Authored By: Dr. K. Shilpi Reddy

HOD & Sr. Consultant Obstetrician & Gynaecologist,

High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)


Urinary incontinence is the involuntary loss of urine. Urinary incontinence may be a temporary condition that results from an underlying medical condition.The severity ranges from occasionally leaking urine when you cough or sneeze to having an intense urge to urinate that you don’t get to a toilet in time. Though it occurs more frequently as people get older, urinary incontinence isn’t an inevitable consequence of aging.

SYMPTOMS

Based on symptoms there are following types of incontinence-

  • Stress incontinence. Urine leaks when when there is pressure on bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
  • Urge incontinence. It is a sudden, intense urge to urinate leading to involuntary loss of urine. It can be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
  • Overflow incontinence. Its frequent or constant dribbling of urine due to incomplete emptying of bladder.
  • Functional incontinence. A physical or mental impairment leads to inability to reach toilet in time. 
  • Mixed incontinence. Presence of more than one type of urinary incontinence.

CAUSES

Urinary incontinence isn’t a disease, it’s a symptom. It can be caused by routine habits, underlying medical conditions or physical problems.

Temporary urinary incontinence

Certain drinks, foods and medications acts as diuretics -They include:

  • Alcohol
  • Caffeine
  • Carbonated drinks and sparkling water
  • Artificial sweeteners
  • Chocolate
  • Chili peppers
  • Foods high in spice, sugar or acid especially citrus fruits
  • Heart and blood pressure medications, sedatives, and muscle relaxants
  • Large doses of vitamin C

Urinary incontinence may also be caused by medical condition those can be treated easily such as:

  • Urinary tract infection. Infections irritates urinary bladder, leading to strong urges to urinate, and occasionally incontinence.
  • Constipation. The rectum is located near the bladder and shares similar nerve supply. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency.

Persistent urinary incontinence

Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:

  • Pregnancy. Hormonal changes induced by pregnancy and the increased weight of the fetus can lead to stress incontinence.
  • Childbirth. Muscles supporting bladder and bladder nerves gets damaged in the process of vaginal birth.
  • Changes with age. Aging of the bladder muscle leads to decrease in storage capacity of bladder. Also, frequency of involuntary bladder contractions increases as you get older.
  • Menopause. After menopause deficiency of estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
  • Hysterectomy. In women, the supporting muscles and ligaments are same for bladder and uterus. Any surgery that involves a woman’s reproductive system, may damage the supporting pelvic floor muscles, which can lead to incontinence.
  • Obstruction. A tumor  along urinary tract blocks the normal flow of urine, leading to overflow incontinence. Urinary stones or stone-like masses that form in the bladder — sometimes cause urine leakage.
  • Neurological disorders. Parkinson’s disease, Multiple sclerosis, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

DIAGNOSIS

Thorough history and physical examination. Simple maneuver like coughing can demonstrate incontinence.

  • Urinalysis- is done to look for signs of infection, traces of blood or other abnormalities in urine.
  • Bladder diary. For several days a record has to be maintained mentioning how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.
  • Post-void residual measurement.

 If further information is needed tests, such as urodynamic testing and pelvic ultrasound might be recommended . These tests are usually recommeded prior to surgery.

TREATMENT

Specific treatment for urinary incontinence will be determined based on:

  • Your age, overall health and medical history
  • Type of incontinence and extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease

Treatment may include:

  • Behavioral therapies:
    • Bladder training: Trains people to resist the urge to void and gradually increase the intervals between voiding.
    • Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.
  • Diet modifications: Removing bladder irritants, such as caffeine, alcohol and citrus fruits from diet.
  • Pelvic muscle rehabilitation (to improve pelvic muscle functioning)
    • Kegel exercises: can improve, and even prevent, urinary incontinence.
    • Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
    • Vaginal weight training: Small weights are held within the vagina which leads to strenghtening the vaginal muscles.
    • Pelvic floor electrical stimulation: Mild electrical pulses are given to pelvic floor muscles which stimulate muscle contractions.
  • Medication :
    • Anticholinergic medications
    • Vaginal estrogen
  • Pessary (is worn inside the vagina to prevent leakage)
  • Office procedure
    • Botox injections into bladder
    • Urethral bulking agents
    • Peripheral nerve stimulation
  • Surgery 
    • Slings (can be synthetic or natural tissue)
    • Bladder suspension
    • Peripheral nerve stimulation

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