Urinary Incontinence in Women

What is urinary incontinence?

Urinary incontinence is a condition presenting as leakage of urine from the bladder. It is an embarrassing condition and impairs the quality of life severely. Urinary incontinence is actually not a disease rather a symptom of underlying medical, surgical or physical problems. There are three main types of urinary incontinence namely, stress, urge and overflow incontinence.

Elderly people and women are more at risk of developing urinary incontinence. Apart from social problems urinary incontinence increases the chance of urinary tract infection and skin rashes. Treatment depends upon the cause and severity of the condition. Options are behavioral therapy, physical therapy like pelvic floor exercises, medication and surgery.

Types of Incontinence

The inability to hold urine due to strong urge or leakage of urine is the main symptom of urinary incontinence. Symptoms commonly depend upon the type of incontinence.

Stress incontinence

Occurs under increased pressure like during coughing, sneezing, laughing and lifting heavy weight. Usually women after childbearing or menopause suffer from this type of incontinence due to weakening of the sphincter muscles responsible to control the flow of urine from the bladder into the urethra. Men may also suffer from this type of incontinence after prostate surgery.

Urge incontinence

Occurs when there is sudden intense urge of urination and immediate passage of urine before giving the person time to reach the toilet. Urinary tract infections, Parkinson’s disease, stroke and trauma are the common causes.

Overflow incontinence

Constant dribbling from bladder occurs without any stress. Patients complain of the sensation of never having fully emptied the bladder. Injury to the nerves supplying the bladder, long standing diabetes, prostate gland problems in men are the common reasons

Functional incontinence

Occurring in elderly patients who are unable to reach the toilet timely due to some other disease like arthritis.

Total incontinence

Leads to continuous dribbling of urine from the bladder.

Causes of Incontinence

There are number of causes which can lead to urinary incontinence. Depending upon the cause it can be temporary or chronic.

Temporary incontinence may occur due to :

  • Alcoholism as alcohol is a bladder stimulant and diuretic.
  • Excessive intake of water.
  • Caffeinated beverages including tea, coffee and certain sodas.
  • Drugs like muscle relaxants, antihypertnsives and sedatives.
  • Urinary tract infection may lead to temporary incontinence along with high fever and burning sensation during urination.

Chronic urinary incontinence may arise with :

  • Pregnancy (hormonal change and bulky uterus give pressure on bladder) and following child birth due to weakening of pelvic floor muscles or injury to nerves controlling bladder movement.
  • Hysterectomy with trauma during surgical removal of uterus which lies close to bladder.
  • Aging.
  • Obstruction in the bladder or the urethra, the draining tube due to cancer and kidney stones.

Risk factors

  • Females
  • Aging
  • Co-existent diseases like diabetes, Parkinson’s disease
  • Obesity

Treatment

Treatment options include :

  • Behavioral therapy like bladder training, avoiding alcohol, smoking, caffeine or reducing weight may help.
  • Physical therapy like pelvic floor exercise (Kegel exercise) to strengthen the muscles regulating urine flow both in men and females.
  • Drugs :
    – Anticholinergics
    – Imipramine, an antidepressant may help in stress induced incontinence
    – Surgery to strengthen the bladder neck (bladder neck suspension), implantation of artificial urinary sphincter

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