Reflex incontinence, caused by bladder spasms in the detrusor muscle, leads to sudden urine leakage without any warning or the urge to go. It typically stems from a neurological impairment that disrupts the signal between the brain and bladder.
While reflex incontinence is most often seen in people with spinal cord injuries and neurological disorders, many are reluctant to speak about the associated symptoms. But this shouldn't hold you back from seeking the help you need to manage your urine leaks and find long-term solutions. Seeking medical advice can significantly improve management and quality of life.
In this article, we take a closer look at this under-discussed and frustrating condition by exploring its symptoms, causes, and treatment options.
What is Reflex Incontinence?
Reflex incontinence is a type of urinary incontinence where the bladder contracts and empties without control or warning. It’s not caused by physical exertion or urgency but by automatic reflexes, often due to nerve damage.
This form of incontinence is usually linked to neurological conditions or spinal cord injuries that interfere with the brain’s ability to signal the bladder correctly. People affected usually do not sense bladder fullness before leakage occurs.
The two types of reflex incontinence
There are two main types of reflex incontinence, including:
Supraspinal reflex incontinence: This occurs when the brain and bladder muscles don't communicate properly because of diseases such as Alzheimer’s, Parkinson’s, and Dementia.
Spinal reflex incontinence: Caused by damage to the spinal cord, resulting in disrupted signals and a lack of control over the bladder muscles.
Other types of urinary incontinence
In addition to reflex incontinence, there are five other main types of urinary incontinence, including:
Urge incontinence: Preceded by a sudden urge to urinate.
Stress incontinence: Caused by physical actions, such as coughing, sneezing, laughing, etc.
Mixed incontinence: A combination of stress and urge incontinence.
Overflow incontinence: Urine leakage caused by a bladder that doesn't empty completely.
Functional incontinence: Caused by physical or mental impairments that make it difficult to get to the bathroom.
Reflex Incontinence Causes
Reflex incontinence stems from nerve damage that disrupts bladder control. This could result from injury, illness, or degenerative neurological conditions. The body loses the ability to sense when the bladder is full and automatically empties.
Reflex incontinence risk factors
While reflex incontinence is relatively rare among the general population, some of the risk factors for developing this condition include:
Spinal cord injury
Multiple Sclerosis
Parkinson's disease
Stroke
Brain tumours
Alzheimer's
Physical trauma to the spinal cord or surrounding area
Surgical complications involving the spinal cord or pelvic nerves
Neurological ageing-related changes
Managing Urine Leakage Caused by Reflex Incontinence
Since the urine leaks caused by reflex incontinence are usually completely random, many people with this condition choose to wear incontinence products or use catheters.
Incontinence products
Here are some of the most popular products used to manage urinary incontinence:
Liners: Well-suited for light leaks of a few drops at a time, incontinence liners are designed to be comfortable and discreet.
Incontinence pads: Available in a wide range of sizes and absorbency levels, incontinence pads can hold significantly more urine than liners. These products come in both reusable and disposable options.
Leak-proof underwear: Typically made with multiple layers of absorbent fabric, incontinence pants look and feel very similar to normal underwear. These products are ideal for those with active lifestyles and who experience light to moderate leakage.
Chair and bed protection: Furniture pads are ideal for nighttime incontinence and for anyone who may be immobile.
Selecting the right combination of products can improve comfort, hygiene, and confidence.
Catheters
Catheters can help manage reflex incontinence by draining urine directly from the bladder. Clean intermittent self-catheterisation is often recommended for those with some dexterity, while indwelling (long-term) catheters may be used in more severe cases. These devices help prevent leaks, protect skin health, and reduce the risk of infection.
Lifestyle Modifications to Alleviate Reflex Incontinence Symptoms
While lifestyle changes may not cure your reflex incontinence, they can help you maintain a healthy bladder and reduce your symptoms. Consider these adjustments:
Lose weight if you are obese or overweight. Excess weight puts pressure on your bladder, increasing your chance of leaks.
Try to eat healthy, including bladder-supporting foods such as berries, bananas, potatoes, lean proteins, and eggs.
Quit smoking. Not only is smoking carcinogenic, but it can also irritate the bladder and worsen symptoms.
Stay away from bladder irritants like caffeine, sugar, processed foods, citrus fruit, and alcohol.
Drink enough water throughout the day to stay hydrated.
Avoid constipation, which can put extra pressure on the bladder, by eating a fibrous diet and staying hydrated.
Find healthy ways to manage your stress, like meditation, yoga, painting, etc.
Reflex Incontinence Treatment Options
Although reflex incontinence can't always be cured, symptoms can be reduced by several treatment options, including:
Bladder training
This involves working with a healthcare professional and creating a strict bathroom schedule, you can empty your bladder at timed intervals. This reduces the risk of "accidents" while training your body to adapt to a urination timetable. Over time, you can slowly increase the periods between using the bathroom and retrain your bladder for better control.
Pelvic floor exercises
Pelvic floor exercises, like Kegels, strengthen the muscles responsible for bladder control. This could help reduce your reflex incontinence symptoms and promote better bladder health. You should seek advice from a pelvic floor physiotherapist for personalised advice.
Kegels involve contracting your pelvic floor muscles for a few seconds, releasing them, then contracting them again. Often they need to be repeated around 20 times a few times a day. To see results, people need to be patient and remain consistent.
Treating underlying conditions
By treating underlying conditions, such as Multiple Sclerosis or Parkinson's Disease, you can minimise your bladder symptoms.
This is why it's so important to understand what type of urinary incontinence you have and what could be potentially causing it. Only then will you be able to treat the underlying cause and hopefully experience some relief.
Medication
Anticholinergic medications, such as oxybutynin or solifenacin, can help reduce bladder spasms by relaxing the bladder muscles. This medication can be helpful for those who have symptoms of urgency or frequency. However, they can have side effects, so it is best to discuss closely with your healthcare professional.
Botox injections
In recent years, Botox injections have provided effective results for those with reflex incontinence. Injecting this neuromodulation into the bladder muscles can help reduce leak-causing spasms. Just keep in mind that this isn't a long-term solution as Botox typically only lasts for a few months and needs repeating
Sacral nerve stimulation
Sacral nerve stimulation involves using electrodes to stimulate the nerves responsible for bladder control. This minimally invasive procedure can help modulate nerve signals and improve bladder function.
Surgery
Surgery is typically considered once other therapies have been trialled. A few of the most common surgical options include sling procedures, augmentation cystoplasty (increasing the size of the bladder), and bladder neck reconstruction.
If you're considering surgery, thoroughly discuss the risks and expectations with your doctor.
The Impact of Reflex Incontinence
From worrying about wetting yourself in social situations to skin irritation, reflex incontinence can significantly impact everyday life. Because it often occurs without any warning, managing it can be especially challenging, both physically and emotionally.
Physical impact
Over time, constant exposure to urine can lead to skin irritation, rashes, and even infections if not managed properly. In severe cases, prolonged moisture can cause pressure sores or dermatitis.
Fear of leaks can also discourage you from participating in physical activity. This can lead to a sedentary lifestyle, impacting your physical health in a multitude of ways.
Social impact
The unpredictability of reflex incontinence can make you reluctant to participate in social activities, travel, or even leave the house. Fear of public accidents or noticeable odour can lead to withdrawal, embarrassment, and reduced quality of life.
Emotional impact
Living with reflex incontinence can take a toll on your self-esteem and mental well-being. Over time, bladder leaks may cause frustration, shame, or even depression. You may feel like your dignity is compromised, especially if you rely on caregivers or continence aids. Seeking support is essential for maintaining emotional well-being.
FAQs
Is reflex incontinence the same as urge incontinence?
Reflex incontinence and urge incontinence are both triggered by similar muscle spasms i.e. involuntary contractions of the detrusor muscle. The key difference is that people with urge incontinence feel a strong, intense urge to urinate followed by leakage, while those with reflex incontinence do not feel any sensation of bladder fullness or urge before involuntary leakage occurs. This sudden, unperceived bladder emptying can make reflex incontinence especially frustrating to manage. Also, reflex incontinence is most commonly associated with neurological conditions such as spinal cord injury, multiple sclerosis or stroke.
Is urine leakage normal?
While the odd one-off urine leak can be overlooked, if you experience "accidents” more frequently, you should make an appointment with your general practitioner as soon as possible. In most cases, the involuntary loss of urine is a sign of a more serious underlying issue. The sooner you receive a diagnosis, the sooner you can treat your symptoms.
How is reflex incontinence diagnosed?
Your general practitioner can diagnose reflex incontinence by discussing your medical history and relevant symptoms. In some cases, they may need to perform a physical examination and use diagnostic tools, such as imaging devices.
What can I do to boost my bladder health?
You can boost your bladder health by performing pelvic floor exercises, staying hydrated, eating a wholesome diet, and avoiding bladder irritants. While some bladder issues are unavoidable, others can be mitigated by healthy lifestyle modifications.
What is overactive bladder syndrome?
Overactive bladder syndrome is characterised by frequent urination (more than 8 times a day) and sudden urges to pee, caused by nerve signal issues, underlying conditions, or bladder muscle overactivity.
Final Thoughts
Common in people with spinal cord injuries, reflex incontinence is an incredibly frustrating condition as it doesn't provide any warning before urine leaks. However, with the right management techniques and incontinence products, you can go about your day as usual.
