Urinary Incontinence- When Our Bladder Has A Mind Of Its Own
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
Humans have control over when they can urinate, or more specifically over the sphincter. But sometimes a person may lose or have weak control over the sphincter causing them to urinate even when they do not want to. This condition is known as urinary incontinence and isn’t that uncommon.
It is usually caused due to stress, coughing and mostly occurs during or after pregnancy or if the person is obese.
This occurrence is more common in women when compared to men, and chances increase with age.
Types of Urinary Incontinence
There are different types of urinary incontinence, classified based on the causes. They include,
Stress Incontinence- This kind of incontinence occurs when there is stress applied o the sphincter muscles. This could happen while coughing, laughing, sneezing or while the patient is engaged in activities such as acting and running
Urge Incontinence- Patient experiences a sudden urge to urinate, and the urine leaks within a few minutes after the patient feel the urge.
Overflow Incontinence- In this case, the patient wouldn’t be able to completely empty the bladder and as a result the bladder leaks.
Total Incontinence- Patients with this type have bladders that cannot store urine at all, thus urinating whenever the bladder has any urine in it.
Functional Incontinence- In this case, the urine escapes the person before he reaches the bathroom. Probably occurs due to a mobility issue.
Mixed Incontinence- As the name suggests, it is a mix of any of the above types.
Causes of Urinary Incontinence
Each type of continence has its own causes, and both are closely linked.
1. Obesity, ageing, pregnancy and childbirth, and surgical procedures such as hysterectomy are factors that cause stress incontinence. Even menopause can be a reason for stress incontinence, as a reduction in estrogen levels can have a weakening effect on the sphincter muscles.
2. Urge incontinence occurs due to the following factors:
Cystis, a condition in which the lining of the bladder is inflamed
If the patient has diseases such as Multiple Sclerosis, Stroke, Parkinson’s disease or other diseases that could affect neurological function
If there is an enlargement in the prostate gland, thus affecting the urethra.
3. Overflow incontinence usually occurs when there is an obstruction in the urethra. The obstruction could have occurred due to
An enlarged prostate gland that irritates the urethra
A tumour that is pressing on the bladder
If there were complications in a previous surgery for incontinence
4. Causes for total incontinence include
An anatomical defect that has been there since birth
Injury in the spinal cord due to which the nerve signals between the brain and bladder aren’t related
Development of a fistula, i.e a development of a canal between the urethra and the vagina
Medications like diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants
Too much alcohol
Urinary Tract Infection
Symptoms of Urinary Incontinence
The most obvious symptom of urinary incontinence is unintentional urination or leaking of urine, but based on the type of incontinence, the how and the when of the leakage varies.
In the case of stress incontinence, urine leaks when the urethra undergoes stress. Stress, here, refers to physical pressure applied to the bladder during actions such as coughing, sneezing, lifting heavy weights, or exercise. Usually occurs who have recently undergone childbirth or menopause.
A patient with urge incontinence gets abnormal urge to urinate and he or she will only have a few minutes before the urine leaks. This is because there is a sudden, involuntary on the bladder wall. A patient may feel the urge to urinate when he or she just changes his position, hears the sound of running water, or while having an orgasm during sexual intercourse.
Overflow incontinence usually occurs among men with problems related to the prostate, damaged bladder or blocked urethra. A patient with this type of urinary incontinence will usually experience constant dripping of urine from the urethra or the frequent need to urinate.
Functional incontinence has very less to do with the loss of control of sphincter muscles and more to do with having mobility issues. These mobility issues could be due to confusion, dementia, improper eyesight or mobility, inability to unbutton pants due to dexterity, mental health issues like depression, anxiety or anger making the person reluctant to use the bathroom. Functional incontinence usually affects the elderly or people with mental health issues.
Symptoms of mixed incontinence is usually a mix of symptoms of urge and stress incontinence.
Total incontinence has the urine constantly leaking off the person or large amounts of urine being leaked periodically.
Diagnosis of Urinary Incontinence
Urinary incontinence is diagnosed by-
Maintaining a bladder diary which records the fluid intake, and their urinary schedules, and quantity of urine released as well as the number of incontinence episodes
Performing a physical exam to check the strength of the pelvic floor (in case of women) or rectal exams to check if there is any enlargement of the prostate. (in case of men)
Analysing the urine to check for infections and abnormalities
Conducting blood tests to assess the kidney functiom
Assessing the amount of urine left in bladder post urination, also called Postvoid residual (PVR) measurement
Conducting stress test, i.e. applying stress on the urethra to see if the body leaks urine
Determining the maximum pressure the sphincter and the bladder can withstand, called urodynamic testing
Taking a cystogram to see the bladder
Taking a cystoscopy to check abnormalities in the urinary tract
Prevention of Urinary Incontinence
The best way to prevent urinary incontinence is to take up exercises that could help strengthen the bladder and sphincter muscles such as bladder control, pelvic floor, or Kegel exercises.
Treatment of Urinary Incontinence
Since there are different types of incontinence, each of them comes with its own set of treatments. Various other factors such as patient’s age, gender, medical history and mental health are also considered when devising a treatment plan.
In case of stress incontinence the most simple treatment for this kind of urinary incontinence is Kegel exercises which will help strengthen the sphincter and pelvic floor muscles. People also employ bladder training methods such as delaying the event by controlling the urge, double voiding (urinating, waiting a few minutes and urinating again) and also by setting a toilet schedule. These exercises help the patient regain control over the bladder.
People with the condition are also provided with medication such as-
Anticholinergics- These help people with urge continence by calming their bladder muscles
Topical estrogen- Since the reduction of estrogen causes the weakening of the muscles, by reintroducing the hormone may strengthen the tissues and muscles in the region
Women are provided with assistive devices such as-
Urethral inserts that act like a plug to avoid leakage while she is performing an activity
Pessary- a kind of ring that helps with holding the bladder up
Radiofrequency therapy - This form of treatment involves heating of the tissue in the lower urinary tract so that tissues become firmer during the healing process.
Botox, a type of toxin injected to make the bladder muscles firmer
Bulking agents are injected to the tissues to help keep the urethra closed
Sacral nerve stimulators, a device connected to the spinal cord that releases electric signals which stimulates the nerve and helps with bladder control.
Another form of treatment is by performing various surgical procedures to prevent leakage in any way possible. Surgery is to be opted only if therapies turn out to be unsuccessful.
Risk Factors of Urinary Incontinence
A person is at the risk of having urinary incontinence if he or she is obese, has smoking habits, is ageing, has prostate disease or certain diseases. Women have a higher chance of having urinary incontinence.
Complications of Urinary Incontinence
When a person has urinary incontinence, his or her body leaks urine, which could also lead to other physical problems such as
Skin problems due to the body being wet or damp all the time
Urinary Tract Infections, if the person is dependant on a urinary catheter for a long time
Prolapse- A condition where parts of the vagina, bladder or the urethra all fall into the entrance of the vagina
People may have to deal with social anxiety and other mental health issues due to embarassment
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