Urinary incontinence is leaking of urine that you can't control. Many men and women suffer from urinary incontinence. People suffer silently since they are too embarrassed to come forward with their problem. Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don't want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.
Risk factors:
Aging, obesity, diabetes, stroke, high blood pressure, smoking, pregnancy, delivery, and number of children increase the risk in women.
Most commonly seen in old age, due to strain on the pelvic area during childbirth especially after normal delivery and after radiation treatment for cancer. The problem may be infrequent and minor, with just a few drops of urine lost when stress is put on the bladder or it could be severe resulting in leakage of large amounts of urine unexpectedly. Not all incontinence is long term. Some causes are temporary so that the incontinence ends when the cause goes away. Vaginal infections can cause temporary incontinence. Irritation, medications, constipation and restricted mobility can cause it. Urinary tract infections (UTIs) are a common cause of temporary incontinence and should be addressed.
What happens normally?
The brain and the bladder control urinary function. The bladder stores urine until you are ready to empty it. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed. This holds the urine in the bladder. The neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra. The urethra is the tube that carries urine out of the body. When the sphincter muscles keep the urethra closed, urine doesn't leak.
Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles contract. This forces the urine out through the urethra, the tube that carries urine from the body. The sphincters open up when the bladder contracts.
What are the types of urinary incontinence?
Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:
Stress Urinary Incontinence (SUI)
SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking may happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more.
The key symptom of SUI is leaking when you are active. The activity and amount of leaking depends on how severe the SUI is. SUI can be mild, moderate or severe.
Ways to manage SUI include "Kegel" exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.
Overactive Bladder (OAB)
OAB is another common type of urinary incontinence. It is also called "urgency" incontinence. With OAB, your brain tells your bladder to empty - even when it isn't full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate. The main symptom of OAB is the sudden urge to urinate. You can't control or ignore this "gotta go" feeling. Another symptom is having to urinate many times during the day and night.
OAB is more likely in men with prostate problems and in women after menopause. Treatment includes life style changes, drugs that relax the bladder muscle, or surgery.
Mixed Incontinence (SUI and OAB)
Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.
Overflow Incontinence
With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should. One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called "dribbling."This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.
Treatment of Urinary Incontinence:
Treatment for urinary incontinence depends upon the cause. The same treatment does not work in all cases. Diagnostic tests and imaging is done to determine why the bladder and associated muscles are not controlling the flow of urine. Causes may be problems in the muscles or in the nerves that control them. Certain types of prior surgery that interfere with the urethra (the tube that allows urine to pass out of the body) may also result in incontinence.
Treatments for urinary incontinence include:
• Strengthening pelvic muscles. Exercises can strengthen the muscles around the urethra that hold urine back. You can also develop a schedule for going to the bathroom, gradually extending this as you regain urinary control.
• Medicines. Bladder spasms may result in a frequent urge to go to the bathroom. Certain medicines can relax your bladder and give you more control over when you urinate.
• Surgery. With surgery, bladder can be repositioned, providing support and restoring control over the sphincter muscles, which hold back urine. Different materials are used to provide support like either your own tissues or synthetic or animal-based materials. Minimally invasive tools can be used to resolve incontinence like cystoscope or transurethral probe. Cystoscopes are small, flexible tubes containing cameras and sometimes other tools. They allow us to view and treat the urethra and bladder without an incision. Using the cystoscope, we can inject medicine to relax the bladder (Botox®). Transurethral probes may be used for imaging procedures, such as ultrasounds, or to deliver radiofrequency energy that stimulates the bladder.