Urinary Incontinence

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Urinary incontinence is a condition in which you are unable to control urination, causing leakage at the wrong place and time. It can be a common and distressing problem, which may have a profound impact on quality of life. It is a problem which often times goes unreported to physicians, as many find it embarrassing to bring up.

The severity of urinary incontinence may range from occasionally leaking urine when you cough or sneeze, to having a sudden and strong urge to urinate that you don't get to a toilet in time. If urinary incontinence affects your daily activities, do not hesitate to see your doctor. In many cases, simple lifestyle changes or medical treatment can go a long way to easing the problem.

Causes Urinary Incontinence

Incontinence occurs if your bladder muscles contract suddenly, or the sphincter muscles are not strong enough to hold your urine back. Urinary incontinence and it's causes may be classified according to the following:

1. Stress Incontinence

Stress incontinence is usually related to weak pelvic floor muscles. It presents as the loss of small amounts of urine associated with coughing, laughing or sneezing, or other movements that increase intra-abdominal pressure and thus increase pressures on the bladder. The outlet of the bladder is usually held closed by the fascia of the pelvic floor. If this support is insufficient, the urethra can move downward at times of increased abdominal pressure, allowing urine to pass involuntarily.

In women, physical changes resulting from pregnancy, childbirth, and menopause often contribute to stress incontinence. In men, stress incontinence is uncommon, except as a post-surgical complication following prostatectomy.

2. Urge Incontinence

Urge incontinence is caused mainly by involuntary and inappropriate contractions of the detrusor muscle (the muscles of the bladder). This in turn may be caused by factors that irritate the bladder (such as cystitis or bladder stones), or a defective Central Nervous System inhibitory response.

With urge incontinence, you leak urine because the bladder muscles contract at the wrong times. Often these contractions occur no matter how much urine is in the bladder.

3. Overflow Incontinence

Overflow incontinence occurs when the bladder is very full, but is unable to empty, resulting in the involuntary leakage of urine. Weak bladder muscles, resulting in incomplete emptying of the bladder, or a blocked urethra can cause this type of incontinence. Overflow incontinence may also be a side-effect of certain medications.

Autonomic neuropathy from diabetes mellitus or other diseases affecting the nerves (e.g. multiple sclerosis or strokes) can decrease neural signals from the bladder (resulting in overfilling) and may also cause weakened bladder contractions (allowing for urinary retention). In men, benign prostatic hyperplasia (BPH) may block the bladder outlet causing overflow incontinence. In women, fibroids or ovarian tumors may sometimes press down on the bladder outlet, causing obstruction.

Diagnosis of Urinary Incontinence

The diagnosis of urinary incontinence is made via a well-taken history and physical examination of the abdomen and rectum. Women will also require a pelvic exam. There may also be a need for a neurological examination to determine if there may be a neurological cause for your incontinence.

Diagnosis Urinary Incontinence
Your doctor may perform some of the following tests:

• Cystoscopy - to look inside the bladder

• Pelvic or abdominal ultrasound

• Post-void residual volume measurement

• Urinalysis or urine culture to rule out infections of the urinary tract

• Urinary stress test (you stand with a full bladder and cough)

• Urodynamic studies (which measure pressure and urine flow)

• X-rays

Treatment of Urinary Incontinence

The choice of treatment will depend on the cause of urinary incontinence, how severe the symptoms are, and how much they interfere with your lifestyle.

1. For Stress Incontinence:

1. For Stress Incontinence:

NON-SURGICAL TREATMENTS:

• Bladder Retraining & Pelvic Floor Exercises

One of the most common treatment recommendations includes exercising the muscles of the pelvis. These include Kegel exercises which help strengthen or retain pelvic floor muscles and sphincter muscles, thus reducing stress leakage. Patients younger than 60 years old typically benefit the most from these exercises. The patient should do at least 24 daily contractions for at least 6 weeks. If done correctly and diligently, it has been shown to improve the quality of life of at least 40-50% of women with urinary stress incontinence.

• Vaginal Devices

Ring pessaries may be inserted into the vagina to help reposition the urethra, leading to reduced stress leakage.

SURGICAL TREATMENTS:

• Bladder Repositioning

Most stress incontinence in women results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Retropubic approaches include the Burch colposuspension and the Marshall-Marchetti-Krantz (MMK) procedure. The aim of both these procedures is to suspend and stabilize the bladder neck. This allows normal pressure transmission during periods of increased intra-abdominal pressure thus restoring continence.

• Sling Procedures

This procedure involves placing a sling, which consists of a ribbon-like natural tissue or synthetic mesh material, under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra. Common methods used include the tension-free transvaginal (TVT) sling procedure and the transobturator tape (TOT) sling procedure.

2. Urge Incontinence & Overactive Bladder

2. Urge Incontinence & Overactive Bladder

• Medication:

Anticholinergic drugs are used in the treatment of incontinence, and they work by helping to block the nerve signals that cause frequent urination and urgency. The main problem with these group of drugs is the side effects of mouth and throat dryness. Also, patients with glaucoma may not be able to take these drugs.

• Removal of Irritants:

Transient urge incontinence may be caused by factors which irritate the bladder, such as a bladder stone or infection. Treatment of these conditions would improve the incontinence. Other measures like reducing the intake of potential diuretics, such as coffee and tea, can also help relieve symptoms.

• Time Voiding:

In time voiding, patients fills in a chart of voiding and leaking. From the patterns on the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak.

• Injections of Overactive Bladder:

Those who are unable to tolerate anticholinergic medication may be offered botulinum toxin injections into the bladder wall. These botox injections relax the detrusor muscles of the bladder, reducing its overactivity.

• Neuromodulation:

Neuromodulation involves electrically stimulating either the sacral or peripheral nerves to modify the behavior of the bladder. It is an option for patients who either cannot tolerate medications or fail therapy. However, therapy is expensive, involving surgery with possible need for revisions and replacements.

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The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.