WHAT IS A URINARY INCONTINENCE ?
Urinary incontinence ( UI ) is the loss of complete control over your bladder causing leakage of urine. Symptoms can range from mild leaking to frank wetting.
Many women and men suffer from urinary incontinence. A lot of people do not tell anyone about their symptoms as they are embarrassed, or they may think nothing can be done. Urinary incontinence is not just a medical problem. It can affect one’s emotional, psychological and social life. Many people with this problem are afraid to carry on their normal daily activities.
Urine leaks out before you can get to a bathroom. Some women may lose a few drops of urine when they cough or laugh. Others may feel a sudden urge to urinate and cannot control it. Urine loss can also occur during sexual activity and can cause great emotional distress.
CAUSES OF URINARY INCONTINENCE
UI is usually caused by problems with muscles and nerves that help to control (hold or pass) urine. Urine is stored in the bladder. It leaves the body through a tube that is connected to the bladder called the urethra. Muscles in the wall of the bladder contract to force urine out through the urethra. At the same time, sphincter muscles around the urethra relax to let the urine pass out of the body. Incontinence happens if the bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine.
UI is twice as common in women as in men. This is because of pregnancy, childbirth, and menopause. However, both women and men can become incontinent from brain injury, birth defects, stroke, diabetes, multiple sclerosis, and physical changes associated with ageing. Other causes that can affect both the sexes include chronic constipation, urinary tract infections, obesity, excessive consumption of caffeine/alcohol or with certain medications.
TYPES OF URINARY INCONTINENCE
- Stress Incontinence
Stress incontinence is the leaking of small amounts of urine during activities that increase pressure inside the abdomen and push down on the bladder. Stress incontinence is most common with activities such as coughing, sneezing, laughing, walking, lifting, or playing sport. Other factors contributing to stress incontinence include diabetes, chronic cough (linked with asthma, smoking or bronchitis), constipation and obesity.
This is the most common type of incontinence in women. It is often caused by physical changes from pregnancy, childbirth, and menopause. Men may develop it after a prostate surgery.
- Urge Incontinence / Overactive bladder
Urge incontinence is a sudden and strong need to urinate.
In a properly functioning bladder, the bladder muscle (detrusor) remains relaxed as the bladder gradually fills up. As the bladder gradually stretches, we get a feeling of wanting to pass urine when the bladder is about half full. Most people can hold on after this initial feeling until a convenient time to go to the toilet arises. However, if you are experiencing an overactive bladder and urge incontinence, the bladder may feel fuller than it actually is. This means that the bladder contracts too early when it is not very full, and not when you want it to. This can make you suddenly need the toilet and perhaps leak some urine before you get there. Leakage usually happens after a strong, sudden urge to urinate. This may occur when you don't expect it, such as during sleep, after drinking water, or when you hear or touch running water.
- Functional Incontinence
Functional incontinence is when a person does not recognise the need to go to the toilet or does not recognise where the toilet is. People with this type of incontinence may have problems thinking, moving, or speaking that keep them from reaching a toilet. For example, a person with Alzheimer's disease may not plan a trip to the bathroom in time to urinate. A person in a wheelchair may be unable to get to a toilet in time.
- Overflow Incontinence
This happens when a person experiences frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
- Mixed Incontinence
In this, a person may have two or more types on incontinence at the same time.
DIAGNOSIS OF URINARY INCONTINENCE
It's important to determine the type of urinary incontinence that you have as this information will decide the line of treatment. Your doctor will take your medical history and do a physical examination. You may be asked to cough to see if urine leaks.
In addition, you may be advised one or more of the following tests :
- Urinalysis - A sample of your urine is checked for signs of infection, traces of blood or other abnormalities.
- Post void residual measurement - This is done to assess how much urine is left in your bladder after you voluntarily empty your bladder. Nowadays, this is usually done by carrying out an ultrasound scan of your bladder.
- Urodynamic Tests - These are a group of tests used to check the function of your bladder and urethra.
- Cystoscopy - A thin, lighted tube with a lens at the end is used to look inside the bladder and urethra.
- Pelvic Ultrasound - This may be advised if your doctor suspects any abnormality within the pelvis.
If you have just been diagnosed with incontinence, you're probably feeling anxious and overwhelmed about how to manage those occassional accidents. The treatment you receive will depend on the type of incontinence you have, and the severity of the symptoms.
MODIFICATIONS IN LIFESTYLE
- Lose weight.In overweight women, losing weight has been shown to decrease the frequency of urine leakage.
- Avoid constipation. Repeated straining will worsen incontinence.
- Limit intake of caffeine ( present in coffee, tea and cola ), which is a diuretic.
- Alter your fluid intake. Too much or too less of fluids will worsen incontinence.
- Seek treatment for chronic coughing.
- Quit smoking.
BLADDER BEHAVIOUR TECHNIQUES
1. Bladder Training
Bladder training is basically an attempt to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every two to four hours. After a few weeks of this training, leakage may occur less often.
2. Managing fluid intake
As discussed earlier, this involves limiting intake of diuretics like caffeine and wisely scheduling your fluid intake according to your lifestyle.
3. Double voiding
Double voiding means passing urine, then waiting a few minutes and trying again. It helps you to learn to empty your bladder more completely.
PELVIC FLOOR EXERCISES
Pelvic floor muscles are the muscles you use to control the flow of urine as you urinate. They surround the bladder and urethra (the tube that carries urine from the bladder to the outside). Your doctor may recommend that you do exercises to strengthen these muscles. They are also known as Kegels exercises and are especially effective for stress incontinence but may also help urge incontinence. Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life.
Biofeedback is a way to monitor how well you are doing the pelvic floor exercises by giving you feedback as you do them. The probes attached to the body sense when the muscles are squeezed and send the information to the monitor.
1. Sling surgery
When you urinate, a circular-shaped muscle ( sphincter ) around your bladder relaxes and releases urine into a tube called the urethra. Strips of your body's tissue, synthetic material or mesh are used to create a pelvic sling around your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling helps keep the urethra closed, especially when you cough or sneeze. This procedure is especially useful in stress incontinence.
2. Pelvic Organ Prolapse Suspension Surgery ( P.O.P.S. )
In some of the cases in females, the incontinence is a result of genito-urinary prolapse in which the urinary bladder descends down into the vagina resulting in incontinence. This is corrected with an advanced surgical technique known as Pelvic Organ Prolapse Suspension Surgery ( P.O.P.S. ). This technique was devised by the world renowned Colorectal surgeon, Dr. Antonio Longo ( Italy ). Having mastered the surgery from Dr. Longo himself, Dr. Ashwin Porwal routinely treats his patients with P.O.P.S. and the results have been rather encouraging.