Urinary incontinence

The urinary bladder is a sac like structure, hollow and muscular, which collects and stores urine excreted by the kidneys. When the bladder gets filled up with urine, a person gets the urge to urinate. However, there can be loss of bladder control, resulting in leakage of urine even before getting to the bathroom. This is known as urinary incontinence.

The urine may leak drop by drop, when you cough or laugh, or you may feel a sudden urge to pass a continuous amount of urine, and cannot make it in time to the restroom. This results in an awkward situation, but should not be ignored, and help must be sought to cure or control the incontinence.

Causes

There are several reasons for urinary incontinence in women, associated with age and lifestyle. Muscles of the urinary bladder and sphincter muscles around the urethra (tiny tube connected to the bladder and carries urine outside the body) may not be strong enough to hold the urine back.

In menopausal women, lack of estrogen can weaken and deteriorate the urethral tissue, resulting in bladder control problems.

During pregnancy and childbirth, there are lots of hormonal changes happening, along with an enlarged uterus causing weakened pelvic muscles. The stress of a vaginal delivery can cause organs to protrude into the vagina, causing incontinence.

Other causes for incontinence of urine include:

  • Constipation

  • Urinary tract infection

  • Alcohol and caffeine

  • Medications

  • Over hydration

  • Excess weight

  • Abnormal growths

  • Neuromuscular problems

Constipation and urinary tract infection are medical conditions, which on treatment can resolve incontinence.

Alcohol, caffeine, medications (for heart, blood pressure, sedatives), drinking lots of fluids and being obese can cause temporary or transient urinary incontinence. Hence, a change in lifestyle and habits can bring relief.

Abnormal growths may also lead to urinary incontinence, and include a tumor on the urinary tract, bladder stones, or polyps.

Neuromuscular problems can occur in diabetes mellitus, stroke, or multiple sclerosis, causing leakage of urine as the signals from the brain and spinal cord do not connect properly with the bladder and urethra. These result in long term incontinence.

Types of urinary incontinence

There are different types of urinary incontinence based on the symptoms exhibited.

Stress incontinence occurs when urine leaks as a result of sudden pressure on your lower stomach muscles. Coughing, sneezing, laughing, exercising, lifting heavy things, and such movements put pressure on the bladder, leading to this kind of incontinence. It is the most common type seen in younger and middle aged women, especially after pregnancy, childbirth and menopause, as a result of weakened tissues and muscles.

Urge incontinence happens when there is a strong desire to urinate and leakage of urine occurs before you can get to a bathroom. Here, the bladder muscles are overactive; hence this is also known as ‘overactive bladder.’ This is more common in older people, and those affected with brain disorders like stroke and dementia. Post menopausal women also experience this type of incontinence because of low estrogen levels.

Mixed Incontinence is seen as more than one kind of incontinence, the most common being a combination of stress and urge incontinence in older women. Urge and functional incontinence are also seen together as age progresses.

Overflow incontinence occurs when there is a steady leak of small amounts of urine. The bladder does not get emptied fully while urinating, which could be due to weak muscles or a blocked urethra. This is seen less commonly in women.

Functional incontinence is seen in people who cannot reach a toilet in time, as a result of thinking, moving or speaking issues. A mental disorder like dementia, or Alzheimer’s or physical immobility like a stroke or severe arthritis restricts the person from using a toilet.

It should be understood that urinary incontinence is not a condition to be accepted as part of bearing children and growing older. There are many changes that a woman’s body undergoes during pregnancy and childbirth.

At the same time, aging can make you to urinate more often as the bladder’s capacity to hold urine declines. All this can be controlled and cured with the proper guidance and treatment.

To help diagnose the right type of urinary incontinence, a bladder diary for at least 3 days should be maintained to record the intake of fluids, the frequency of urination, the urges experienced, and the number of incontinence episodes.

A laboratory analysis of urine and blood sample will be done to test for infection.

A physical examination to determine any damage to the nerves leading to the bladder, or any other abnormalities is carried out.

Other specialized tests include postvoid residual measurement (to check leftover urine in the bladder), pelvic ultrasound, urodynamic tests (to measure bladder strength), stress test, dye test, cystogram (X-ray of the bladder), and cystoscopy.

Based on the history and diagnosis, the doctor will determine the best urinary incontinence treatment.

Behavioral remedies like bladder training and Kegel exercises (pelvic muscle exercises) along with lifestyle changes, may be enough to treat the condition. Bladder training helps to control the urge to urinate, and set the number of times the patient visits the bathroom.

Kegel exercises helps to stop urine flow by teaching how to train the pelvic floor muscles, which helps in stress and urge incontinence. To know whether the right muscles are squeezed, the urine flow has to be stopped or slowed down without using the stomach, leg or buttock muscles. The muscles should be squeezed, and held for a few seconds. After that, the muscles should be relaxed, and the process can be repeated, gradually increasing the hold to more counts. These are specially designed for women and best done lying down initially. As the muscles get stronger, the exercises can be done standing or sitting. It is best to learn these exercises from a qualified trainer.

Biofeedback will also help to identify and contract the correct muscles, by placing sensors and measuring on a monitor. In people, who cannot perform the exercises, electro stimulation can be done to strengthen the muscles.

Lifestyle changes like losing weight, reducing caffeine intake, drinking the right amount of water, scheduling urination (timed voiding) will help fight incontinence.

To ease the discomfort of leaking urine, absorbent pads and adult diapers are available at drug stores.

Medications can be prescribed along with behavioral therapy. They help relax the bladder and prevent sudden contractions

Estrogen creams are available to apply in the vagina for mild stress urinary incontinence. Surgery is an option when other treatments are not working.

Certain lifestyle changes would help to ease pain and discomfort. These include:

  • Taking adequate rest
  • Lying down to keep the scrotum elevated
  • Applying cold packs to your scrotum
  • Wearing an athletic supporter
  • Avoiding lifting of heavy objects
  • Abstaining from sexual contact