Urinary Incontinence

Urinary incontinence is leakage of urine while you cough or sneeze or sudden urge to urinate. It is a common problem for many people causing embarrassment in public places. You may not get a toilet when you have sudden urge to urinate. Incontinence is caused by weakened nerves on the urinary tract and can be treated easily through medications. Though it looks like a simple problem, it can cause discomfort for many people, especially women.

Facts on Incontinence :

  • As you grow old, you are more likely to develop incontinence
  • Women are more in number having incontinence than men
  • It is reported that out of 10 women (middle aged) 5-6 women would have incontinence
  • Out of 10 men (old age) 1-4 would develop incontinence
  • On the basis of ethnic group white women have increased chance to have urinary incontinence when compared with Asian women
  • Urinary incontinence can be easily treated by medications and by certain pelvic floor exercises

Types and Causes :

Stress incontinence and urge incontinence are the two major types of incontinence.

  • Stress Incontinence :

It occurs due to the condition of weakened pelvic muscles. This happens during childbirth and due to excess of weight. Actually, it is the pelvic floor muscles that give support to bladder and when it becomes weak due to the above reasons, it pushes the bladder down exerting great pressure. Tightening of pelvic muscles is not possible at this stage. This leads to non-closure of urethra fully causing leakage of urine. Incontinence occurs when the person coughs, or sneezes or does strenuous exercises. Stress incontinence is common among elderly women after childbirth.

  • Urge Incontinence :

This type of incontinence occurs when the muscles of bladder contracts involuntarily to push out the urine from the bladder. Exact reason for this type of incontinence is not known. Sudden stress, irritation of bladder and certain type of diseases like Parkinson’s syndrome can cause urge incontinence. For some people, overactive bladder can cause this problem. When the nerves that control the urinary tract becomes weak or gets damaged it can cause incontinence.

Urinary Incontinence

Symptoms :

Sudden leakage of urine while coughing, sneezing or laughing is the symptom of stress incontinence. When the bladder is not full also, incontinence can occur. In the case of urge incontinence, the person may develop a sudden urge to pass urine and in the attempt of searching the toilet, he/she may wet his/her clothes. Urination can occur throughout the night also. This gets worse if you are diabetic or have neurological disorder. Some people will have frequent dribbling of urine since the bladder is not emptied fully.

Causes Of Urinary Incontinence :

For some people, incontinence is caused due to the intake of certain foods like caffeine, alcohol, carbonated drinks and using artificial sweeteners. Certain medications like diuretics (given for managing blood pressure) and muscle relaxants and certain medical conditions like urinary tract infection can cause incontinence. Due to certain conditions like pregnancy or childbirth, continence can occur since increased weight and damaged bladder nerves cab contribute for incontinence. As one grows old, bladder may get weak unable to store urine properly. Women can develop incontinence during menopause and after hysterectomy.

Who are at risk?

Old age, being women and being obese increases the risk of developing incontinence. Continence can cause complications like urinary tract infection in rare cases.

Tests :

After listening to your symptoms, your doctor may order for urine test to rule out the possibility of infection. He may ask you to maintain bladder diary by noting down how much volume you drink and how much urine you produce. If required, he may order for further testing cystoscopy and urodynamic test to measure the strength of bladder.

Urinary Incontinence Treatment :

Your doctor will find out the root cause of incontinence before starting any treatment. In many cases, certain lifestyle changes and behavior techniques might improve your symptoms. Medications are given only if this method does not work.

Behavior Modification :

  • You can delay passing urine gradually by holding it for few more minutes after you have an urge. This would give enough strength to your bladder to hold the urine for lengthy time.
  • Double voiding is another method in which you will have to empty the bladder frequently not waiting for urge.
  • Making scheduled trips to toilet can reduce the chance of wetting clothes.
  • Make changes in your diet by cutting down alcohol and caffeine. Do regular exercises and reduce your weight.

Kegel Exercise :

You can learn certain types of pelvic exercises to strengthen the pelvic muscles. This type of Kegel exercise is effective to manage incontinence without any medication. You can practice this by tightening the pelvic muscles by contracting the pelvic region to stop urinating. Hold on for few seconds and now relax.

Do this technique for contracting the pelvic muscles for at least 10 seconds. Repeat this simple exercise several times a day. This would eventually strengthen your muscles helping you to hold the urine for more time. Some experts recommend electrical stimulation method in which electrodes are inserted into the rectum/vagina for strengthening the pelvic muscles.

Urinary Incontinence

Medications :

  • Anticholinergics like Ditropan XL, detrol or enablex are given to control the overactive bladder. Mirabegron would relax the muscles of your bladder to help holding urine for long.
  • Alpha blockers like flomax, uroxatral and doxazosin are prescribed for men with prostate problems.
  • Certain medical devices are inserted directly in the urethra (for women) to prevent incontinence.
  • Taking a shot of Botox injection can help to control the overactive bladder.

Surgery :

This is the last option if other methods are not working. Several methods of surgery like sling procedure (a sling is created to close the urethra), bladder neck suspension (to provide additional support to urethra) and mixed approaches.

Pads/Catheters :

  • Absorbent pads can be used along with normal underwear to prevent wetting of clothes.
  • A catheter can be inserted into the urethra directly to empty the bladder properly fully.
  • Quit smoking and drinking.
  • Manage to stay on healthy weight.
  • Do regular exercises.

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