urology Urinary Incontinence

Urinary Incontinence is the involuntary leakage of urine where the person urinates even when she does not want to. The patient suffers from a weakened control over the urinary sphincter or even a total loss. This problem is quite common and affects a lot of people. It is much more common among women than men. The person cannot prevent urine from leaking out. Urinary incontinence is classified as follows.

  1. Stress incontinence - Stress incontinence is one of the most common kinds of urinary incontinence, especially in multiparous mothers and menopausal women. 'Stress' relates to increased physical intra abdominal pressure like heavy weight lifting, sneezing, coughing or laughing or even Climbing stairs when the bladder and the muscles in urinary control are placed under sudden extra pressure. Then urine leaks out. Quantity of leak varies from few drops to copious urine leak. This happens due to loss of support to pelvic floor and weakness of the urinary spincter.
  2. Urge incontinence - . It is the second most common type where there is a sudden and involuntary contraction of the bladder wall that causes an urge to urinate which cannot be stopped. The person gets urgency to pass urine, but before he reaches the toilet some urine leaks out.. This might be caused by
    • UTI
    • Prostate enlargement.
    • Neurogenic bladder
    • Over active bladder
    • Interstitial cystitis.
    • Small capacity bladder
  3. Mixed incontinence - The symptoms of both stress and urge incontinence would be present
  4. Overflow incontinence - Common in men with prostate gland problem., the bladder is full and cannot hold any more urine. What ever more urine comming in to bladder over flows and leak as dribbling. Patient mighr feel the pain or
  5. Functional incontinence - The person would know there is a need to urinate but would not be able to make it to the bathroom in time due to problems in mobility. The common causes include:
    • dementia
    • poor dexterity
    • poor eyesight or mobility
    • confusion
    • anxiety, depression
  6. Total incontinence - The person leaks urine continuously or has periodic uncontrollable leakage of urine. There might be a congenital problem, a hole (fistula) in the bladder and the vagina or an injury to the spinal cord or injury to the urinary spincter.

What are the causes of the different types of urinary incontinence?

The causes and types of incontinence are closely linked:

1. Stress incontinence:

  • hysterectomy and other surgical procedures
  • obesity
  • age
  • menopause
  • pregnancy and childbirth

2. Urge incontinence:

  • enlarged prostate
  • neurological conditions, including stroke, multiple sclerosis and the Parkinson's disease
  • cystitis or an inflammation of the lining of the bladder

3. Overflow incontinence:

  • urinary stones
  • a tumour pressing against the bladder
  • an enlarged prostate gland
  • constipation
  • Post Surgeries like hernia, hip replacement, spinal surgeries
  • Prolonged labor 

4. Total incontinence:

  • a spinal cord injury impairing nerve signals between the brain and the bladder
  • an anatomical defect from birth
  • a fistula, a tube or channel developing between the bladder and a nearby area
  • Trauma or surgical damage to the sphincter.

5. Other causes include:

  • alcohol
  • medications like , diuretics, sedatives, sleeping tablets or muscle relaxants
  • urinary tract infections

What are the risk factors in urinary incontinence?

The risk factors include:

  • smoking
  • obesity
  • old age
  • diseases or conditions like kidney disease, diabetes, neurological problems or a spinal cord injury
  • diseases in the prostate

How can the condition be treated?

The different treatment methods include:

  • Bladder training - double voiding, delaying the event and a toilet timetable
  • Medications
  • Medical devices like pessary, urethral inserts, botox, radiofrequency therapy, sacral nerve stimulator and bulking agents
  • Surgery

Urinary incontinence can be treated. Do not Stay in isolation and suffer. Do come and discuss the problem with your physician.

Authored By : Dr. Mahendra Jain

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