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Urinary Incontinence

The urinary bladder is a part of the urinary tract that comprises of a pair of kidneys, ureters, urinary bladder and urethra. These work collectively to produce urine, commonly called as urination. The function of kidneys and ureters is involuntary, whereas, the function of the urinary bladder is voluntary.

Urinary incontinence is the involuntary release of urine due to poor urinary bladder control. This condition is more common in females than in males. Though urinary incontinence is a common problem, it is an embarrassing situation.

Symptoms

The main symptom is the leakage of urine. The various types of urinary incontinence are:

  • Stress incontinence: Urinary leakage occurs when there is pressure on the urinary bladder due to jogging, coughing, sneezing and lifting heavy weights. This may cause leakage of urine.
  • Urge or reflective incontinence (an overactive bladder): Urinary leakage occurs due to the sudden involuntary contraction of the muscle wall of the urinary bladder that causes an urge to urinate.  A change in position, orgasms etc may develop an urge to urinate, followed by leakage of urine. 
  • Overflow incontinence: This is more common in men due to prostate gland problems, a damaged urinary bladder, and a blocked urethra. These patients experience dribbling.
  • Functional incontinence: Urinary leakage caused due to physical and mental impairments that do not allow the patient to reach the toilet in time.

Causes

The causes of urinary incontinence differ for different types of urinary incontinence. These are:

Stress incontinence: The various causes of stress incontinence are:

  • Pregnancy
  • Menopause
  • Obesity
  • Age
  • Surgical  procedures such as hysterectomy

Urge incontinence: This is caused due to:

  • Inflammation of the lining of the urinary bladder
  • Central nervous system problems such as multiple sclerosis, Parkinson’s disease, and stroke
  • Enlargement of the prostate  gland causes the urinary bladder to drop and leads to irritation

Overflow incontinence: The cause for overflow incontinence is obstruction of the urinary bladder that is caused due to:

  • Urinary stones
  • Enlargement of the prostate gland
  • Tumors that press against the urinary bladder
  • Surgeries

Functional incontinence: The common causes of functional incontinence are:

  • Dementia
  • Confusion
  • Poor eyesight
  • Poor dexterity
  • Depression
  • Anger
  • Anxiety

Risk Factors

The risk factors that can cause urinary incontinence are:

  • Obesity
  • Smoking
  • Old age
  • Gender
  • Prostate gland diseases and disorders
  • Neurological diseases

Complications

Urinary incontinence gives rise to many problems such as:

  • Skin problems: rashes, skin sores, infections occur as the skin is wet.
  • Urinary tract infections: long-term use of catheter increases the risk of infection.
  • Prolapse: it occurs as a result of weakened pelvic floor muscles. The urethra or part of the vagina, and the bladder fall into the entrance of the vagina.  

Diagnosis

Urinary incontinence is diagnosed by the following ways:

  • A bladder diary is maintained by the patient to record the quantity of water or liquids consumed, the quantity of urine produced and the number of episodes of incontinence.
  • A physical examination is done in females to examine the vagina and the strength of the pelvic muscles. In males the rectum is checked for determining the enlargement of the prostate gland.
  • Cystoscopy is done by using cystoscope for identifying any abnormalities in the urinary tract.
  • Cystogram is an x-ray procedure to visualize the urinary bladder and detect any bladder problems.
  • Intravenous pyelogram test is an imaging test performed that detects the size, shape, and function of the kidneys. It also checks for the presence of kidney stones, tumors, and any kind of obstruction.
  • The post-void residual test is a test to measure the urine retention in the bladder after urinating.
  • Blood test is performed to assess the kidney function.
  • Urine analysis is done to check for infection and abnormalities.
  • A stress test is done by applying sudden pressure to check for any leakage from the bladder.
  • Urodynamic testing is performed to determine the extent of pressure the bladder and the urinary sphincter can withstand.

Treatment

Treatment of urinary incontinence depends on several factors such as the patient’s age, general health, and mental condition. The treatments followed in treating urinary incontinence are:

  • Kegel exercises: These are the pelvic floor exercises that help to strengthen the pelvic muscles and urinary sphincter in females.
  • Bladder training:  It is used to treat urge incontinence. The patient undergoes training to delay the urination time and frequency.
  • Medications such as anticholinergics, tricyclic antidepressants, and topical estrogens are used to treat urinary incontinence. 
  • Pessaries:  A device inserted into the vagina, prevents urine leakage by supporting the bladder neck. This is most useful in treating stress incontinence.

Surgical Treatment

Surgical procedures are performed when the treatments mentioned above do not provide relief. Three different surgeries are followed:

  • Sling procedure: A strap of tissue is inserted below the bladder neck to support the urethra and stop urine leakage.
  • Colposuspension: This procedure is useful in patients suffering from stress incontinence. The bladder neck is lifted and supported.
  • Artificial sphincter: A valve or sphincter is inserted to control the flow of urine from the bladder into the urethra.

Self management

Urinary incontinence can be controlled or prevented by the following modalities:

  • Lifestyle changes: change in lifestyle, such as maintaining healthy weight, reducing alcohol consumption and caffeine related drinks.
  • Devices and absorbent products: some devices and absorbent products such as protective pads, panty liners, can be used to prevent urinary leakage and embarrassment in public.

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