Urinary incontinence is a medical term for loss of bladder control. It is a common and obviously an embarrassing problem for any human being. This condition varies in severity. It can be an occasional leaking of urine upon coughing or sneezing to having a very strong and sudden urge to urinate, which you can't hold till you get to a toilet in time. Never hesitate to consult your physician regarding your urinary incontinence, especially if it is affecting your daily activities and your quality of life. In many of the cases, lifestyle changes and medical treatment helps in stopping the urinary incontinence and easing its inconvenience.
Treatment consists of lifestyle modifications, behavioral techniques, medicines and surgery.
Causes of Urinary Incontinence
Urinary incontinence isn't a disease in itself, but a symptom of an underlying condition. It can also be caused by a person's everyday habits and other physical problems. A complete evaluation by your physician is needed to determine the cause behind the incontinence.
Temporary Urinary Incontinence
- Temporary Urinary Incontinence occurs from intake of certain foods, drinks and medications which act as diuretics and increase the volume of the urine and stimulate the bladder. These substances include: Caffeine, alcohol, tea, carbonated drinks, corn syrup, artificial sweeteners, spicy/sweet/acidic foods, medicines for hypertension and heart, sedatives, muscle relaxants and large doses of vitamins B & C.
- Urinary tract infection can cause urinary incontinence, as the infection irritates the bladder resulting in strong urges to urinate and can also cause incontinence. Symptoms of urinary tract infection also include foul-smelling urine and burning sensation when urinating.
- Constipation can also cause urinary incontinence. The rectum which holds the stool is situated near the bladder and both the bladder and the rectum share many nerves. So, if there is hard, impacted stool in the rectum, it puts pressure on the nerves causing them to be overactive and leading to increased urinary frequency and sometimes incontinence.
Persistent Urinary Incontinence
Underlying physical problems can cause persistent urinary incontinence. Some of these problems or changes in the body include:
- Hormonal changes in pregnancy along with increase in the weight of the uterus can put pressure on the bladder leading to stress incontinence.
- Childbirth via vaginal delivery tends to weaken the muscles which are required for bladder control. Vaginal delivery can also sometimes cause some damage to the bladder nerves and its supportive tissue. All this leads to a prolapsed pelvic floor, which in turn causes the bladder, rectum, uterus and sometimes small intestine to shift from their normal position and protrude into the vagina resulting in incontinence.
- Menopause: After menopause there is a decrease in the production of the estrogen, which is a hormone, whose function is to help keep the lining of the urethra and bladder healthy. With decrease in estrogen, there is a decline in the health of these tissues which can cause or aggravate incontinence.
- Age related changes, such as aging of the muscles of the bladder decreases the capacity of the bladder to store urine and causes incontinence.
- Hysterectomy is a procedure in which a woman's uterus is surgically removed. The bladder and uterus in females share and is supported by many same ligaments and muscles. Hysterectomy can cause damage to the supporting muscles of the pelvic floor leading to incontinence.
- Prostate Enlargement (Benign Prostatic Hyperplasia), particularly in older men, causes incontinence.
- Prostate cancer can cause urge or stress incontinence in men. In many cases, incontinence occurs as a side effect of the prostate cancer treatment.
- Obstruction, especially by a tumor or stones in the urinary tract, can hinder the normal flow of the urine resulting in overflow incontinence. Sometimes, urinary stones can also cause urine leakage.
- Neurological disorders, such as Parkinson's disease, multiple sclerosis, brain tumor, stroke or a spinal injury can disturb the nerve signal transmission leading to loss of bladder control.
Risk Factors for Urinary Incontinence
- Women are more prone to suffer from stress incontinence, as they go through major body changes, such as pregnancy, childbirth and menopause. Although, men are also at an increased risk for urge and overflow incontinence due to problems from the prostate gland.
- As a person gets older, the muscles of the bladder and urethra get weak and lose their strength. This leads to decrease in the capacity to hold urine and can cause involuntary urine leakage.
- Excess weight or being overweight puts increased pressure on the bladder and its surrounding muscles. This increased pressure weakens these muscles and cause stress incontinence that is the urine to leak when a person coughs or sneezes.
- Other medical conditions, such as diabetes or some neurological diseases like Parkinson's, increases the risk of urinary incontinence.
Symptoms & Types of Urinary Incontinence
Urinary incontinence is a symptom in itself of some other condition. Some people leak urine upon sneezing or coughing, which is known as stress urinary incontinence; whereas some people have persistent urinary incontinence. Some of the types of incontinence include:
- Urge Incontinence: In this type, patient experiences an intense, sudden urge to urinate followed by an involuntary passing of urine. Patient needs to urinate frequently even during the night. The underlying cause behind urge incontinence can be minor, such as an infection, or it can be due to diabetes or some other neurologic disorder.
- Stress Incontinence: In this condition, patient leaks urine due to pressure exerted on the bladder by sneezing, coughing, exercising, laughing or lifting something heavy.
- Functional Incontinence: In this type, a person is not able to make it to the toilet in time. This is due to some mental or physical impairment such as severe arthritis; where the patient is not able to unbutton their pants fast enough to make it to the toilet on time.
- Overflow Incontinence: This happens when the bladder is not emptied completely due to which the patient experiences constant or frequent dribbling of urine.
- Mixed Incontinence: In this type, patient experiences more than one type of the above mentioned urinary incontinence.
You should immediately consult your doctor if the incontinence is frequent and severe and affects your quality of life; even though you may feel embarrassed or uncomfortable in discussing this problem with your physician, but it is important to seek medical attention as the urinary incontinence can indicate a serious underlying medical problem. It can also limit your social activities. Old people are at an increased risk for falls as they have to hurry to the toilet to relieve themselves.
Investigations for Urinary Incontinence
A complete medical history and physical exam is undertaken, as it is important to isolate the problem causing loss of bladder control. There is a simple maneuver which determines if the patient has incontinence; in which the patient has to close his/her mouth, pinch the nose and exhale sharply. After this some of the tests which will be done include:
- Urinalysis to check for infection or other abnormalities.
- Bladder diary is advised to record the amount of fluids patient is drinking, how many times in a day the patient has an urge to urinate and the number of episodes of incontinence in a day.
- Post-void residual measurement is taken where a patient is told to urinate into a container to measure the urine output. After which the doctor measures the amount of urine left in the bladder with the help of a catheter or ultrasound testing. If there is a large amount of urine left in the bladder, then it means that there is an obstruction in the urinary tract or some problem with the muscles or nerves of the bladder.
- Cystoscopy is a test where the doctor inserts a thin tube containing a tiny lens into the urethra to look for and to possibly remove any abnormalities present in the urinary tract.
- Urodynamic testing can be done where the doctor/ nurse inserts a catheter into the urethra in order to fill the bladder with water. A pressure monitor is used to measure and record the pressure in the bladder. This test helps in measuring the strength of the bladder and the health of the urinary sphincter. Urodynamic testing also helps in identifying the type of incontinence the patient has.
- Cystogram is a test where the doctor inserts a catheter into the urethra and bladder and injects a special type of dye. When the patient urinates or passes this fluid, x-ray images of the bladder are taken to reveal any problem with the urinary tract system.
- Pelvic ultrasound can be done where the urinary tract system and the genitals are assessed for any abnormalities.
Treatment for Urinary Incontinence
Treatment depends on the type of urinary incontinence, the underlying cause and the severity of the urinary incontinence. Different combination of treatments may be required. Some of the treatment options starting from the least invasive are:
- Double voiding helps in avoiding overflow incontinence and helps the patient to learn to empty the bladder more completely. In double voiding, after urinating once, patient needs to wait for some time and try to urinate again.
- Bladder training is to delay the urination when the patient gets the urge to urinate. Patient can start by trying to control the urge for 10 minutes and gradually increase the time gap between each trip to the toilet until the patient is urinating every 2 to 3 hours.
- Planned toilet trips should be made, so that the patient urinates every three to four hours instead of waiting for the urge to void.
- Better management of fluid and diet should be done in order to regain the control of the bladder. Patient needs to decrease the consumption of caffeine, alcohol and acidic foods. If the patient is overweight, then he/she should try to lose weight, decrease liquid consumption, and increase physical activity and exercise to solve the problem.
Exercises To Strengthen The Pelvic Floor Muscles (Kegel Exercises)
These exercises are also known as Kegel exercises and they help in strengthening the pelvic muscles and thus help in controlling the urination. Kegel exercises are especially helpful in stress incontinence; however, they also benefit in urge incontinence. Kegel exercises are done in the following manner:
- Contract or tighten the pelvic muscles as if you are trying to stop urination and hold this for five seconds followed by relaxing the muscles for five seconds. You can start off with 2 to 3 seconds also and go onto holding the contractions for 10 seconds. Do at least three sets of 10 repetitions every day.
- Anticholinergics help in calming an overactive bladder and are beneficial in treating urge incontinence. Examples of anticholinergics include trospium (Sanctura), oxybutynin (Ditropan XL), darifenacin (Enablex), tolterodine (Detrol), solifenacin (Vesicare) and fesoterodine (Toviaz).
- Alpha blockers are prescribed in men who are suffering from overflow or urge incontinence. These medications help in relaxing the bladder neck muscles as well as muscle fibers in the prostate thus making it easier for complete emptying of the bladder. Some of the alpha blockers include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo) and terazosin (Hytrin).
- Mirabegron (Myrbetriq) is used to treat urge incontinence by relaxing the muscles of the bladder and helps in increasing the amount of urine the bladder can hold. This medicine also helps in increasing the amount of urine the patient is able to urinate at a time, thus helping in emptying the bladder more completely.
- Low-dose topical estrogen can be applied in the form of a vaginal cream, patch or ring. This helps in toning and rejuvenating the urethral and vaginal tissues and helps in relieving the symptoms of incontinence.
In this method, electrodes are inserted temporarily into the rectum or the vagina in order to stimulate and strengthen the muscles of the pelvic floor. Gentle electrical stimulation is beneficial in treating urge and stress incontinence. Multiple treatments are needed over a period of several months.
- Urethral insert is a tampon-like disposable device which can be inserted into the urethra before the patient has to perform any specific activity, such as playing tennis, which can trigger incontinence. This insert prevents leakage by acting as a plug and is removed before urinating.
- Pessary is a stiff ring which is inserted into the vagina. This device supports the bladder and helps in preventing urine leakage. Pessary is particularly helpful if the incontinence is from a prolapsed uterus or bladder.
- Synthetic bulking material injections are injected into surrounding tissue of the urethra. This material helps in keeping the urethra closed and reducing the leakage of the urine. This procedure needs to be repeated every now and then.
- Botox Injections (Botulinum toxin type A) can be given into the bladder muscle. This benefits individuals with an overactive bladder. Botox is usually used only when other medications have not been useful.
- Nerve stimulator is a device similar to pacemaker and is implanted under the skin (in the buttock). This device transmits painless electrical pulses to the bladder nerves which help in controlling the urge incontinence. This is done if all other treatment therapies have been unsuccessful.
There are different surgical procedures which can be done to treat the problems causing urinary incontinence. These surgical procedures are done only if the lesser invasive therapies haven't worked and include:
- Bladder neck suspension surgery helps by providing support to the urethra and bladder neck. An incision is made into the abdomen and it can be done under general or spinal anesthesia.
- Sling procedures consist of stripping the tissue from the body and creating a pelvic sling around the urethra and the bladder neck. This pelvic sling is made of mesh or synthetic material and helps in keeping the urethra closed, and is beneficial in stress incontinence where the urine leaks upon coughing or sneezing.
- Surgery for prolapse is done in women who suffer from mixed urinary incontinence and prolapse of the pelvic organs. Surgery consists of a combination of a prolapse surgery and sling procedure.
- Artificial urinary sphincter can be implanted in men. This is a small, fluid-filled ring which is placed around the neck of the bladder to help keep the urinary sphincter closed until the patient is ready to urinate. Artificial urinary sphincters are especially beneficial for men who have incontinence as a side effect of enlarged prostate gland or prostate cancer and its treatment.
Catheters & Absorbent Pads
These products help in alleviating the discomfort and the inconvenience of urinary incontinence:
- These days, pads and other protective garments are not bulkier than any normal undergarments; hence they can be worn easily without any hassle under our normal everyday clothes. A drip collector can be used by men who dribble urine. All these products help in absorbing the urine leakage and save you the embarrassment of incontinence when you are outside doing some activities.
- Catheters can be used if there is incomplete emptying of the bladder resulting in incontinence. A catheter, which is a soft tube, can be inserted into the urethra multiple times a day to drain the bladder.
Lifestyle Modifications for Urinary Incontinence
After the urine leakage, use a soft and clean cloth to wipe yourself and allow your skin to air-dry. Do not rub your skin. Try to avoid frequent douching and washing, as this can destroy the body's natural defenses against infection. Using a barrier cream, such as cocoa butter or petroleum jelly, will protect the skin from urine. If the patient is having frequent nighttime incontinence, then it is better to make the trip to the toilet easier by removing any furniture or rugs so as to avoid tripping or colliding with the furniture on the way to the toilet. Also make sure to use light near the toilet so you can see where you are going and thus avoid falls.
If you are suffering from functional incontinence, then it is helpful if you keep a bedpan in your room. Also it is beneficial if you install an elevated toilet seat and increase the width of the doorway to your toilet.