Urinary Incontinence

What is urinary incontinence?

Involuntary leakage of urine is defined as urinary incontinence or enuresis. It must not be confused with bedwetting (nocturnal enuresis) that occurs when a person is asleep. Most often, it is a socially embarrassing situation that affects the patient’s confidence and quality of life. Urinary incontinence can be a temporary problem but most cases are permanent and gets progressively worse over time. Depending on the type of urinary incontinence, the treatment options may vary.

What are the types of incontinence?

  • In obese people and pregnant women, increased pressure on the bladder leads to stress incontinence.
  • People with neurological disorders may experience involuntary loss of bladder control once the urge to urinate arises (urge incontinence).
  • In elderly or disabled subjects, a physical or mental impairment could prevent them reaching the toilet in time (functional incontinence).
  • Total incontinence is a case where there is a continuous leakage of urine and may underlie a serious ailment requiring immediate attention.

What are the symptoms?

The urge to urinate occurs when more than 250 to 300ml of urine gets collected in the urinary bladder. The elimination of urine is mediated by the coordinated action of the muscles of the bladder and urethra, under the control of the nervous system. Urinary incontinence is a sign of weakening of the bladder and urethra muscles or damage to the nerves innervating these organs.

People experiencing urinary incontinence, usually have dribbles of urine on their undergarments or may wet their clothes. The dampness caused by urine leakage can increase the risk of skin rashes and urinary tract infections. In cases of urinary tract infection, the incontinence is associated with a burning sensation while passing out foul-smelling urine.

What causes urinary incontinence?

Urinary incontinence can occur temporarily after consumption of excessive fluids, especially alcohol and caffeinated beverages such as tea and coffee. Caffeine is a diuretic which triggers the faster elimination of urine. A similar effect is produced by the diuretic medications prescribed to patients of cardiovascular diseases. However, most people are able to find a suitable facility before urinating.

The accumulation of hard stools in constipation increases the pressure on bladder, stimulating the nerves and thus, causing urinary incontinence. In women, pregnancy, childbirth and menopause are the three major causes of urinary incontinence. While pregnancy and childbirth increase the pressure on the bladder and associated nerves, urinary incontinence during and post-menopause is attributed to the drop in estrogen levels.

Men who have medical conditions affecting the prostate gland are more likely to have urinary incontinence. These conditions include inflammation (prostatis) and tumors of the prostate gland. Aging, stress, cigarette smoking, kidney diseases, neurological diseases such as multiple sclerosis or Parkinson’s disease and tumors of the bladder are other causative factors.

How is urinary incontinence treated?

A person’s bladder diary providing an assessment of the fluid input-output balance helps to diagnose urinary incontinence. Subsequently, the underlying cause is determined by blood and urine tests. Urodynamic testing helps to measure the strength of the bladder muscles. Obstructions to urine flow, if any, are identified by post-void residual measurement, pelvic ultrasound and cystograms.

Medications, commonly used to treat urinary incontinence include :

  • Anti-cholinergics like  oxybutynin, tolterodine, darifenacin, solifenacin.
  • Anti-depressants such as imipramine and duloxetine.
  • Estrogen creams for topical use in menopausal women.

This is augmented with bladder training to hold urine longer, double urination techniques and Kegel’s exercise which strengthens the pelvic floor muscles. Proper management of fluid and dietary intake can help to effectively handle this otherwise harmless condition.

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