Urinary Incontinence – Causes, Symptoms and Prevention

What is Urinary Incontinence?

When you cannot control urination, you might have a pathological condition known as ‘Urinary Incontinence’. This condition is also known as “Leaky Bladder or Enuresis.”

Urinary Incontinence is common, although often underreported. Urinary Incontinence has major impact on the quality of life and overall health. You may experience depression and social isolation when you have Urinary Incontinence. But, a variety of treatment options exist that can significantly improve the symptoms. Lifestyle modifications, medications, and surgical options also improve incontinence episode frequency and ultimately the quality of life and general health for those individuals impacted.

Urinary Incontinence is defined as loss of bladder (where urine is stored) control or unintentional voiding. Urinary Incontinence may be of many types such as stress, urge, overflow, functional, or mixed variety of incontinence. Determining the underlying cause of incontinence episodes is critical for appropriate treatment.

What are the types of urinary incontinence?

If you, or any loved one suffers from urinary incontinence, you are not alone. Any person(at any age) can experience urinary incontinence. However, the issue is essentially more common in women because the urethra is shorter, with a high probability of childbirth weakening the urethra and bladder’s muscular support. There are five types of incontinence that are categorized by the cause as well as severity of symptoms within the urinary tract.

Stress incontinence: In this type, urine spills out in abrupt sprays when you cough, sneeze, strain, twist, lift or laugh. Every one of these movements presses the abdomen and bladder, making urine to flow out unexpectedly. It is most commonly the consequence of debilitated or overstretched muscles that help the bladder store urine.

Vaginal delivery past pelvic medical procedures, being overweight, and having a family history of stress incontinence are risk factors. The loss of estrogen, related to menopause, can also cause stress incontinence. Stress incontinence regularly doesn’t happen in men and might be seen post a prostate medical procedure.

Urge incontinence: This also known as “overactive bladder” and in this condition, you feel an urgent need to urinate,  including all through the night. Urge incontinence may either be caused by a minor condition like infection, or a more serious condition like diabetes or a neurological disorder.

Overflow incontinence: This happens when the bladder stores more urine than it can deal with. It frequently occurs in  older adults who have enlarged prostate (called benign prostatic hyperplasia). In benign prostatic hyperplasia, the enlarged prostate presses or packs the urethra and prevents normal  urine flow. The urine at that point begins to get retained in the bladder until it gets full and the bladder becomes  overstretched and urine spills out.

Functional incontinence: This kind of incontinence happens when you have the urge, yet cannot get to the latrine because of some conditions, for example, dementia, stroke, or immobility.

Mixed Incontinence: It is a mix of four kinds. The most common combination  is  urge and stress incontinence. Incontinence can either be momentary  (e.g., brought about by diseases or prescriptions) or constant.

When to see a doctor?

Assessment by a doctor is the initial phase in diagnosing urinary incontinence. The doctor will do a  physical assessment, and run laboratory tests. The doctor likewise poses inquiries to decide if the incontinence happens only around evening time (night-time), or during both day and night, to how much of urine leaks out   and what triggers it.

You will be asked about medications that you may be taking, and you will also be asked to keep a bladder journal (recording the measure fluid intake and urine output). This data enables your doctor to find why you may be encountering incontinence.

Postvoid residual measurement: You will be asked to urinate (void) into a container which measures the urine output. Then your doctor will check the amount of leftover urine in the bladder using ultrasound test or a catheter. If there is a large amount of leftover urine in your bladder, it may mean that you either have an obstruction in the urinary tract or have problem with your bladder muscles or nerves.

Your doctor may test your urine or blood to check whether diabetes is causing incontinence. A pelvic and  rectal exam may likewise be performed. Discovering the reason for the problem that assists with figuring out what treatment is given .

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What are the causes of urinary incontinence?

There are numerous potential reasons for Urinary Incontinence, including:

1. Obstruction: A tumor anywhere along the urinary tract may block the normal flow of urine, causing overflow incontinence. Urinary stones (hard, stone like masses that form in bladder) can sometimes cause urine leakage
2. Neurological disorders: a brain tumor, a spinal injury, stroke, multiple sclerosis or Parkinson’s disease can affect the nerve signals involved in bladder control, leading to urinary incontinence.
3. Enlarged prostate: Incontinence can be due to benign prostatic hyperplasia, particularly in older men.
4. Prostate cancer: Stress incontinence or urge incontinence, in men can be linked to untreated prostate cancer.
5. Pregnancy: the increased pressure  of the fetus on the bladder and hormonal changes and can cause stress incontinence.
6. Childbirth: Vaginal delivery can weaken muscles required for bladder control. It can damage bladder nerves including the supportive tissue, causing a dropped (prolapsed) pelvic floor. With prolapse, the small intestine. uterus, rectum, or bladder can get pushed down from its usual position and protrude into the vagina. Such protrusions may be linked to incontinence.
7. Changes with age: With age, the bladder muscle can reduce the capacity of the bladder to store urine. In addition, involuntary bladder contractions can get more frequent as you age older.
8. Menopause: Women, after menopause, produce less estrogen (a hormone that helps keep the lining of bladder and urethra healthy). Weakening of these tissues can worsen incontinence.

What are the risk factors of urinary incontinence?

There are multiple risk factors for Urinary Incontinence:

• Multiple childbriths , history of vaginal deliveries, and menopause are risk factors for Urinary Incontinence in women.
• For men , prostate surgery or enlargement can pose a risk for incontinence.
• increasing age and obesity are risk factors for both genders in the development of Urinary Incontinence. After age 80, both genders are equally affected by Urinary Incontinence.

What are the complications of urinary incontinence?

The failure to hold urine can sometimes prompt inconvenience, shame, and other physical issues. Common complications include :

• Sores and skin infections.
• Rashes.
• Effects on personal & social life.
• Urinary tract infections.

What are the treatments for urinary incontinence?

Numerous treatment alternatives are accessible.

1. Double voiding: This means urinating, and then waiting for few minutes and trying to urinate again
2. Bladder training: To delay urinating after getting the urge to go
3. Scheduled toilet trips: Urinating every two – four hours rather than waiting till you have to go
4. Fluid and diet management: Regaining control of the bladder.
5. Pelvic floor muscle exercises: Also called Kegel exercises, pelvic floor muscle exercises include techniques that are effective especially for stress incontinence but may also help urge incontinence.
6. Medications: Medicines commonly used to treat incontinence include:
7. Anticholinergics.
8. Mirabegron
9. Alpha blockers 
10. Topical estrogen
11. Electrical stimulation: Electrodes are inserted temporarily into the rectum or vagina to stimulate and strengthen pelvic floor muscles.
12. Medical devices: The devices designed to treat women having incontinence include:
13. Pessary: a flexible silicone ring inserted into that vagina that is worn the whole day
14. Urethral insert: a tampon-like small disposable device that is inserted into the urethra before starting a specific activity like tennis, which may trigger incontinence
15. Interventional therapies: Interventional therapies which may help with incontinence include:
16. Onabotulinum (Botox) Injections: Botox injections into bladder muscle may benefit those who have urge incontinence and an overactive bladder
17. Bulking material injections: Injection of a synthetic material into the tissue surrounding urethra may help keep the urethra closed and also reduce urine leakage
18. Nerve stimulators: There are two kinds of devices which uses the painless electrical pulses to stimulate sacral nerves, nerves involved in the bladder control  

Surgery

1. Sling procedures. Strips of your body’s tissue or synthetic material (mesh) are used to create a pelvic sling underneath the urethra and the thickened muscle area where the bladder gets connected with the urethra. The sling helps in keeping the urethra closed, particularly when you sneeze or cough. The procedure is used for the treatment of stress incontinence.
2. Bladder neck suspension: Bladder neck suspension is a procedure designed to provide support to the urethra and bladder neck
3. Prolapse surgery

What are the prevention measures for Urinary Incontinence?

While urinary Incontinence is not generally preventable, to help decline the risk:

• Practice pelvic floor exercises
• Maintain a healthy weight
• Avoid bladder irritants like acidic foods, caffeine and alcohol
• Consume more fiber that can prevent constipation, a cause for urinary incontinence
• Do not smoke (Seek help to quit if you are a smoker)

Conclusion

If you are suffering from incontinence, you may feel embarrassed due to unpleasant odors. You may avoid going out with friends or family and this can lead to isolation and depression. You should see a doctor as soon as possible. It would be best if you see a urologist when incontinence symptoms are associated with recurrent symptomatic urinary tract infections, new-onset neurologic symptoms, marked prostate enlargement, or pelvic organ prolapse When left untreated incontinence can prompt rashes and other skin issues. Urinary retention can be a medical emergency.

Frequently Asked Questions (FAQs)

Q. Does pregnancy leave an enduring issue with Urinary Incontinence?

A. Not all pregnant patients have incontinence following delivery.

Q. What are the main sources of Urinary Incontinence in people?

A. In men , prostate issues are likely the most well-known reasons for Urinary Incontinence. In ladies, pregnancy and menopause  are likely to be the most common reasons for Urinary Incontinence.