Urinary incontinence (the loss of bladder control) is a common and often embarrassing problem. The severity of this condition ranges from occasional leakage when you cough or sneeze to having an urge to urinate that’s so sudden and strong that you can’t hold until you get to a toile tin time.
Don’t hesitate to see your doctor if urinary incontinence affects your daily activities. Simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence in most people.
WHAT ACTIONS TRIGGER STRESS INCONTINENCE?
- A sudden cough
- Heavy lifting
The amount of urine that leaks out depends on how full the bladder is and how affected the muscles are.
SYMPTOMS OF URINARY INCONTINENCE
- Urge incontinence (reflex/effort incontinence): The second most common type of urinary incontinence. The condition means that the bladder is either unstable or overactive. A sudden, involuntary contraction of the muscular wall of the bladder (detrusor muscles) causes urinary urgency. An involuntary loss of urine occurs for no apparent reason while suddenly feeling the need or urges to urinate.People with this condition tend to pass urine frequently; sometimes having to get up to go to the toilet during the night.Bladder muscles are activated involuntarily due of damage to the nerves of the bladder, the nervous system or to the muscles themselves.The person has a very short time when the urge comes before the urine is released regardless of what they try to do. This urge may be caused by:
- A sudden change in position
- The sound of running water (for some people)
- Sex (especially during orgasm)
- Stress incontinence: The most common kind of urinary incontinence. This is especially true for women who have given birth or have gone through menopause.“Stress” in this case refers to physical pressure, rather than mental stress. The person may urinate involuntarily when the bladder and muscles involved in urinary control are placed under sudden extra pressure.
- Overflow incontinence: This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. The bladder may be obstructed by an enlarged prostate gland. The person often only manages to urinate in small trickles and has to go to the toilet frequently. There is a sensation that the bladder is never really completely emptied, even after trying hard. Some patients constantly dibble urine as opposed to frequently dribbles urine.
- Mixed incontinence: When a patient experience both stress and urge incontinence, they have mixed incontinence.
- Functional incontinence: In this case, the person knows there is a need to urinate but don’t make it to the bathroom in time due to mobility problems. An example would be if they have a disability they may not be able to pull their pants down in time. The amount of urine lost may be large.
Common causes are:
- Poor eyesight
- Poor mobility
- Poor dexterity (fail to unbutton pants in time)
- Depression,anxiety or anger (unwilling to go to the toilet)People experiencing this condition may have difficulties in thinking, moving or communicating. Functional incontinence is more prevalent among elderly people and is a common condition in nursing homes.This condition may occur even when there is nothing physically wrong with the person. For example, if you are on a long trip and dying to urinate but there are not toilets nearby.
- Gross total incontinence: Either the person leaks urine continuously all day and night or has periodic uncontrollable leaking of large amounts of urine. Basically, the bladder is unable to store urine.Sometimes the patients may have a congenital problem or there may be an injury to the spinal cord, an injury to the urinary system, or there may be a fistula between the bladder and, for example the vagina.
TREATMENT OPTIONS FOR URINARY INCONTINENCE
The type of treatment for urinary incontinence depends on the type of incontinence, severity and the underlying cause. A combination of treatments may be needed.
- Bladder training: Delay urination after you get the urge. At the start, you may begin by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal here is to prolong the time between trips to the toilet until you’re urinating only every 2 to 4 hours.
- Double voiding: Help you to learn how to empty your bladder more completely to avoid overflow incontinence. Double voiding is when you urinate, pause for a few minutes and then try urinating again.
- Scheduled toilet trips: Practice urinating every 2 to 4 hours instead of waiting for the need to go.
- Fluid and diet management:Helps to regain control of your bladder. During this time, you will have to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity can also help ease the problem.
PELVIC FLOOR MUSCLE EXERCISES
You may be recommended by your doctor to do pelvic floor muscle exercises (kegel exercises) frequently to strengthen the muscles that help control urination. These techniques are especially effective for stress incontinence but may also help to improve urge incontinence.
To do the Kegel exercise, just imagine that you’re trying to stop your urine flow. Here are the steps on how to do the exercise:
- Contract the muscles you would use to stop urinating and hold it for 5 seconds. Then relax for five seconds – If this is too difficult, you may start by holding for 2 seconds and relaxing for 3 seconds
- Gradually work up to holding the contractions for 10 seconds at a time
- Aim for at least 3 sets of 10 repetitions every day
Your doctor may suggest you work with a physical therapist or try biofeedback techniques to help you identify and contract the right muscles.
To stimulate and strengthen pelvic floor muscles, electrodes are temporarily inserted into your rectum or vagina. Gentle electrical stimulation can be effective for both stress incontinence and urge incontinence. However, you may require multiple treatments over several months.
Medications commonly used to treat this condition are:
- Anticholinergics: These medications are used to help calm an overactive bladder and may be helpful for urge incontinence. Example of medications include:
- Oxybutynin (Ditropan XL)
- Tolterodine (Detrol)
- Darifenacin (Enablex)
- Fesoterodine (Toviaz)
- Solifenacin (Vesicare)
- Trospium (Sanctura)
- Mirabegron (Myrbetriq): This medication relaxes the bladder muscle and may increase the amount of urine your bladder can hold. It may also help to increase the amount you are able to urinate at one go, which helps to empty your bladder more completely. This medication is used to treat urge incontinence.
- Alpha blockers: These medications help to relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder in men who are suffering from urge or overflow incontinence. Examples include :
- Tamsulosin (Flomax)
- Alfuzosin (Uroxatral)
- Silodosin (Rapaflo)
- Terazosin (Hytrin)
- Doxazosin (Cardura)
- Topical estrogen: Low-dose, topical estrogen (in the form of a vaginal cream), ring or patch are used to help tone and rejuvenate the tissues in the urethra and vaginal areas. This may help to reduce some of the symptoms of incontinence.
- Urethral insert: This is a small, tampon-like disposable device that is inserted into the urethra before a specific activity that may trigger incontinence (such as playing tennis). This device acts as a plug to prevent leakage and is removed before urination.
- Pessary: A pessary is a stiff ring that you insert into your vagina and wear throughout the day. It helps to hold up your bladder to prevent urine leakage. A pessary may benefit you if you experience incontinence due to a prolapsed bladder or uterus.
- Bulking material injections: The tissue surrounding the urethra is injected with a synthetic bulking material. It helps to keep the urethra closed and reduce urine leakage. This method is less effective compared to more invasive treatments such as surgery. This method usually needs to be repeated regularly.
- Botulinum toxin type A (Botox): Patients with the condition may also benefit from botox injections in the bladder muscle. This method is only prescribed to patients if other medications haven’t been successful.
- Nerve stimulators: Painless electrical pulses are delivered to the nerves involved in bladder control (sacral nerves) by a device resembling a pacemaker that’s implanted under your skin. Stimulation of the sacral nerves can help in controlling urge incontinence if other therapies haven’t worked. This device may be implanted in the skin of your butt and connected directly to the sacral nerves or via a nerve in the ankle.
When other treatments aren’t working, there are several surgical procedures that can treat the problems:
- Sling procedures: A pelvic sling around your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck) is created from strips of your body’s tissue, synthetic material or mesh. It will help to keep the urethra closed, especially when you cough or sneeze. This surgery is used to repair stress incontinence.
- Bladder neck suspension: Designed to provide support for your urethra and bladder neck. It’s performed during general or spinal anesthesia as it involves an abdominal incision.
- Prolapse surgery: Surgery may include a combination of a sling procedure and prolapse surgery for women with mixed incontinence and pelvic organ prolapse.
- Artificial urinary sphincter: In men, a small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter closed until the patient is ready to urinate. To pass urine, simply press a valve implanted under the skin. This will cause the ring to deflate and allow urine from your bladder to flow. This procedure is especially helpful for men whose incontinence is related to prostate cancer treatment or an enlarged prostate gland.
- History taking and physical exam: Your doctor will ask questions about the symptoms you have been experiencing and conduct a physical examination. Identifying the type of urinary incontinence that you have is extremely important as it will guide treatment decisions. You may then be instructed to do a simple movement that can demonstrate incontinence. For example, close your mouth, pinch your nose shut and exhale hard.
- Urinalysis: A sample of your urine is taken to be checked for signs of infection, traces of blood or other abnormalities.
- Bladder diary: This involves recording how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes for several days.
- Post-void residual measurement: This involves urinating (void) into a container. Your doctor will then check the amount of leftover urine in your bladder by using a catheter or ultrasound test. It may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles if there’s a large amount of leftover urine in your bladder.
- Urodynamic testing: A catheter is inserted into your urethra and bladder to fill your bladder with water while a pressure monitor will measure and record the pressure within your bladder. It measures your bladder strength and urinary sphincter health. It’s an important tool for determining the type of incontinence you may have.
- Cystoscopy: A thin tube with a tiny lens is inserted into your urethra. This will help your doctor to check for and possibly remove abnormalities in your urinary tract.
- Cystogram: A catheter into your urethra and bladder and injects a special dye into you. X-ray images of your bladder will help to reveal problems with your urinary tract as you urinate this fluid out.
- Pelvic ultrasound: In this ultrasound, your urinary tract or genitals are checked for abnormalities.