Urinary Incontinence

WHAT IS URINARY INCONTINENCE?
In Urinary incontinence, a person is not able to hold urine, which means they have less or weekend urine control. It can be ranged from slight leakage to severe frequent urine wetting. Thus, a life of person gets affected who is suffering from urinary incontinence during his work, travel, social recreation and sexual activities.

WHAT IS THE INCIDENCE OF URINARY INCONTINENCE?
The incidence of urinary incontinence is far more prevalent in women than in men, as per the report of World Health Organizations. In the general population of between 15 to 64 years, only 1.5-5 % of the men are affected with urinary incontinence compared with 10-30 % of women. However, the condition is associated with shame, embarrassment and silence; the exact figures are still unknown to researchers.

URINARY INCONTINENCE AN INEVITABLE PART OF AGING?
The urge to urinate becomes more frequent with the growing age and it becomes hard to get control over it. However urinary incontinence can affect men and women if all ages and thus is not a normal response to aging.

THE INCIDENCE OF URINARY INCONTINENCE SIMILAR IN MEN AND WOMEN?
No, women experience incontinence two times more often than men. Pregnancy and child-birth, menopause and the structure of the female urinary tract account for this difference. However, both women and men can become incontinent from stroke, multiple sclerosis and other physical problems associated with old age.

WHAT ARE THE RISK FATORS FOR URINARY INCONTINENCE?
Risk factors for urinary incontinence can be acute & temporary, and chronic incontinence.

Acute and temporary incontinence can be caused due to:

  • Childbirth
  • Limited mobility
  • Medication side effect
  • Urinary tract infection

Whereas chronic incontinence can be caused due to:

  • Birth defects
  • Bladder muscle weakness
  • Blocked urethra
  • Brain or spinal cord injury
  • Nerve disorders
  • Pelvic floor muscle weakness
  • Vaginal prolapse

WHAT ARE THE CONSEQUENCES OF URINARY INCONTINENCE?
As the urinary incontinence is full of embarrassment, stigmatization. Isolation, demoralization and depression, it also has far reaching consequences not only on a person’s physical health but also on the mental condition. It is also associated with an increased number of falls, urinary tract infections, and skin breakdown.

ARE THERE DIFFERENT TYPES OF URINARY INCONTINENCE?
Yes, basically there are three types of urinary incontinence. They are:

  • Urge incontinence- In this condition, there is a sudden involuntary contraction of the muscular wall of the bladder that causes an urge to urinate that cannot be controlled.
  • Stress Incontinence- It can be caused due to various factors including child birth, pregnancy, menopause, a hysterectomy, surgeries, age, or obesity.
  • Overflow bladder- This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra.

WHAT IS URGE INCONTINENCE?
Urge incontinence or detrusor over activity is a common problem that increases in frequency and severity with advancing age. In this condition, the patient often loses urine for no apparent reasons while suddenly feeling the need or urges to urinate. In urge incontinence, the bladder involuntarily empties during sleep, after drinking a small amount of water, or while touching water or even when hearing it run (as when someone else is taking a shower or washing dishes).

WHAT CAUSES URGE INCONTINENCE?
The most common cause of urge incontinence is inappropriate and involuntary bladder contractions. These involuntary contractions may occur because of inflammation or irritation within the bladder or when certain neurological diseases impair control of bladder contractions.

  • Urinary tract infections
  • Cancer
  • Parkinson’s disease
  • Alzheimer’s disease
  • Certain drugs such as hypnotics or narcotics
  • Injury (such as those occurring during surgery)
  • Benign prostatic hyperplasia (BPH).
  • Urge incontinence can also occur when mobility is impaired (for example, in patients with arthritis), making it difficult for patients to get to the bathroom in time. This condition is sometimes referred to mass “functional” incontinence.

WHAT IS STRESS INCONTINENCE?
Stress incontinence is the most prevalent form of incontinence in elderly patients. It is caused by malfunction of the urethral sphincter that causes urine to leak from the bladder when intra-abdominal pressure increases, such as during laughing, coughing or sneezing.

WHAT CAUSES STRESS INCONTINENCE?
Stress incontinence is commonly caused because of physical changes resulting from pregnancy, childbirth, and a menopause. This is the most common incontinence condition in the women. Certain muscles, known as the “pelvic floor muscles” support the bladder. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence can also occur as a result of drugs, surgical trauma or radiation damage.

WHAT IS OVERFLOW INCONTINENCE?
Because of the prevalence of obstructive prostate gland enlargement, urinary incontinence due to overflow bladder is more common in men. . In this condition urine accumulates in the bladder until maximum bladder capacity is reached. It then leaks through the urethra by “overflow”, usually manifesting as dribbling. However sometimes, overflow incontinence is confused with stress incontinence as increased intra-abdominal pressure, which occurs during coughing and sneezing may also cause loss of urine.

WHAT CAUSES OVERFLOW INCONTINENCE?

Overflow bladder incontinence occurs because of:

  • Week bladder muscles caused by nerve damage from diabetes or other diseases
  • Obstructed urinary outflow, such as those caused by prostate enlargement and urinary stones
  • Under active bladder contractions caused by certain medications. These medications lead to urinary retention with bladder distension.

ARE THERE ANY OTHER TYPES OF INCONTINENCE?

  • Combinations of both stress and urge continence is sometimes referred as “mixed incontinence”, which is common among women.
  • Transient or temporary incontinence’s causing factors can e medications, urinary tract infections, mental impairment, restricted mobility and severe constipation, which can push against the urinary tract and obstruct outflow.

IS THERE ANY TREATMENT OF URINARY INCONTINENCE?
Most types of urinary incontinence can be effectively treated through examining the patient’s frequency of urinating and diagnosing it accordingly.

  • A bladder diary
  • Physical exam
  • Urinalysis
  • Blood test
  • Post void residual measurement
  • Pelvic ultrasound
  • Stress test
  • Urodynamic testing
  • Cystogram
  • Cystoscopy

WHAT ARE THE TREATMENT OPTIONS FOR URGE INCONTINENCE ?
These patients often respond to behavioral therapy consisting of bladder re-training provided they are motivated to do so and their mental faculties are all right. For example, such patients are instructed about a fluid intake schedule, voiding techniques and scheduled voiding. Institutionalized patients can also benefit from behavioral training using scheduled toileting or prompted voiding. Urge incontinence also responds to various drugs. Special care must be taken when using these medications, especially in patients who may have urinary outflow obstruction, as these drugs can precipitate urinary retention.

WHAT ARE THE TREATMENT OPTIONS FOR STRESS INCONTINENCE ?

Women suffering from stress incontinence can be relaxed with:

  • Kegel exercises to strengthen the pelvic muscles.
  • Electrical stimulation can be helpful to get back the injured muscles to fitness to record progress in strengthening treatments and exercises.
  • Medical devices that block or capture urine.
  • Hormone cream to restore the tissue of the vagina and urethra to their normal thickness Surgery to repair or lift the urethra or bladder neck to provide support during straining or sudden movement.
  • Certain prescribed drugs for the management of stress incontinence.
  • Oestrogen replacement therapy

HOW DO PELVIC FLOOR EXERCISES HELP ?
The urinary sphincter, with the help of surrounding pelvic floor muscles, controls release of urine from the bladder. Pelvic floor exercises strengthen these muscles, which help to prevent or reduce incontinence.

WHICH ARE THESE EXERCISES?
Exercises used to strengthen these muscles called “Kegels”. To do them, imagine that you are trying to stop passing gas. Squeeze the muscles you would use to stop the gas and hold the squeeze as you count to 3. Relax, count to 3 again, and then repeat the squeezing exercise. Don’t use stomach, leg, or buttock muscles. Do this for about 5 minutes three times a day. It may take 6-8 weeks before any beneficial effect is noted. Reported improvement/cure rates have been as high as 77%. These exercises can be done practically anywhere-while driving, watching television, or fixing a meal. But the important thing is to get into the habit of doing Kegels regularly. But remember to avoid pelvic floor exercises while you are urinating, because that may actually weaken the muscles.

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WHAT ARE THE TREATMENT OPTIONS FOR OVERFLOW INCONTINENCE?
Overflow incontinence treatment is done with the objective to improve bladder drainage as the patient faces difficultly in emptying their bladder. This can be achieved by:

  • Drugs,
  • Catheterization, and
  • Intermittent self-catheterization may also be used for chronic management in patients with overflow incontinence.
  • Patients with overflow incontinence can also be instructed in assisted voiding techniques, e.g., abdominal strain, Crede maneuver.

WHAT ARE THE TREAMTENT OPTIONS FOR FUNCTIONAL INCONTINENCE?
Treatment of functional incontinence depends on the successful management of causative or contributing conditions. Mobility can be improved by relieving pain and providing equipment for patients suffering from arthritis, contractures, deconditioning and neurologic impairments. Environmental modifications can be useful in selected patients

SHOULD THESE PATIENTS USE ABSORBENT UNDERGARMENTS?
Although absorbent undergarments can help elderly patients regain freedom lost as a result of urinary incontinence, they may cause many patients to avoid medical evaluation and simply accept the incontinence. Absorbent undergarments are expensive and may cause skin irritation and breakdown with long-term use.

ARE THERE ANY OTHER TREATMENT OPTIONS?
Behavioral therapy has been recommended as the initial approach to urinary incontinence. Even when surgery is the treatment of choice, it is often complemented with some form of behavioral treatment . Behavioral interventions include pelvic muscle exercises, biofeedback, bladder training and fluid /dietary modifications.

WHAT IS ELECTRICAL STIMULATION ?
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Brief doses of electrical can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.