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Urinary Incontinence

urinary incontinence


If you have urinary incontinence it means that you pass urine when you do not mean to (an involuntary leakage of urine). It can range from a small dribble now and then, to large floods of urine. Incontinence may cause you distress as well as being a hygiene problem.

The kidneys make urine continuously. A trickle of urine is constantly passing to the bladder down the ureters (the tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat.

The bladder is made of muscle and stores the urine. It expands like a balloon as it fills with urine. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles below the bladder that surround and support the urethra .

When a certain volume of urine is in the bladder, you become aware that the bladder is getting full. When you go to the toilet to pass urine, the bladder muscle contracts (squeezes), and the urethra and pelvic floor muscles relax to allow the urine to flow out.

Complex nerve messages are sent between the brain, the bladder, and the pelvic floor muscles. These tell you how full your bladder is, and tell the correct muscles to contract or relax at the right time.

How common is urinary incontinence?

Urinary incontinence is common, especially in women. It can occur at any age, but it is more likely to develop as you get older.

What are the causes of urinary incontinence?

There are several different types of urinary incontinence:

Stress incontinence is the most common type. It occurs when the pressure in the bladder becomes too great for the bladder outlet to withstand. This is usually caused by weak pelvic floor muscles. Urine tends to leak most when you cough, laugh, sneeze or when you exercise (such as when you jump or run). Stress incontinence is common in women who have had several children, in obese people and with increasing age. Stress incontinence can occur in men who have had some treatments for prostate cancer. This includes surgical removal of the prostate (prostatectomy), and radiotherapy.

Urge incontinence (unstable or overactive bladder) is the second most common cause. This is when you get an urgent desire to pass urine. Sometimes urine leaks before you have time to get to the toilet. The bladder muscle contracts too early and the normal control is reduced. In most cases, the cause of urge incontinence is not known. Some people with certain neurological disorders may experience urge incontinence. Examples are Parkinson's disease, multiple sclerosis (MS), spinal cord injury and after stroke.

Mixed incontinence. Some people have a combination of stress and urge incontinence.

Overflow incontinence. This is when there is an obstruction to the outflow of urine. The obstruction prevents the normal emptying of the bladder. A pool of urine constantly remains in the bladder that cannot empty properly. This is called chronic urinary retention. Consequently, pressure builds up behind the obstruction. The normal bladder emptying mechanism becomes faulty and urine may leak past the blockage from time to time. Treatment depends on the cause.

What can be done about urinary incontinence?

Assessment

It is important to know which type of incontinence you have. Tell your doctor if you leak urine on a regular basis. He or she will be able to assess your symptoms, examine you, and may do some simple tests to try to clarify the cause.

  1. Urinalysis. This is a simple dipstick test to check for infection, glucose (sugar), blood or protein in urine. A urinary tract infection (UTI) can cause incontinence, particularly in older people. Diabetes causes sugar in the urine and may cause increased thirst and an increased desire to urinate.
  2. Residual urine. This test finds out if any urine is left in your bladder, and how much urine is left, after you have gone to the toilet. The amount of urine is usually measured using an ultrasound scan which can look at your bladder and measure the amount of urine in it.
  3. Vaginal and anal examination. A doctor or nurse may insert a gloved finger into the vagina and rectum. This can assess the strength and tone of the pelvic floor muscles. For men, the rectal examination can also assess the size of the prostate gland. For women, the doctor or nurse may also look for signs of pelvic organ prolapse during the vaginal examination.
  4. Urodynamics. These are tests of urine flow that are sometimes done in a hospital unit if the cause of the problem is not clear. Urodynamics may also be carried out where surgery is considered to treat the problem.

Treatment

Lifestyle changes may also significantly help some types of incontinence. These can include:

  1. Changing how much you drink.
  2. Changing what you drink. Drinks containing caffeine (for example, tea, coffee, hot chocolate and cola) make urge incontinence worse.
  3. Changing when you drink. You should try to maintain a normal life as much as possible with regard to drinking and visiting the toilet. However, drinking late at night may mean your sleep is disturbed by the desire to get up and go to the toilet.
  4. Weight loss. It has been shown that losing a modest amount of weight can improve urinary incontinence in overweight and obese women.
  5. Avoiding constipation. Try to maintain a healthy balanced diet that contains plenty of fruit, vegetables and soluble fibre. Severe chronic (long-term) constipation can stop the bladder emptying properly and cause overflow urinary incontinence (as well as faecal incontinence).

Specific Measures:

Based on the evaluation undertaken your urologist may decide to treat the condition medically or surgically. The various surgeries for incontinence are complex and beyond the scope of this discussion.


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