatening condition, it’s clear that the physical, mental and financial burdens that are placed on a person with the condition severely affect overall quality of life.

But, the good news is that there is a wealth of treatment options available to patients, which can ease many of these burdens. However, in order to get the treatment that so many need, we must first start by thinking about this condition differently.

Doctors need to have a forthcoming discussion with their patients about incontinence, and patients need to be willing to speak up about the condition with their doctors. And, as a community, we all need to be more open about incontinence to erase the stigma that has held so closely to it for so many years.

If you live with this condition, or know someone who does, we urge you to speak up, educate yourself, and get treatment. Because living with a condition that so severely impacts you physically, mentally and financially is no way to live.

A diary to track problems can help determine whether treatments are working.
If treatment is desired, pelvic floor exercises, bladder training, and other behavioral methods are initially recommended.
Weight loss in those who are overweight, decreasing caffeine consumption, and drinking moderate fluids, can also have benefits.
Medications, typically of the anti-muscarinic type, are only recommended if other measures are not effective.  They are no more effective than behavioural methods; however, they are associated with side effects, particularly in older people.
Some non-invasive electrical stimulation methods appear effective while they are in use. Injections of botulinum toxin into the bladder is another option. Urinary catheters or surgery are generally not recommended.

Social Effects of Bladder Control

While the physical impact of incontinence is substantial, the effect of incontinence on a person’s mental health can be truly devastating.  Many people with incontinence carry an emotional burden of shame and embarrassment in addition to the physical disruption on their lives. They learn to hide their problem from close friends and family, and even significant others for years. Most wait at least 6 years before even discussing the problem with a doctor.  They shy away from social activities for fear they will have an accident in public, and stop doing things they once took joy in. Slowly, their isolation and shame may lead to depression and anxiety. Even after accounting for other medical conditions and demographic differences, incontinence negatively impacts a person’s quality of life.

In fact, research has found an association between incontinence and declining mental health and an increased risk of the onset of psychological distress and depressive symptoms.  In one study, women with severe urinary incontinence had an 80% greater possibility of presenting deep depression while women with mild incontinence had a 40% greater possibility of presenting depression.  Another study showed when urinary incontinence is severe enough, the incidence of a stress disorder increased by 4 times.

And the impact doesn’t stop there – sexual functioning also takes a hit. One study reported that 43% of participants with urinary incontinence felt that their urinary disorder had adversely affected sexual relations.

Premenopausal women with urinary incontinence have reported lower scores of desire, stimulation, lubrication of the vagina, orgasm and satisfaction.  Add to that the anxiety that many women feel that they may have an incontinent episode during sex, and it’s easy to see why many women with incontinence may avoid the act all together.

Unfortunately, the mental impact of incontinence doesn’t just affect the patient.  The physical and psychological toll of those caring for an incontinent loved one is also significant. Many caregivers have reported problems with role change, sleeping, finances, intimacy and social isolation. It’s been shown that incontinence adds to the psychological and physical burden of caregivers and can be a risk factor for nursing home placement, hospitalization and death.  In fact, urinary incontinence has been reported to be one of the leading causes of nursing home admissions.  Given the extreme guilt that often accompanies this decision, it’s no surprise that incontinence negatively affects caregivers as well as patients.

Ongoing worry about bladder control

If you are having an ongoing issue with overactive bladder symptoms, make a booking with your GP, and get the help that is out there.

It is completely natural to feel awkward when  talking about our bodily functions we have always (mostly) done in private. Feelings won’t kill us, not talking about problems might. Remember, we all have the same biology.

Find out more

Resources, Links and Research Downloads

Lise Kay, MD and Merete Bertelsen, PT
From the Danish Society of Polio and Accident Victims, Rødovre, Denmark

Q: To describe bladder symptoms among polio survivors
and the inconvenience they cause.
W: 272 eligible subjects responded to a survey using the validated Danish Prostatic Symptom Score questionnaire concerning bladder symptoms.
A: Within 2 weeks 87.5% of respondents had experienced at least one bladder symptom, and 76.5% reported that they had been bothered by a bladder  symptom. Out of the 12 symptoms in the questionnaire we found a significant gender difference, with straining and weak stream reported more often among men, and urge incontinence reported more often among women. Incontinence occurred significantly more often among women (73.3%) than among men (40.9%). Compared with a similar study of the background population, bladder symptoms overall occurred approximately twice as often among polio survivors.

Psychosocial impact of urinary continence.

First steps in the management of urinary incontinence

Queensland Health

Q: Psychosocial impacts must be carefully assessed because urinary incontinence has a significant impact on an individual’s quality of life.
W: This is a comprehensive overview of current best practice for bladder control
A: People do not have to accept urinary incontinence. Something can be done about