Urinary Incontinence means the loss of bladder control or uncontrollable urinary leakage. It occurs when urine leaks before one gets to the bathroom. It can happen when women cough or laugh, or some drops of urine are lost, in some. In others, there is a feeling of a sudden urge to urinate without having absolute control of it. It can, in fact, get so bad that urine can be lost during sexual intercourse, causing significant emotional distress.
Urinary incontinence can affect the emotional, psychological and social lives of men and women. People suffering from this condition are often afraid of doing normal daily activities, do not want to be so far from a toilet and this causes limitations in their way of life. According to statistics, about 1/4 to 1/3 men and women in the United States are suffering from urinary incontinence - depicting that approximately 33 million Americans have an overactive bladder which represents symptoms of urinary urgency and frequency. The risk increases with the number of childbirth, especially in vaginal delivery.
Urinary incontinence occurs when muscles and nerves that help to control micturition are affected in a way or the other. Usually, the urine stored in the bladder leaves the body through the urethra, and there is a contraction of the bladder to force the urine out through the urethra while, simultaneously, there is a relaxation of the muscles around the urethra to allow for the passage of urine out of the body. Incontinence happens if and when there is a contraction of the bladder muscles, or the muscles of the sphincter are weak to hold urine back.
Urinary incontinence is more prevalent in women than in men, and this is a result of pelvic floor muscle weakening by pregnancy in women. Other conditions that provoke urinary incontinence in women include childbirth and menopause. Prostate cancer or prostate inflammation are the most common causes of urinary incontinence in men. Brain injury, congenital disabilities, stroke, diabetes, multiple sclerosis, and other chronic diseases that occur during old ages can cause urinary incontinence in both males and females. Lifestyle habits such as caffeine and alcohol use, certain medications and being overweight are also predisposing factors for urinary incontinence in men and women.
Types of Urinary Incontinence
- Stress incontinence
- Urge incontinence
- Functional incontinence
- Overflow incontinence
- Mixed incontinence
- Transient incontinence
Stress incontinence is caused by strenuous activities such as coughing, sneezing, laughing and other forms of physical activities that exert pressure on the bladder. The most common causes of stress incontinence are childbirth, weight gain, and other conditions that cause the pelvic floor muscles to stretch. The inability of these tissues to adequately support the bladder causes it to drop down and push against the vagina. Hence, it is not possible to tighten the muscles that close the urethra, and urine gets to leak out due to the extra pressure the bladder is being subjected to.
The urge type of incontinence is characterized by sudden and intense urge to urinate, followed immediately by the loss of urine (involuntarily). Patients may, therefore, be required to urinate often, especially all through the night. Infections or more severe conditions as in diabetes might be responsible for this.
Overflow incontinence is common with men that have prostate gland problems - their bladder is damaged, or their urethra is blocked. An enlarged prostate gland can press upon of the bladder, and as a result of this, the bladder cannot efficiently hold as much urine as the body is making and consequently, cannot empty totally, causing some small amounts of leakage urine.
The mixed form of incontinence is a situation where the patient is suffering from several types of urinary incontinence, i.e., more than one at the same time.
Functional incontinence is characterized by the ability to discern when they have to discharge urine but cannot make it down to the restroom on time because of some mobility issues. Functional incontinence can be caused by confusion, dementia, poor eyesight, reduced mobility, poor dexterity, depression, anger, anxiety, among others.
Urinary incontinence is diagnosed via physical examination, ultrasound, urodynamic testing and functional tests such as cystoscopy, urinalysis, and a bladder stress test. A medical history and anamnesis are also crucial in making a preliminary diagnosis.
Urinary incontinence is not a disease; instead, it can be a symptom of some conditions or the result of individual events that the patient has experienced, so when a patient with the clinical manifestations of incontinence will undergo other tests so that the doctor can discover the underlying cause.
Urinary incontinence is treated in many ways, and the doctor decides which is best for every patient depending on the type of incontinence they have. A combination of treatment might also be necessary depending on the severity of incontinence. The treatment can be in the form of behavioral therapies, medicines for bladder control, devices, nerve stimulation, biofeedback, surgery, and catheterization. The behavioral therapies involve pelvic muscle exercises (Kegel exercises), double voiding, bladder training, fluid intake management, weight loss, dietary changes and quit smoking. It is necessary to cut down on alcohol and drinks; especially the ones that have caffeine content (tea, coffee, cola) as these drinks can prompt the kidney to produce more urine that gets the bladder irritated. The limit recommended for alcohol consumption is 14 units per week. One unit of alcohol is about 25 ml of spirits.
Some medical devices are appropriate for treating urinary incontinence in females such as urethral inserts, pessary, radiofrequency therapy, botox (botulinum toxin type A), bulking agents, sacral nerve stimulator. Surgical treatment is usually indicated if other conservative therapies have been ineffective. Surgeries for urinary incontinence are sling procedures, colposuspension, artificial urinary sphincter, urinary catheter, and absorbent pads.
If you notice symptoms of urinary incontinence, endeavor to visit your health care provider and have all the necessary tests done. The earlier it’s treated and controlled, the better.