Urinary Incontinence: What you need to know

Urinary incontinence is the persistent urinary leakage. It means that a person urinates when he doesn’t want to. Command over the sphincter of the urine either gets lost or weakened.

Urinary incontinence is a serious issue affecting a great many people.

According to the American Urological Association, urinary incontinence is reported by one-quarter to one-third of men and women in the USA.

Urinary incontinence is more common in women than in men. An approximate 30% of females aged 30-60 are thought to suffer from it, compared with 1.5%-5% of males.

Fast facts on urinary incontinence

Here are some key points about urinary incontinence. More detail is in the main article.

  • Urinary incontinence is more common in females than in males.
  • There are a number of reasons why urinary incontinence can occur.
  • Obesity and smoking are both risk factors for urinary incontinence.

What is urinary incontinence?

Urinary incontinence is a common problem.
Urinary incontinence is a common problem.

Urinary incontinence is when an person is unable to prevent urine from leaking out.

It can be attributed to stress factors such as coughing, it can happen during and after pregnancy, and conditions such as obesity are more common.

Through age the odds of that occurring increase.

Bladder control and pelvic floor exercises, or Kegel, can help prevent or reduce it.

Treatment

Treatment may depend on many factors, such as form of incontinence, age of the patient, general health and mental status.

Stress incontinence

Pelvic floor exercises, also known as Kegel exercises, help reinforce the muscles of the urinary sphincter and pelvic floor-the muscles that help control urination.

Bladder training

  • Delaying the event: The aim is to control urge. The patient learns how to delay urination whenever there is an urge to do so.
  • Double voiding: This involves urinating, then waiting for a couple of minutes, then urinating again.
  • Toilet timetable: The person schedules bathroom at set times during the day, for example, every 2 hours.

Bladder training slowly helps the patient regain control of their bladder.

Medications for urinary

Typically this is in combination with other methods or activities while medicine is being used.

For treating urinary incontinence the following drugs are prescribed:

  • Anticholinergics calm overactive bladders and may help patients with urge incontinence.
  • Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
  • Imipramine (Tofranil) is a tricyclic antidepressant.

Medical devices

The following medical devices are designed for females.

  • Urethral inserts: A woman inserts the device before activity and takes it out when she wants to urinate.
  • Pessary: A rigid ring inserted into the vagina and worn all day. It helps hold the bladder up and prevent leakage.
  • Radiofrequency therapy: Tissue in the lower urinary tract is heated. When it heals, it is usually firmer, often resulting in better urinary control.
  • Botox (botulinum toxin type A): Injected into the bladder muscle, this can help those with an overactive bladder.
  • Bulking agents: Injected into tissue around the urethra, these help keep the urethra closed.
  • Sacral nerve stimulator: This is implanted under the skin of the buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping bladder control.

Surgery

When other therapies don’t work, surgery is an alternative. Women who intend to have children will speak with a doctor about surgical choices before making the decision.

  • Sling procedures: A mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out.
  • Colposuspension: Lifting the bladder neck can help relieve stress incontinence.
  • Artificial sphincter: An artificial sphincter, or valve, may be inserted to control the flow of urine from the bladder into the urethra.

Other options

Urinary Catheter: A tube that goes from the bladder, through the urethra, out of the body into a bag which collects urine.

Absorbent pads: A wide range of absorbent pads is available to purchase at pharmacies and supermarkets.

Causes

The causes and the type of incontinence are closely linked.

Stress incontinence

Factors include:

  • pregnancy and childbirth
  • menopause, as falling estrogen can make the muscles weaker
  • hysterectomy and some other surgical procedures
  • age
  • obesity

Urge incontinence

The following causes of urge incontinence have been identified:

  • cystitis, an inflammation of the lining of the bladder
  • neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson’s disease
  • enlarged prostate, which can cause the bladder to drop, and the urethra to become irritated

Overflow incontinence

It occurs when the bladder is obstructed or blocked. The following can trigger blockage:

  • an enlarged prostate gland
  • tumor pressing against the bladder
  • urinary stones
  • constipation
  • urinary incontinence surgery which went too far

Total incontinence

This can result from:

  • an anatomical defect present from birth
  • a spinal cord injury that impairs the nerve signals between the brain and the bladder
  • a fistula, when a tube or channel develops between the bladder and a nearby area, usually the vagina

Other causes:

These include:

  • some medications, especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants
  • alcohol
  • urinary tract infections (UTIs)

Types

The type of urinary incontinence is normally linked to the cause.

They include:

  • Stress incontinence: Urine leaks out while coughing, laughing, or doing some activity, such as running or jumping
  • Urge incontinence: There is a sudden and intense urge to urinate, and urine leaks at the same time or just after.
  • Overflow incontinence: The inability to empty the bladder completely can result in leaking
  • Total incontinence: The bladder cannot store urine
  • Functional incontinence: Urine escapes because a person cannot reach the bathroom in time, possibly due to a mobility issue.
  • Mixed incontinence: A combination of types

Symptoms

The principal symptom is the spontaneous release (leakage) of urine. When and how this happens depends on what sort of urinary incontinence is involved.

Stress incontinence

This is the most common type of urinary incontinence, particularly among women who gave birth or went through menopause.

In this case “stress” applies not to emotional stress, but to physical strain. The person may urinate involuntarily when the bladder and muscles involved in urinary control are put under sudden extra pressure.

The following actions can trigger stress incontinence:

  • coughing, sneezing, or laughing
  • heavy lifting
  • exercise

Urge incontinence

Often known as the “overactive bladder” or reflex incontinence, this is the second most common form of urinary incontinence. There is a sudden, involuntary contraction of the bladder’s muscle wall which triggers urination, which can not be prevented.

When the urge to urinate arrives, the person has a very short time to release the urine, no matter what they try to do.

The urge to urinate may be caused by:

  • a sudden change in position
  • the sound of running water
  • sex, especially during orgasm

Bladder muscles may activate involuntarily due to damage to the bladder nerves, the nervous system, or to the muscles themselves.

Overflow incontinence

This is more common in men with problems with the prostate gland, a weakened bladder or a blocked urethra. The bladder can be obstructed by an swollen prostate gland.

The bladder can not hold as much urine as the body does, or the bladder can not completely empty, causing minor amounts of urinary leakage.

Patients may also need to urinate regularly, and can experience “dribbling” or a persistent urine leakage from the urethra.

Mixed incontinence

There will be symptoms of both stress and urge incontinence.

Functional incontinence

With functional incontinence, the person knows that urinating needs to be done, but due to a mobility problem, he can not make it to the bathroom in time.

Common causes of functional incontinence include:

  • confusion
  • dementia
  • poor eyesight or mobility
  • poor dexterity, making it hard to cannot unbutton the pants
  • depressionanxiety, or anger can lead to an unwillingness to use the bathroom

Functional incontinence among elderly people is more widespread, and is frequent in nursing homes.

Total incontinence

It either means that the person regularly leaks urine, or that he or she has occasional uncontrollable leakage of significant quantities of urine.

The patient may have a congenital condition (born with a defect), the spinal cord or urinary system may get damaged, or there may be a hole (fistula) between the bladder and, for example, the vagina.

Risk factors

The following are risk factors linked to urinary incontinence:

  • Obesity: This puts extra pressure on the bladder and surrounding muscles. It weakens the muscles, making leakage more likely when the person sneezes or coughs.
  • Smoking: This can lead to a chronic cough, which may result in episodes of incontinence.
  • Gender: Women have a higher chance of experiencing stress incontinence than men, especially if they have had children.
  • Old age: The muscles in the bladder and urethra weaken with age.
  • Some diseases and conditions: Diabetes, kidney disease, spinal cord injury, and neurologic diseases, for example, a stroke, increase the risk.
  • Prostate disease: Incontinence may present after prostate surgery or radiation therapy.

Diagnosis

Ways to diagnose urinary incontinence include:

  • A bladder diary: The person records how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
  • Physical exam: The doctor may examine the vagina and check the strength of the pelvic floor muscles. They may examine the rectum of a male patient, to determine whether the prostate gland is enlarged.
  • Urinalysis: Tests are carried out for signs of infection and abnormalities.
  • Blood test: This can assess kidney function.
  • Postvoid residual (PVR) measurement: This assesses how much urine is left in the bladder after urinating.
  • Pelvic ultrasound: Provides an image and may help detect any abnormalities.
  • Stress test: The patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
  • Urodynamic testing: This determines how much pressure the bladder and urinary sphincter muscle can withstand.
  • Cystogram: An X-ray procedure provide an image of the bladder.
  • Cystoscopy: A thin tube with a lens at the end is inserted into the urethra. The doctor can view any abnormalities in the urinary tract.

Complications

Often the inability to maintain urine may cause pain, humiliation, and sometimes other physical problems.

These include:

  • Skin problems – a person with urinary incontinence is more likely to have skin sores, rashes, and infections because the skin is wet or damp most of the time. This is bad for wound healing and also promotes fungal infections.
  • Urinary tract infections – long-term use of a urinary catheter significantly increases the risk of infection.
  • Prolapse – part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. This is usually caused by weakened pelvic floor muscles.

Embarrassment can cause people to socially withdraw and this can lead to depression. Anyone dealing with urinary incontinence should see a physician, as support may be available.

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