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Urinary Incontinence

Overview

Urinary incontinence is a prevalent and occasionally unpleasant issue. The intensity might vary from sometimes dribbling urine to having a sudden, intense desire to urinate. Urinary incontinence is not a natural part of becoming older, even though it happens more frequently as individuals age. Most people may address their urinary incontinence symptoms with easy lifestyle adjustments or medical attention. Visit your healthcare provider if it causes difficulty in day-to-day activities.

Types

Stress incontinence

Urine leaks when you strain your bladder by laughing, sneezing, coughing, working out, or lifting anything heavy.

Urge incontinence

You have an abrupt, strong desire to urinate followed by an uncontrollable urine flow. You can have frequent urination needs, even at bedtime. A viral infection, a more serious illness like diabetes, or a neurological issue may cause urge incontinence.

Overflow incontinence

 You often or continuously urinate or dribble because your bladder doesn't empty completely.

Functional incontinence

You can't go to the bathroom quickly due to a physical or psychological handicap. For instance, you might not be unable to unzip your jeans quickly enough if you have bad arthritis.

Mixed Incontinence

If you have more than one form of urinary incontinence, you often have both urge and stress incontinence.

Causes

Urinary Incontinence causes include:

·         Excessive bladder muscle activity

·         Complications following surgery

·         Weakened muscles in the pelvic region.

·         Injury to the nerves that govern bladder function.

·         Other bladder problems such as long-term bladder inflammation.

Signs And Symptoms

Clinical features of urinary incontinence are as follows:

·         Drops of urine leaking while laughing, sneezing, coughing, or working out

·         Experiencing sudden, overwhelming urges to pass urine

·         A lot of urine

·         Many night-time awakenings for urination.

·         Night-time urination

Diagnosis

History and examination

Your physician will do a medical examination and inquire about your prior health in order to determine the reason for your urine incontinence. Your physician will ask what you drink and how much. You'll also be questioned about how much, how frequently, and how much of your pee leaks. If you record these details using a urine diary for three or four days before your doctor’s appointment, it could be simpler for you to give answers. Your doctor could ask you if you drip urine while you cough during standing. You will probably undergo extra testing if your doctor believes there may be more than one explanation for your issue.

Urinalysis and culture

These tests detect blood or glucose in your urine and urinary tract infections. It can also reveal a man's prostatic condition.

Bladder stress test

It mimics the unintentional urination that might happen when you laugh, sneeze, cough, or exercise.

Pad test to quantify leakage

This can demonstrate the amount of urine leakage. A weighted water-absorbing pad is provided to you. You use the pad until the urine leaks, bringing it for another weigh-in. The pad's increased weight estimates the amount of urine leakage.

Imaging

It can be used to look at how the kidneys and urethra move when you urine, cough, or exert yourself.

Urodynamic testing

It is usually carried out only when a procedure is being planned or after all other treatments fail. These tests include:

·         Uroflowmetry

·         Pressure-flow study

·         Residual volume after voiding

Cystometry

These are several tests to evaluate bladder pressure at various stages of fullness.

Electromyogram (EMG).

The electrical impulses of muscles are monitored during this examination.

Cystoscopic examination

Using a tiny, illuminated tube, your physician can perform this test to view the interior of the urinary system.

Voiding Cystourethrogram

An X-ray of the urinary system is taken while you are urinating.

Treatment

Depending on the type you suffer from and how much it interferes with your life, you may need treatment for urine incontinence.

Medications

Anticholinergic drugs

These can aid with urge incontinence and can relax an overactive bladder. Oxybutynin, tolterodine, darifenacin, solifenacin, and trospium chloride are a few examples.

Mirabegron

This medicine can increase the quantity of urine your bladder can retain and is used to manage urge incontinence. It relieves the muscles of the bladder. Additionally, it could allow you to pass more frequently, which would help empty your bladder.

Alpha-blocker medications

These drugs loosen up the prostate and the bladder neck, making it simpler for men with urge incontinence or overflow incontinence to empty their bladder. Tamsulosin, alfuzosin, and doxazosin are a few examples.

Topical estrogen

Toning can be aided by using a vaginal cream, rings, or patches containing trace amounts of estrogen.

Procedure

Electrical stimulation

Temporary electrodes are put into the rectum or vagina to stimulate the pelvic floor. Both urge incontinence and stress incontinence may benefit from modest electrical stimulation.

Medical equipment

Urethral inserts and pessaries are two devices used to treat incontinence in females.

Injecting bulk materials

The urethral tissue is infused with a synthetic substance. In general, more aggressive procedures like surgery are more successful than this method for treating stress incontinence.

Botox

People with hyperactive bladders and urge incontinence may improve from Botox injections into the bladder muscle.

Nerve stimulants

These gadgets activate the bladder control neurons using painless electric signals.

Sling techniques

A pelvic sling is constructed around your urethra and the region of enlarged muscle where the urethra joins the bladder using synthetic material.

Suspension of the bladder neck

Your bladder and urethra neck will be supported by this method.

A prolapse procedure

Surgery may incorporate a sling treatment with prolapse surgery in patients with pelvic floor prolapse and mixed incontinence.

An artificial sphincter in the bladder

A tiny, fluid-filled band is inserted around the bladder neck to maintain the urinary sphincter closed until the need to urinate.

Prognosis

Urinary incontinence might have an undesirable impact if it is not treated well. Urine exposure to exposed skin for an extended period of time damages the skin and can cause contact dermatitis. If neglected, these skin conditions can lead to secondary infection, bed sores, and ulceration.

Lifestyle Modifications

·         Do not wash or towel frequently since this might wear down your body's natural bladder infection resistance. After cleaning yourself with a cloth, let your body air-dry.

·         To shield your skin from urination, think about applying a layer of lotion-like cocoa butter or moisturizer.

·         Consult your doctor about urine removal products that are designed specifically for you and may not be as irritating as other products.

·         If you experience urge incontinence or overnight incontinence, move any carpets or objects that you could fall over or bump into while going to the bathroom.

·         If you have functional incontinence, you could use a raised toilet seat and install a side toilet in your bedroom.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on June 02, 2023.

References

Urinary incontinence - NHS (www.nhs.uk)

https://www.nhs.uk/conditions/urinary-incontinence/

Incontinence: Symptoms & Treatment - Urology Care Foundation (urologyhealth.org)

https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence

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