Urinary incontinence
Definition
Urinary incontinence is the failure to retain the urine in the bladder.
There are various types of urinary incontinence urge incontinence, stress incontinence, overflow incontinence, functional incontinence, gross total incontinence and mixed incontinence
Alternative names
Uncontrollable urination, Loss of bladder control, Urination – uncontrollable, Incontinence- urinary
Causes, incidence and risk factors
Over hydration, dehydration, bladder irritation, caffeine, alcohol, certain medications, urinary tract infections, constipation, certain illnesses and injuries can cause urinary incontinence temporarily. Conditions that cause permanent urinary incontinence are changes with ageing, pregnancy and childbirth, prostatitis, interstitial cystitis (painful bladder syndrome), hysterectomy, cancer of urinary bladder, stones in urinary bladder, bladder spasm, enlarged prostate, prostate cancer, urinary obstruction, and disorders of nervous system.
Older age, being woman, vascular diseases, high impact sports, smoking, obesity, kidney diseases and diabetes are the risk factors for urinary incontinence.
Symptoms
There are different symptoms depending on the type of incontinence. In stress incontinence there is leakage of urine by simple sneezing, coughing or laughing. In urge incontinence there is an urge to urinate but there is loss of urine before he patient reaches the toilet. In overactive bladder there is a leakage and then there is strong urge to urinate. In general, there is unintentional loss of urine, urgency to pass the urine, frequent urination, leakage of urine and vague, sporadic, weak flow of urine.
Signs and tests
The condition is diagnosed by medical history, physical examination and laboratory tests. Urine analysis, urine culture, cytoscopy, urodynamic studies, uroflow, post void residual measurement, stress test, blood tests and ultrasound are the tests done for diagnosing urinary incontinence
Treatment
The treatment of urinary incontinence depends on the type and severity of the condition and the cause behind it. The treatments available are behavioral techniques, medications, devices and surgery. Generally the treatment is started with least invasive treatment such as behavioral therapy and it does not work then further treatments are used.
Behavioral therapy includes pelvic floor muscle (Kegel) exercise (to strengthen the pelvic floor muscles), bladder training, scheduled toilet trips and food and fluid control. Bladder training involves controlling the urine initially for 10 minutes after the urge to urinate. As the control is achieved then time to control is increased till the urination becomes regular (every two to four hours). In food and fluid management avoiding caffeine, alcohol, acidic foods and control over fluid intake helps in gaining control over urinary incontinence. Loosing weight is also helpful.
Medications used for the treatment of urinary incontinence are anticoligernic drugs (tolterodine, oxybutynin, solifenacin and derifenacin), antidepressant (imipramine), antibiotics and drug to strengthen the bladder muscles (bethanechol).
Pelvic floor muscles can be strengthen by electrical stimulation. It is mainly used for the treatment of stress and urge incontinence. But it may cause diarrhea, abdominal cramps and bleeding.
Urethral devices and pessaries are also used to treat urinary incontinence
When all the other treatments fail surgery is the option. There are various types of surgeries carried out to treat urinary incontinence.
If no treatment works then catheters, absorbent pads, diapers and protective garments can be used.
Expectations (Prognosis)
If the condition is detected and treated in time it can be controlled or treated.
Complications
Changes in activities, personal life and professional life; skin problems and urinary tract infections are the possible complications of urinary incontinence.
Calling your health care provide
If there are symptoms of urinary incontinence then one should take an appointment with the health care provider. But if the condition is more severe and one can not talk or walk, loss of control over bowel movements, confusion, unconsciousness, vision loss, weakness, numbness or lack of sensation in arms or legs then it should be considered as medical emergency.
Prevention
Avoiding bladder irritants, maintaining healthy weight, eating more fibers to avoid constipation, doing Kegel exercise and quitting smoking can prevent urinary incontinence.
Reference
Nih.gov, wikipedia.com, mayoclinic.com