Urinary Incontinence

Urinary Incontinence is a condition wherein the ability to control the flow of urine is lost resulting in small to moderate amounts of urine seepage. This accidental loss of urine is known to affect nearly twelve million U.S individuals with a greater percentage of women being affected than men.

There are varied forms of urinary incontinence such as:

Stress Incontinence: This occurs due to heightened pressure on the abdomen during activities like exercising, laughing, sneezing or coughing.

Urge Incontinence: In this type of incontinence also known as the ‘hyperactive bladder’, the recurrent urge to visit the loo with little control while reaching there, leading to involuntary urine leakage.

Mixed Urinary Incontinence: A few women experience a combination of both Stress and Urge Incontinence.

Overflow Incontinence: Affecting mostly men, in this form of incontinence, the inability to totally empty the bladder during urination leads to repeated urine dribbling.

Functional Incontinence: In this form of incontinence, physical ailments prevent one from timely reaching the loo.

Urinary Incontinence Causes:

• Stress incontinence is caused due to several pregnancies and giving birth to a child that lead to stretch, damage or weakening of the muscles and tissues of the pelvic floor. Obesity, excess weight, genetic or other unremitting conditions, having undergone radiation therapy.
• Urge incontinence occurs due to damage caused to the nerves of the urinary bladder, muscles or the nervous system.
• Overflow incontinence is caused due to several factors like weakened muscles of the bladder, obstruction to the urethra due to enlarged prostate and presence of tumours.
• The lesser common forms of urinary incontinence have several other causes. When a complete loss of urinary control or total incontinence occurs either due to a neurogenic bladder, sudden bladder contractions, injury caused to the spinal cord, multiple sclerosis or other nerve function disorders.
• Those with dementia, arthritic problem or other disability find it hard to make it to the toilet or use the loo in time for urination.
• A congenital urinary tract problem also known as anatomical incontinence also leads to involuntary urination.

Urinary Incontinence Symptoms:

Difficulty in holding urine is the main symptom of urinary incontinence. However, the conditions and the problem types that affect urination vary with the causes. The symptoms include:

• Mild to moderate urine dribbling during physical activities, coughing, laughing or sneezing that point to Stress incontinence.
• Recurrent, abrupt and strong urge for urination that could be triggered in few occasions on listening to the sounds or touch of water. Difficulty in holding urine till one reaches the toilet and moderate to heavy dribbling of urine; all of these indicate the presence of Urge incontinence.
• A combination of symptoms relating to both stress and urge incontinence when experienced is known as mixed incontinence.

Exams & Tests:

A correct diagnosis is crucial as treatment that is derived from improper detection would only aggravate the incontinence problem.

• The diagnosis of urinary incontinence is carried out by the doctor after delving into the patient’s medical past, symptoms, routine habits like nature of dietary or fluid intake and the frequency or time of urination. One would need to maintain a record of liquid intake, the frequency and amount of urination for three to four days that the doctor would examine to determine the urine dribbling pattern that would indicate the incontinence type. A physical examination that would be inclusive of a pelvic exam wherein one might be asked to do some coughing in a standing posture to test for stress incontinence.
• A bladder stress test, Bonney test and pad test are amongst the other testing procedures undertaken.
• The rather pricey, sophisticated form of bladder function test, the Urodynamic testing is normally performed when surgery is the option left, if mixed incontinence with greater than a singular cause is suspected or past treatments have proven unfruitful necessitating the requirement for in-depth analysis. The definite tests undertaken during Urodynamic testing mostly vary from Cystometry testing that includes tests like Leak point pressure or LPP and Maximum urethral closure pressure or MUCP. The Post void residual or PVR size and imaging methods X-rays, ultrasound.
• If the causes are still blurred despite the above testing, a broad range of non-routine tests would be essential like Cystoscopy and voiding cystourethrogram- a form of X-ray technique.

Urinary Incontinence Treatment:

Urinary incontinence in majority of cases is treated with introduction of behavioural methods, pelvic firming exercises like Kegel to treat stress incontinence prior to going in for medication treatment.

• The Behaviour methods involve three forms like bladder re-training to treat urge incontinence, timed and prompted voiding that are undertaken to treat functional incontinence. Though, this has high success rates in halting or reducing urinary incontinence, the results varying from person to person and necessitates enhanced encouragement levels and a dedicated caregiver.
• Medicines to treat stress incontinence include anti-depressants like duloxetine, imipramine. Urge incontinence is treated with anti-cholinergic medications like Detrol, Ditropan, Oxytrol that cause side effects like dryness in the mouth, constipated sensation, hazed or blurring of vision and incapacity in urination, though time-discharge and skin patches formulation could cause lesser side effects. Imipramine like Tofranil that is an anti-depressant is engaged for urge and stress incontinence and used in conjunction with a particular anticholinergic medicine.
• Application of a miniscule quantity of estrogen cream within the inter part of the vagina might assist women with menopause having urge incontinence, though this is yet being delved into in detail by researchers.
• Several sessions of mild electrical stimulation to the rectal and vaginal area helps in treating stress and urge incontinence.
• Certain medical aids like urethral insertions or pessary aid in treating incontinence in women.
• Intervention-based treatments like the non-invasive radiofrequency treatment, injecting botox or botolinum toxin type A to the urinary bladder muscle-yet to receive FDA approval. Injections of collagen, carbon-covered zirconium or coaptite are injected into the urethral tissues to keep it closed or decrease urine dribbling. The sacral nerve stimulator is much similar to a pacemaker that is embedded beneath the buttock skin.
• If treatments are proving ineffective, then surgical interventions like artificial urinary sphincter implantation-especially useful for men, pelvic sling procedure, bladder neck suspension procedure-to offer assistance to the urethra and bladder neck.
• In many circumstances, medical treatments are not able to totally halt urinary incontinence or one would need assistance till a certain procedure could be commenced. The locally available absorbent pads to be worn in the undergarments help in soaking the accidental loss of urine. In men, a drip collector device is suitable that fits snugly in the undergarment. Adult diapers, underwear liners could also be used by both the sexes. If the bladder is not adequately emptying, then the doctor might recommend the daily use of catheter- a delicate tubular structure that is inserted into the urethra to drain away the urine from the bladder. This would help in gaining better leak control, particularly in overflow incontinence.

Possible Complications:

Severe urinary incontinence could cause complications like:

• Skin problems due to persistently clammy skin could lead to skin complaints, irritation, ulcers or sores, rashes.
• The risk for recurrent urinary tract infection is heightened due to incontinence.
• Social withdrawal, disruption in professional and personal front.

Prevention:

Though urinary continence isn’t avertable at all times, one could reduce the risk by inculcating the following steps:

• Maintaining idyllic weight.
• Quitting smoking.
• Some doctors could recommend expectant women to practise Kegel exercises as a pre-emptive measure.
• Increasing intake of fibre or consuming fibre supplements aid in averting constipation that is a risk element.
• Reducing or halting particular food items or drinks like coffee.
• Introducing some form of physical activity into daily routine.

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