52 Urinary-Incontinence

Urinary Incontinence

Urinary Incontinence

Overview :



Women are seen to have twice the amount of incidence of urinary incontinence than men. Urinary incontinence is more prevalent in aged women but it is not age dependent as it is a medical problem.

At the time of urination the urinary bladder muscles contract and urine is thrown out of the bladder to the urethra. At this time the muscles of the urethra relax and the urine is thrown out of the body. If the bladder muscles contract suddenly or the urethra muscles are weak and unable to hold the urine then the urine may come out with low pressure.

The problem of urinary incontinence is very common in women and it is treatable at all ages.



Symptoms :



General:

There are various types of urinary incontinence and the symptoms depend upon the type of incontinence.



*Stress incontinence: urinary incontinence related to stress like physical changes due to pregnancy, childbirth and menopause. Simply sneezing, coughing, laughing, or any other activity causes pressure to the bladder. Stress related urinary incontinence may get worse in the week preceding the menstrual period as the low estrogen levels causes reduced muscular pressure of the urethra muscles and the urine may leak.



*Urge incontinence: In this there isurge or need for urination and there is loss of some urine. This is because the bladder contracts abnormally. Here the nerve signals may not be peculiar which may be causing the bladder to spasm. In this there may be urination in sleep, after intake of small water, touching water or hearing its sound. Uncontrolled diabetes or hyperthyroidism may cause or worsen the existing urge incontinence.



*Overactive bladder: This is due to the abnormal nerve signal to the bladder to contract at the incorrect time. Urination for eight or more than eight times a day, urgent need to urinate, leakage followed by strong need for urination and awaking in the night to urinate are some of the symptoms of overactive bladder.



*Functional incontinence: People with physical and medical problems suffer from this type. People who cannot think, move or communicate have this type of urinary incontinence as they are not able to go to the toilet.



*Overflow incontinence:In this type the completeemptying of the bladder is lacking. If the bladder muscles are weak (because of nerve damage in diabetes) or urethra is blocked (due to tumor or stone) then this type of urinary incontinence is seen.



*Other types: Combination of stress and urge type of urinary incontinence known as mixed type. Transient incontinence may be due to coughing, constipation, mobility restriction, urinary tract infections, certain medications or mental impairment.



Causes :



The makeup of the female urinary tract, pregnancy, child birth and menopause are the reasons for the higher incidence of urinary incontinence in them.The risk or prevalence of urinary incontinence is similar in men and women if there are reasons like birth defects, neurological problems, stroke, multiple sclerosis, problems because of ageing.



 



Risk Factors:





  • Obesity.




  • Ageing.




  • Pregnancy, child birth and menopause.




  • Diabetes.




  • Problems related to nervous system.




  • Inability to move, think.





 



Treatment :



Precautions:

Kegel exercise may be done to strengthen the muscles of urethra.



Basic

The treatment is not the same for everyone suffering from urinary incontinence.





  • Timed visits to bathroom at regular intervals. Once the control is achieved then the intervals may be extended.




  • Kegel exercise may be done to make the muscles more strong to hold the urine. This is called behavioral therapy. In this there is exercise of vaginal muscles.




  • For the treatment of overactive bladder, drugs from anticholinergics class are given. These drugs help to relax the bladder and bladder spasm is prevented.




  • Urge incontinence may be treated by neuromodulation technique, but it is very expensive and needs surgery and not fit for every person with urge incontinence.




  • A pessary or stiff ring may be inserted into the vagina to hold the urethra in proper position and results in less stress and the leakage. It may cause urinary tract and vaginal infections.




  • Urine catheters may be used to collect the urine in a bag.




  • Some bulking agents may be injected into the bladder tissue around the neck. This causes thickening of the tissue and proper closing of the bladder opening and decreases stress incontinence.




  • Sometimes the urinary bladder may shift its position especially after delivery. Surgery may be carried out to place the bladder in the position. There are three types of surgeries, retropubic suspension, Sling procedures and anti-incontinence procedure.




  • If some drugs are already in use like drugs for high blood pressure (which causes more urination) by changing these drugs the problem of urine incontinence can be controlled. No extra medicines are required.




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