Urine Incontinence

Everything You Need to Know About Urine Incontinence

Types | When to see | Symptoms | Causes | Diagnosis | Treatment | Risk | Complications | Prevention | Success rate | Cost

Types of urinary incontinence

There are six types of urinary incontinence. These are –

• Stress incontinence

This is a kind of incontinence that occurs during activities, such as jumping, coughing, laughing, sneezing, or lifting. Some of the incontinence causes are surgical trauma, pregnancy, menopause, childbirth, and pelvic radiation.

• Urge incontinence

This sometimes happens when there is a sudden urge to urinate with a high volume of urine loss. The causes of urge incontinence are pelvic trauma, pregnancy, menopause, childbirth, and also some neurological diseases such as multiple sclerosis and Parkinson’s diseases.

• Mixed incontinence

This combination is the result of urge and stress incontinence. The causes of the urge and stress incontinence, which are stated above, are the causes of mixed continence.

• Overflow incontinence

Inefficient emptying of the bladder results in the frequent leakage of urine. The symptoms of overflow incontinence are much similar to that of stress incontinence. Some of the causes of overflow incontinence are multiple sclerosis, neurological damage, diabetes, spinal cord injury, or prostate enlargement.

• Functional incontinence

This type of loss of urine is associated with the urinary system. The causes of functional incontinence are cognitive and physical impairment, like head injury, immobility, and Alzheimer’s disease.

• Reflex incontinence

Spastic bladder or reflex incontinence occurs when urine is filled in the bladder and a reflex that is involuntary causes the bladder to contract to empty it. The causes of reflex incontinence include injury over the area of the T12 level of the spinal cord.

When to see a doctor?

Whenever you find yourself unable to control the urge to urinate, you must immediately consult a doctor. Nevertheless, in females, whenever you find that you need to use absorbent pads or change your underwear frequently, you must seek help from a gynecologist.

You must talk to your doctor before it becomes embarrassing for you. Seeking medical advice is good because the incontinence problem might lead to :

• Serious health issues
• Older adults have more risks as it can increase the chances of them falling.
• Your interactions and social activities would be limited and sometimes restricted.

Symptoms of urinary incontinence

There are many symptoms of urinary incontinence like:

• Leakage of urine during sneezing, walking, coughing, or jumping.
• The intense will to urinate followed by uncontrolled loss of urine.
• When the urine passes due to a sudden change in your position.
• Pass urine when you reach orgasm.
• Problems related to passing the urine.
• Sometimes when you feel that you have not emptied the bladder completely.

Causes of urinary incontinence

The incontinence of urine is not a disease. It is a symptom caused by daily habits, ongoing medical conditions, or various physical issues. A thorough check-up by the doctor can help you to know the exact cause of the urinary incontinence.

Different kinds of foods, medications, and drinks act as diuretics, which can cause urinary incontinence. They stimulate the bladder and also increases the volume of urine. Some of the diuretics are:

• Caffeine
• Alcohol
• Chili peppers
• Chocolate
• Sparkling water and carbonated drinks
• Citrus fruits
• High doses of Vitamin C
• Sedatives, blood pressure, and heart medications, muscle relaxants

The incontinence may also be caused due to:

• Constipation

The rectum and bladder share many nerves because they are close to each other. Urinary frequency increases because of the compacted and hard stool that causes the nerves to be overactive.

• UTI or Urinary Tract Infection

The bladder becomes irritated by the infections that can cause the strong will to urinate.

• Pregnancy

Pregnancy leads to the fetus’s increased weight and hormonal changes, which may result in incontinence.

• Childbirth

Normal delivery can weaken the muscle that is meant for controlling the bladder. It also results in damaging the nerves of the bladder and supporting tissues. This leads to prolapse. Incontinence is caused by prolapse when the bladder, rectum, small intestine, and uterus get pushed away from the usual position and fall into the vagina.

• Aging

The bladder muscles are also subjected to aging, resulting in a decrease in the bladder’s capacity to hold the urine. As you get older, the contractions of the involuntary bladder increases, which results in incontinence.

• Hysterectomy

The uterus and the bladder gets support from many joint ligaments and muscles in women. Any surgery in a women’s reproductive system has a high chance of damaging the pelvic floor muscles. This may lead to incontinence.

• Menopause

Estrogen is a hormone that helps keep the lining of the urethra and the bladder healthy. After menopause, less estrogen is produced, which can deteriorate the tissues and ultimately lead to incontinence.

• Prostate enlargement

A condition in older men known as benign prostatic hyperplasia is caused when incontinence occurs due to enlarged prostate glands.

• Prostate cancer

Urge continence and stress continence may lead to prostate cancer. Incontinence is a popular side effect of prostate cancer treatment.

• Neurological disorders

Stroke, multiple sclerosis, brain tumor, spinal cord injury, or Parkinson’s disease can affect bladder control, resulting in urinary incontinence.

• Obstruction

Tumors are responsible for blocking the flow of urine that is normal, thus leading to overflow incontinence. Urinary stones are a typical kind of blockage that causes leakage in urine.

Treatment Options For Urogynecology

Diagnosis of urinary incontinence

If you are experiencing urinary incontinence, you must see a general practitioner first. They can diagnose the type of incontinence. Do not be embarrassed while talking to a healthcare professional about your problems.

The general practitioner will ask a few questions. Some of them are:

• How frequent urinary incontinence occurs?
• Whether it occurs while laughing or coughing?
• Is there any difficulty you face while urinating?
• Quantity of alcohol, caffeine, or fluid you consume?
• Is there any medication going on?

The general practitioner will also suggest some tests to confirm that you are suffering from incontinence or not. The health of the urinary system will be examined first by the general practitioner. A pelvic examination will be conducted to see whether there is any urine leakage while you cough or sneeze.

Your vagina will also be examined to confirm whether a part of the bladder bulges into the vagina or not, also known as a cystocele. It happens in case of stress incontinence.

The doctor will ask you to compress the pelvic floor muscle while placing the fingers inside the vagina. Urinary incontinence will occur if there is any damage to the pelvic floor muscle.

In the case of a male, the prostate gland’s health will be checked first by the general practitioner. The prostate gland is located between the bladder and the penis, and it surrounds the urethra. A digital rectal examination might be needed, which includes the insertion of fingers into the bottom so that the prostate gland can be felt. In case the gland enlarges, it will cause urinary incontinence.

• Dipstick Test

A sample of urine is sent for testing if the general practitioner thinks that the symptoms are of UTI or urinary tract infection. The urine is tested to find out the presence of bacteria.

A stick that is chemically tested will be placed in the urine sample taken. In case the color of the stick changes, the presence of bacteria will be confirmed. The small chemically treated stick can also check the presence of protein and blood in the urine.

• Residual urine test

A test is performed to determine how much urine is being left in the bladder after you pee. This test is known as the residual urine test. An ultrasound scan of the bladder is performed to see the quantity of urine that is left in the bladder. It is generally measured after a catheter drains the bladder.

• Other tests

The doctor will conduct more examinations if the cause of incontinence is not clear. The treatment for your problem will be started first, and then further tests will be followed if the ongoing treatment does not show any positive outcome.

• Cystoscopy

The cystoscopy procedure involves a thin tube with a camera that helps to have a view of the inside of the urinary tract and the bladder. It helps to identify any abnormalities in the bladder or urinary tract, causing urinary incontinence.

• Urodynamic tests

A group of tests performed to check the functioning of the urethra or the bladder is known as urodynamic tests. You may be instructed to keep a bladder diary for some days and then go for various tests at the clinic or hospital. Some of the tests are:

(i) Calculating the bladder’s pressure by insertion of a catheter into the urethra

(ii) Calculating the pressure in the abdomen by insertion of a catheter in the bottom

(iii) Measuring the flow and amount of your urine by asking you to urinate into a particular machine

Treatment for urinary incontinence

The type of treatment to be followed during urinary incontinence will depend on the kind of incontinence you are suffering from and the kinds of symptoms you are having. In urinary incontinence, which is caused by other medical conditions, you will be treated for both.
Treatments that do not involve surgery or medicines are tried first. Some of them are:

• Lifestyle changes

A general physician might suggest you go for a lifestyle change first to bring improvements to your incontinence.
You may be recommended to:

(i) Reduce the consumption of caffeine found in cola, tea, or coffee

(ii) Having an appropriate quantity of fluid each day

(iii) If you are overweight, you are suggested to lose weight.

• Bladder training

In the case of urge incontinence, you will be suggested bladder training. It can also be combined with training on pelvic floor muscle in case of mixed urinary incontinence. It will help you to learn several techniques that will eventually help to lengthen the time between feeling the urge to urinate and passing the urine. This will go on for six weeks.

• Training for pelvic floor muscle

The muscles of the pelvic floor are responsible for controlling the urine flow as soon as you pee. These muscles surround the urethra and the bladder. If the muscles of the pelvic floor are damaged or weak, it can cause incontinence. You must often exercise these muscles to avoid incontinence.

You will be suggested to start a program that can help you learn the techniques of pelvic floor muscle exercise. The specialist will assess your power of contracting the pelvic floor muscles. If you can contract the muscles of the pelvic floor, you will be given specific exercises. According to reports, pelvic floor muscle training is beneficial to everyone who is suffering from urinary incontinence.

• Medicines

In the case of stress incontinence, if it is not improved with the treatment as mentioned above, then you will be provided with surgery as the next step. If you are not the right person to go for surgery, you will be provided with some antidepressant medicine known as duloxetine. This will help to increase the urethra’s muscle tone so that it remains close.

You will be prescribed duloxetine tablets twice a day. Furthermore, you need to go to the doctor after two to four weeks. It is to assess that the prescribed medicine benefitted you or caused severe side effects.

If the training for pelvic floor muscle is not adequate in the case of urge incontinence, doctors will prescribe an antimuscarinic to you.

Risk factors

There are many risk factors that lie with urinary incontinence. Some of them are:

• Age

The muscles of the urethra and the bladder weaken as age increases. The bladder changes tend to reduce the strength of the bladder, and its chances of urinary incontinence increase.

• Gender

Urinary incontinence varies depending upon the gender too. Women with normal anatomy, pregnancy, menopause, and childbirth suffer the most from urinary incontinence. On the other hand, men with problems in the prostate glands suffer the most from urinary incontinence.

• Overweight

If you are overweight, the pressure increases on the surrounding muscles of the bladder. It makes the bladder weak, and thus, urine leaks out in case you sneeze or cough.

• Family History

The risk of incontinence increases in case any of the family members have this issue. The chances of urge incontinence increase the most.

• Smoking

If you are addicted to tobacco, the risks of getting urinary incontinence are much higher.

Complications

The complications of urinary incontinence are many. Some of them are:

• Infections

Due to incontinence, you may develop the chances of getting affected by UTI or urinary tract infections. The frequent urge to urinate increases this risk.

• Skin problems

Due to incontinence, you may develop many sores, skin infections, and rashes. Your skin gets wet frequently, which increases your chances of getting skin problems.

Preventing urinary incontinence

You may not always be able to prevent urinary incontinence, but you can decrease the risks:

• Try to practice exercises that will help to strengthen your pelvic floor muscles.
• Do maintain a proper weight.
• Try to quit smoking by taking help from professionals.
• Acidic foods, caffeine, and alcohol irritate the bladder. Try not to consume such foods.
• Fiber helps to prevent constipation. Try to consume more fiber.

Urinary incontinence surgery success rate

The urinary incontinence surgery success rate is between 36% to 87%. The rate of success varies according to the age and condition of the patient.

Cost of urinary incontinence surgery

The cost of urinary incontinence ranges from Rs. 30,000 to Rs. 1,50,000. The range differs because some patients may need urgent incontinence surgery while others may need stress incontinence surgery.

Sometimes you just cannot prevent urinary incontinence with certain medications. However, you must follow the doctors’ instructions to avoid the issue from escalating.