When you do not have voluntary control over your urinary bladder and have urine leakage due to sneezing, coughing, or laughing and other problems, it is called Urinary Incontinence.
Incontinence is more common in women and the elderly, but it can affect both men and women in any age group.
Many people with incontinence suffer from social humiliation, loneliness, ill-health, and even depression. Simple lifestyle changes or medical care will relieve discomfort or halt urinary incontinence for most people.
The types of urinary incontinence and their indications are mentioned in the table below.
|TYPES OF URINARY INCONTINENCE||SYMPTOMS/ INDICATIONS|
|Stress incontinence||In this type, there is leakage of urine when there is pressure on the urinary bladder due to sneezing, laughing, coughing, and doing weight lifting exercise.|
|Urge incontinence||In this type, there is an intense urge to urinate without any control of the urinary bladder. It is caused due to infection, neurological disorders and diabetes.|
|Overflow incontinence||When the urinary bladder does not empty completely, then there is frequent dribbling of urine. Such condition is observed in this type of incontinence|
|Functional incontinence||In this type of incontinence, one cannot understand the need to urinate on time due to physical or mental impairment.|
|Mixed incontinence||As the name suggests, more than one type of incontinence is involved.|
The voluntary control of urination is not a simple process. It is an intricate interaction between the human brain, the nervous system, and the organs in the pelvis. The pelvic organs include the bladder, urethra, and the prostate in men. Storage of urine and empty urine are the two essential functions of the bladder. The outflow of urine is controlled by two valves, or sphincters, located in the bladder neck and the earliest portion of the urethra. The bladder neck sphincter is regulated involuntarily (autonomically), while the urethral sphincter has both voluntary and involuntary regulations. When any of the system's components lose normal function, it may impair urinary regulation. Neural injury, damage of the bladder, sphincters, supporting structures, and even pelvic floor may all result in urinary incontinence.
The risk of urinary incontinence includes:
Positive family history
Neurological disease or diabetes
Urinary tract infection
Pregnancy and Childbirth
Less oestrogen production in women due to menopause
Hysterectomy in women
Benign Prostatic Hyperplasia in older men
Presence of tumour along the urinary tract
Neurological disorders like multiple sclerosis, Parkinson’s disease, brain tumour, spinal injury, etc.
Initial treatment includes behavioural techniques, pelvic floor muscle exercises, and electrical stimulations to treat urinary incontinence.
Behavioural techniques include bladder training, double voiding, scheduled toilet trips, and fluid and diet management.
The physician may recommend pelvic floor muscle exercises which are also known as Kegel exercises. These exercises strengthen the muscles of the urinary bladder. Please visit a physiotherapist to know the correct techniques.
Electrical stimulation is also a tool used for the treatment of urinary incontinence. Electrodes are implanted momentarily into your rectum or vagina to relax and strengthen the muscles of the pelvic floor. Smooth electrical stimulation may be successful for stress incontinence and urge incontinence. However, this technique requires several months of multiple treatments.
The medications used to treat Urinary Incontinence are:
Urinary bladder muscle relaxant
Alpha blocking drugs
Low Dose Topical oestrogens
There are certain medical devices designed to treat urinary incontinence in the female. These include:
However, certain interventional therapies provide aid in treating urinary incontinence. Bulking material injections, Botulinum Toxin Type A, and nerve stimulators are examples of interventional therapies.
Surgical procedures are the last resort to treat Urinary Incontinence if any of the above methods fail to provide relief.
The surgical procedures involved are Sling procedures, Bladder neck suspension, Prolapse surgery, and artificial urinary sphincter. The combination of a sling procedure and prolapse surgery is carried out in women with mixed incontinence and pelvic organ prolapse. Before carrying out the surgical procedures, the physician and the medical team will explain to you clearly how to prepare for the surgery.
Some non-medical treatments also can be utilised by patients if medical treatments cannot eliminate urinary incontinence completely. Absorbent pads, protective garments and catheter are some of the products that may help ease the discomfort and inconvenience of leaking urine
Here are some of the lifestyle changes that one should do if they are suffering from Urinary Incontinence:
Wash your private parts properly with a washcloth
You should let your skin to air-dry
You should consider using barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine
A bedside commode is a better lifestyle change to prevent leakage of urine.
You should maintain a balanced diet and keep your weight on check
You should practice pelvic floor exercises
You should avoid caffeine, alcohol, and foods that are acidic
You should include fibre in your diet which will prevent constipation
You should not smoke. If you are a regular smoker, please seek the advice of a therapist.
You should try not to intake any fluid substance two to four hours before going to bed.
Visit your physician on regular intervals for a check-up.
Consultant - Urology
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