What is Urinary Incontinence

Urinary incontinence is the loss of voluntary control of the bladder causing leakage of urine. The temporary or chronic condition has multiple mechanisms and many causes. It can occur when you are straining (lifting objects, sneezing, coughing), when your bladder is full, or when you have a bladder infection. Each use has its own diagnostic methods and its own treatment plan.

A urinary tract infection is a careful balance between the pressure of your bladder to empty and the resistance of the sphincter (valve) in your output. The pressure to empty increases suddenly when the bladder reaches a certain volume.

The resistance of the sphincter depends not only on the strength of the muscle but also on its position. Both forces are controlled primarily by your autonomic (automatic) nervous system, the same system that regulates body temperature, heart rate, blood pressure, digestion, and everything else your body does without you thinking about it. However, you do have control over the sphincter and you can reinforce it with exercise.

In the United States, 20 million women have some form of urinary incontinence. This occurs daily or weekly in a quarter of women over 60 and half of women confined in institutions. Due to the anatomical differences in men and women, there is a substantial difference between the sexes and the incidence of the various types of incontinence. Because of the prostate gland, men have more problems with obstructive incontinence than with stress incontinence. Occasionally, prostate surgery can cause incontinence.

Further to this Article you will read:

• What are the causes of incontinence?
• What are the risk factors for urinary incontinence?
• What are the symptoms of urinary incontinence?
• How is urinary incontinence diagnosed?
• What are the treatments for urinary incontinence?
• Are there screening tests for urinary incontinence?
• How can I reduce my risk of urinary incontinence?
• What questions should I ask my health care professional?
• What is it like to live with urinary incontinence?
• Where can I get more information about urinary incontinence?

Urinary Incontinence Causes  

There are several types of urinary incontinence The causes vary depending on the type.

Temporary incontinence

Temporary incontinence can be caused by:

• Muscular weakness
• Medications
• Constipation
• Urinary infection
• Restricted mobility
• Unavailability of bathroom

Many medications can cause urinary problems, including anti-pressure pills blood pressure, sleeping pills, anti-indigestion medications and antidepressants. Consult your doctor if you suffer from incontinence and are taking this type of medication.

Non-temporary incontinence

The most permanent incontinence can be classified according to one of the following four types. Some people have a combination of these classes. In some cases, incontinence can have several different causes. Sometimes, the cause is not clear.

Stress incontinence

Stress incontinence occurs when certain activities increase the pressure on the bladder. The leak can be triggered by laughing, sneezing, lifting heavy objects or exercising. This is the most common type of incontinence and its causes are:

• Weakness of the muscles that support the bladder
• Weakness of the sphincter muscle that controls the urinary flow

Urgency incontinence

Urgency incontinence is the loss of control of the bladder followed by an urgent need to urinate. The person is not able to hold urine long enough to reach the bathroom. This is also known as overactive bladder. It can be caused by the following:

• Infection of the urinary tract
• Diabetes type 1 and 2
• Irritation of the bladder (calculation, tumor)
• Drugs, such as hypnotics or diuretics
• Caffeine
• Alcohol
• Nerves damaged due to:
• Injury spinal cord
• ACV
• Multiple sclerosis
• Parkinson's disease
• Constipation
• Excessive fluid consumption

Overflow incontinence

Overflow incontinence occurs when the bladder is full. The increased pressure generated by a full bladder exceeds the resistance of the valve that holds urine. It can be caused by the following:

• An obstruction in the bladder, such as that caused by a scar in the urethra (stenosis)
• Fecal retention
• Medications, such as antidepressants, hypnotics, antipsychotics, antihistamines and calcium antagonists
• Vitamin B12 deficiency
• Muscular weakness of the bladder
• Nerves damaged due to:
• Surgery
• Diabetes
• Spinal cord injuries

Other factors

When there is no control of the nerves over the bladder, as in the case of spinal cord injuries, the bladder empties when a certain volume is reached. This is called neurogenic bladder. If you suffer from this condition, you will learn to drain the urine periodically or permanently with a tube called a catheter, which is inserted directly into the bladder.

Functional incontinence

Bladder control may be perfectly normal, but any mental or physical condition that slows or confines it could result in an inadequate loss of urine. This is called functional incontinence.

Other causes of incontinence

Fistula

Occasionally, an abnormal channel called a fistula opens between the bladder and the outside world. This can be a congenital defect, the result of an injury or a surgical complication. The fistula causes continuous and uncontrolled dribbling of urine and can be surgically repaired.

Urinary Incontinence Risk Factors 

A risk factor is something that increases your chance of getting a disease or condition.

It is possible to develop chronic urinary incontinence with or without the risk factors listed below. However, the more risk factors you have, the greater your chance of developing urinary incontinence. If you have numerous risk factors, ask your health care professional what you can do to reduce your risk.

Although there are many different causes of incontinence, the risk factors mentioned here belong to the most common types of incontinence.

Medical Conditions

The following conditions increase your risk of developing incontinence:

• Childbirth (women)
• Prostate enlargement or prostate surgery (men)
• Dementia

Age

The risk of incontinence generally increases with age.

Sex

Women are more likely to develop stress incontinence. Men are more likely to develop incontinence related to obstruction and overfilling.

Urinary Incontinence Symptoms

Urinary incontinence is a symptom of other conditions. Any loss of voluntary control of the bladder can be considered incontinence.

Symptoms include:

• Urine leak triggered by laughing, sneezing, heavy lifting, or exercising
• A strong urge to urinate followed by loss of urine
• Inability to hold urine long enough to reach the bathroom
• Difficulty to start urinating
• Effort to empty the bladder
• Reduced flow of urine or 'drip'

Treatments for Urinary Incontinence

The treatment and control of urinary incontinence may involve simple exercises, medications, changes in lifestyle, or surgery. The goal of treatment is to stop the leakage of urine, or at least minimize it and the complications that arise from it.

The treatment involves the following:

Changes in lifestyle

Know Your Medications

Some medications (diuretics) can increase your urinary frequency for several hours until the effect decreases. Discuss with your doctor when it is the best time for you to take them and plan accordingly.

Try the Collectors and Pads

There are numerous devices available to catch urine. Small amounts can be controlled with sanitary napkins or special condoms (for men). Larger amounts can be absorbed by protective undergarments with high-tech coatings that prevent moisture from spoiling your skin. The use of collectors and pads along with scheduling your fluid intake can turn many incontinence problems into minor discomforts.

Use catheters as directed.

For hospitalized patients and people who have large amounts of urine leakage, it may be necessary to remove urine through a catheter. Most urinary catheters become infected when they are left inside more than a few days, so they are avoided whenever possible. If you have a neurogenic bladder, you will learn how to insert a catheter into your bladder periodically to empty it. In men, a condom attached to a catheter avoids the risk of infection. Sometimes a catheter is placed directly into the bladder through the abdominal wall.

If you have a catheter, you will be instructed to connect it, after you drain it when you get to the bathroom. Or, a bag will be attached to it that you can take with you and drain it periodically.

When to Contact Your Healthcare Professional

You can control the restriction of fluids, pads, and collection devices by yourself. However, catheters require frequent professional attention from specially trained nurses to handle the following problems:

• Filtration around the catheter
• Urine does not come out
• Increased pain, burning or urgency, which may be a sign of infection
• Bleeding

Medications

Miorrelaxers

Mirabegron (Myrbetriq)
This medication relaxes the soft muscles associated with the act of urinating. Possible side effects include the following:

• High blood pressure
• Cold symptoms
• Urinary infection
• Headache

Estrogens

Common names for topical estrogens include:

• Ogen
• Premarin
• Estrace
• Estring

Estrogens also they can be administered orally, injectable or transdermally, but topical is the best for this condition.

Estrogen is the hormone that stimulates and maintains the breasts, ovaries, uterus and vagina. Upon reaching menopause, estrogen levels fall substantially and these organs begin to age. The tissue that holds the bladder is the anterior wall of the vagina. If it weakens or stretches, the bladder falls out and stress incontinence can occur. The replacement of estrogen in the body rejuvenates the vaginal wall and can cure the drip.

Estrogen has both positive and negative effects. To avoid most of these side effects, estrogen for stress incontinence can be applied topically in the form of a vaginal cream.

Possible side effects include the following:

• The more rapid growth of other female cancers, such as breast and uterine cancer
• Gallbladder disease
• Blood clots
• High blood pressure

Botulinum toxin injections

Botulinum toxin type A can be injected directly into the muscles of the bladder during an outpatient procedure. In the case of people with urge incontinence, Botox can relax the muscles of the bladder.

Potential side effects include the following:

• Pain
• Infection
• Inflammation

Special Considerations

When estrogen is used differently than topical creams, consult your doctor to discuss the pros and cons. Also, if you have a medical condition, you may not be able to take certain medications. For example, some people with glaucoma can not use anticholinergics.

If you have bladder problems, you should contact your doctor before taking any other medication, including over-the-counter medications and herbal supplements. Many have urinary side effects.

If you are taking medication, follow these general guidelines:

• Take medications as directed. Do not change the amount or schedule.
• Do not stop taking them without talking to your doctor about it.
• Do not share medications.
• Ask what the results are and the side effects that may occur. Tell your doctor.
• Some medications can be dangerous when mixed. Talk to a doctor or pharmacist if you take more than one medication. This includes over-the-counter medications and food or herbal supplements.
• Plan replenishments in advance so you do not run out of medication.
• When to contact the doctor

Call the doctor if any of the following occurs:

• Have any concerns about estrogen treatment
• Side effects cause serious problems

Surgery

There are several surgical procedures for various types of incontinence. These procedures are reserved for people who have tried conservative treatments without success and are healthy enough to undergo surgery.
A general, regional, or local anesthesia will be administered, depending on the extent of the procedure.

Procedures for Female Incontinence by Effort

Retropubic Suspension – When the bladder or urethra has fallen out of place, this procedure is used to hold the tissue next to the bladder or urethra to the pelvis (bring the bladder or urethra back to the correct position). The procedure is called Marshall-Marchetti when the vaginal tissue is attached to the back of the pubic bone. It is called the Burch procedure when the vaginal tissue is attached to the side of the pelvis.
An incision is made in the lower part of the abdomen so that stitches can be placed.

Pubovaginal Fascial Sling – The surgeon holds a piece of resistant material, similar to the so-called fascial tendon around the neck of the bladder to prevent leakage of urine. Two incisions are made;
one through the vagina and one through the abdomen.

Suburethral Sling – When the urethra has fallen from its position or when the sphincter muscle of the urethra is weak, this procedure is used to place a sling under the urethra. The sling can be made of natural tissue or synthetic material. It acts as a hammock to support the neck of the bladder (where the urethra enters the bladder) and to prevent leaks. Some slings are attached to the pubic bone by stitches, while others are tied in front of the abdomen over the pubic bone.
Sling procedures are performed through small incisions in the vagina and abdomen.

Most Recent Procedures – New less invasive and safer suburethral procedures include tension-free vaginal tape (TVT) and transobturator tape (TOT). TVT is a mesh that is placed around the middle part of the urethra. A small incision is made in the vagina, and two small incisions are made in the abdomen. TOT is a similar procedure that involves a small incision through the vagina below the urethra and a small incision in each thigh.
Because the risks associated with an abdominal procedure are avoided, this approach may be safer in some cases.

Procedures for Male Urinary Incontinence

Sling for Men – The surgeon places a strip of material under the urethra to provide support and to prevent the urethra from spontaneously opening.
The ends of the strip are attached to the pelvic bone.

Artificial sphincter – The procedure helps men who have severe leakage of urine, often after prostate surgery, as a result of nerve damage, or due to weak sphincter muscles. An artificial sphincter is a device that keeps the urethra closed until you are ready to urinate. A soft device is placed around the urethra to gently tighten the closed urethra. A small pump is placed in the scrotum, which can be manually squeezed through the skin, transferring fluid into a small recipient balloon in the abdomen.
This allows urination to take place while the urine then flows through the urethra.

Sacral Nerve Stimulation

This procedure reduces urge incontinence. The surgery is carried out to place a thin wire with a small electrode tip in the lower part of the spine near the sacral nerve. A nervous stimulator continuously sends electronic impulses to the sacral nerve.
This nerve stimulation therapy creates a bladder pacemaker, which reduces or eliminates urgency incontinence.

Volume injections

When the sphincter muscle of the urethra is very weak, a substance called 'bulk material' is injected into the tissues around the urethra. This causes the sphincter to become narrower, and therefore increases resistance to leakage of urine. The volume material is organic collagen (a natural protein found in the body) or a synthetic substance composed of small zirconium droplets covered in carbon.
This is a non-invasive surgical procedure that involves an injection, which can be carried out in an outpatient setting under local anesthesia.

Bladder size Increase

When the bladder is too small to support the normal amount of urine produced by the kidneys, this complex reconstructive surgery can increase the size of the bladder and also its ability to stretch. A portion of the intestines or stomach is attached to the bladder. A general anesthetic is needed, while a large incision is made in the abdomen. Frequently patients will need to continuously use a catheter

Review for Urinary Incontinence

The purpose of the review is early diagnosis and treatment. In general, screening tests are given to people without current symptoms, but who may be at risk for certain diseases or conditions.

Currently there are no indications of revision for urinary incontinence.

Reducing Your Risk of Urinary Incontinence

Frequently, urinary incontinence is a symptom of another condition. It can not always be prevented. Women can reduce their chances of developing stress incontinence by doing Kegel exercises. This is especially useful in women who have given birth, because childbirth weakens the tissues around the bladder.

General Guidelines for Controlling Urinary Tract Infections

Drink Enough Water

Be sure to drink at least 8 eight-ounce glasses of water per day. Drinking enough water can help you get rid of the bacteria in your urinary system. It also helps eliminate antibiotics from your system.

Do not Withhold Urine

When you have the sensation of urinating, do so as soon as possible. Withholding urine can cause an increase in bacterial growth in the urinary tract.

Also, urinate before and after a sexual encounter.