What is Urinary Incontinence?
Urinary incontinence is the involuntary loss of urine. The person urinates when they don’t want to. In simple terms, they lose control over their bladder.
It is more common in women than in men. Almost 30-60% of women suffer from incontinence as compared to 1.5-5% of men.
Types of Urinary incontinence include:
- Stress incontinence: In stress incontinence, urine leaks when there’s pressure on the bladder, like in the case of coughing, sneezing, laughing, exercising or lifting anything heavy.
- Overflow incontinence: There is a constant dribbling of urine because the bladder doesn’t empty properly.
- Urge incontinence: There is a sudden need to urinate followed by loss of urine. Urination urge is often, mostly in the night. It can be caused by diabetes or an infection.
- Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
- Mixed incontinence: It is a mix of more than one type of incontinence.
How common is Urinary incontinence?
24 million people nationwide are said to be affected by the condition. It’s more common in people over 45 years of age.
What are the causes of Urinary incontinence?
- Aging: Aging of the bladder muscle can decrease the bladder’s capacity to store urine.
- Urinary Tract Infection: Infections can irritate the bladder, causing a strong urge to urinate and lose bladder control.
- Hard stool: The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency in both men and women.
- Menopause: After menopause, there is lesser production of estrogen, the hormone which keep the lining of the urethra and bladder healthy. Deterioration of these can increase incontinence.
- Surgeries: In women, the bladder and uterus are supported by many of the same muscles and ligaments. Surgery that involves a woman’s reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, causing incontinence.
- Neurological disorders: Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence. All these conditions can cause Detrusor Hyperreflexia, which causes involuntary bladder contractions. Multiple sclerosis or a spinal injury can also cause Detrusor Hyper Sphincter Dyssynergia, which is a disturbance of the normal synergistic coordination between bladder contraction and external urethral sphincter muscles relaxation during voiding.
- Enlarged prostate: Benign Prostatic Hyperplasia or BPH in older men, which is the enlargement of the prostate, can also cause incontinence.
- Prostate cancer: In men, it can be either because of untreated prostate cancer, or side effect of cancer treatment.
What are the risk factors of Urinary Incontinence?
The factors that increase your risk of urinary incontinence include:
- Age: With age, the urethra muscles lose their strength. It increases the chances of detrusor instability, wherein the detrusor muscle (the muscle responsible for contracting the bladder so that urine can be voided) contracts involuntarily and for no reason.
- Gender: Pregnancy, childbirth, menopause and hormonal changes make women more prone to incontinence than men.
- Weight: Extra weight creates pressure on the bladder, in turn making them weak and causing urine to leak out when you cough or sneeze.
- Smoking: Tobacco use makes you more prone to incontinence
- Family history: If a close family member has urge incontinence, you are more likely to develop it too.
- Other causes: Diabetes or neurological disease make increase your risk factor for urinary incontinence.
How is Urinary Incontinence diagnosed?
Doctor may diagnose incontinence in the following ways:
- Physical exam: The doctor may examine the vagina and check for pelvic floor muscle strength. They check the rectum in male patients to look for prostate enlargement.
- Urinalysis: Tests done to look for urine infections.
- Blood tests: To assess the kidney function.
- Postvoid residual (PVR) measurement: To assess how much urine is left in the bladder after urinating.
- Pelvic ultrasound: To look for abnormalities.
- Stress out: The doctor will ask the patient to apply sudden pressure while he looks for loss of urine.
- Urodynamic testing: This gives an understanding of how much pressure the bladder and urinary sphincter muscle can withstand.
- Cystogram: An X-ray is done to provide an image of the bladder.
- Cystoscopy: A thin tube with a lens at the end is inserted into the urethra to help the doctor view any abnormalities in the urinary tract.
How is Urinary Incontinence treated?
Treatment depends on various factors, like gender, age, type of incontinence, etc. Kegel exercises and yoga can help in treating stress incontinence. Also, keeping a toilet diary and delaying urination is suggested to control the urge.
Few other treatment paths can also be taken:
- Topical treatment: Topical estrogen in women and an antidepressant in men can be provided to lessen the symptoms. Anticholinergics can also calm an overactive bladder but any medicine should be only taken after speaking to a doctor.
- Medical devices: A urinary catheter may be used to treat severe cases. A tube goes from the bladder, through the urethra, out of the body into a bag which collects urine. In women, urethral inserts, pessary (ring inserted into a vagina and worn all day, or bulking agents to keep the urethra closed may also be used.
- Surgery: An Artificial sphincter to control the flow of urine, or a sling procedure where a mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out, can be done depending on various factors. Women who are planning to have children should speak to the doctor before opting for a surgery.
What are the complications of Urinary Incontinence?
Complications may include:
- Skin issues: People with urinary incontinence are likely to have skin sores, rashes, and infections because the skin is wet or damp most of the time
- UTIs: Incontinence increases the chances of a urinary tract 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.
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