Urinary Incontinence ( Involuntary Passage of Urine ): Types, Causes, Diagnosis & Treatment

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Urinary incontinence is the Involuntary passage of urine or passing of urine when you don’t want to urinate. In these cases, control over the urinary sphincter is either weakened or lost. It is a much more common problem in the world than we think. People having urinary incontinence feels its embarrassing and are often limited to their home. They feel awkward in socialization. This ranges from occasions where you leak urine while coughing, Sneezing etc. to a strong sensation to pass urine that you often do not reach to the toilet and pee on your pants on the way to the toilet. It affects daily life activities of an individual and is socially embarrassing.

Types of Urinary Incontinence

 Types of urinary incontinence  are as follows:

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  • Urge Urinary Incontinence
    In this type involuntary leakage of urine is associated with strong desire to pass urine. It is due to the overactive urinary bladder.
  • Stress  Urinary Incontinence
    This includes involuntary leakage of urine with sudden pressure on the urinary bladder as such with coughing, Sneezing. It is more common in females.
  • Mixed Urinary Incontinence
    It is associated with both urge and stress urinary incontinence.
  • Overflow Urinary Incontinence
    Involuntary leakage of urine associated with the loss of controlling ability of the urinary bladder and because of bladder outlet obstruction resulting in incomplete emptying of the urinary bladder and retention of urine.
  • Functional Urinary Incontinence
    Here, The urinary bladder’s capacity to store and empty urine is intact, but the involuntary leakage is associated with the functional, Cognitive and mobility difficulties which bar them from the use of the toilet. Physically and Mentally handicapped people are often found to have functional urinary incontinence.

Causes of Urinary Incontinence

  • Stress incontinence occurs due to the weakness of the pelvic floor muscles (often as a result of childbirth) a chronic cough, Obesity, Advancing age etc.
  • Other causes of urinary retentions are urethral stenosis, Foreign bodies (for example Ring pessaries) constipation, Bladder stone, urethral carcinoma, Uterine fibroid, Prolapse of pelvic organs etc.
  • Reversible causes include urinary tract infections, Side effects of drugs, Alcohol consumptions, Caffeine intake, Severe constipation, Atrophic vaginitis etc.
  • Disease such as Diabetes may also cause urinary incontinence.
  • Cancer of brain and spinal cord affects nerve, which controls the bladders and pelvic muscle causing urinary Incontinence.

Complications of Urinary Incontinence

  • The long-term urinary incontinence may result in rashes, skin infection and sometimes sores due to the presence of constantly wet skin.
  • It also increases the risk of repeated urinary tract infections.

Urinary incontinence brings the foul smell from the clothes which leads to a person being embarrassed in a working environment. It also affects the psychology of the people working with you and hence affecting your relationships with them.

Management of Urinary Incontinence:

  • You may limit the amount of fluid intake, particularly the consumption of alcohol and coffee.
  • Passing urine before bedtime and before performing physical exercise reduces the degree of urinary incontinence.
  • Losing weight helps in reducing the pressure on the bladder and its supporting muscles.
  • Avoid smoking: Cigarettes contain nicotine which irritates the bladder and avoiding smoking also helps in reducing the frequency of coughing which reduces the incidence of stress urinary incontinence.
  • Use of pads which absorbs the urine helps you in avoiding social stigma.
  • Kegel exercise: This includes exercise to tighten the muscles which help to stop the flow of the urine. During this exercise muscles of abdomen thigh and buttock should be relaxed.

Diagnosis

  • Keeping a journal where you record the time when you urinated, Frequency(how often) and amount of urine passed (how much).
  •  Routine examination of urine and urine culture to look for urinary infections as well as other causes.
  • Stress test:- In this test, You are asked to keep the bladder full and then you are asked by the medical practitioner to cough as much as possible.
  • Ultrasonography:- Visualization of the parts of the urinary bladder by using sound waves as well as other parts of the urinary system which are responsible to hold urine.
  • Cystoscopy is an endoscopic device which uses a camera to visualize the urinary bladder to find out the causes.
  • Cystogram:- It is an imaging test which uses x-ray to diagnose the problems of the urinary bladder.

Treatment

Treatment of urinary incontinence depends upon the type and severity of incontinence and the causes which lead to the leakage of urine or duration of incontinence. A single type or a combination of these may be needed to treat urinary incontinence.  In most of the cases, 2 or 3 of these are advised.

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  1. Bladder training
                 It includes delaying of urination after you feel the desire to urinate. Every time you feel a strong desire to pass urine, hold it for 10 minutes. This training should not be stopped until you achieve the good of going to the toilet for urination every two to four hours.
  2. Double micturition
                 Passing of urine then again trying to pass urine after 5-10 minutes. This helps incomplete evacuation of the urinary bladder.
  3. Fluid management
                 Decrease consumption of fluids mainly alcohol and coffee may help you to regain your bladder control.
  4. Pelvic floor muscle exercise
               It is also known as Kegel’s exercise. It includes tightening of the muscles used for holding the urine for five seconds and then relaxing it for the next five seconds. The aim is to hold urine for at least 10 seconds. This exercise should be done in three sets, Ten times daily.
  5. Electrical stimulation
            Insertion of electric rods into the vagina or rectum to strengthen the pelvic floor muscles.
  6. Drugs such as tamsulosin, Alfuzosin, Terazosin can be given to male patients to relax the muscles of the prostate and neck of the urinary bladder. Use of local steroids in low dose in the form of the vaginal cream maintains the tone of pelvic floor muscles in females.
  7. Medical devices such as urethral insert can be used to treat women with incontinence.
  8. Interventional therapies like the injection of Botulinum toxin which helps to calm the overactive urinary bladder. Injection of bulking material helps to keep the urethra closed and reduce urinary incontinence.
  9. Surgical treatment is usually done when no other options were beneficial or failed their indication.
  10. Insertion of catheters to drain urine can also be done.

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