Urinary incontinence

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

Urinary incontinence, a common and often awkward problem, varies in severity. It can manifest as occasional minor leakage when coughing or sneezing, or as a sudden, strong urge to urinate that makes it difficult to reach a restroom in time.

While urinary incontinence becomes more common with age, it’s important to note that it isn’t an inevitable aspect of getting older. If urinary incontinence starts affecting your daily life, it’s recommended to consult a doctor without hesitation. The majority of individuals can manage their urinary incontinence symptoms through simple dietary and lifestyle modifications or by seeking medical intervention.

Symptoms

Incontinence is primarily characterized by the unintentional release of urine. This can manifest as a continual trickle of urine or occasional instances of leakage. Those affected by incontinence may encounter varying volumes of leaked urine, ranging from significant amounts to smaller quantities.

You might leak urine when you cough, sneeze, laugh, feels the urge to urinate but could not reach the toilet, have the feeling of urinating at night, or when you are working out.

Urinary incontinence comes in a variety of forms.

Stress incontinence. When you put strain on your bladder through coughing, sneezing, laughing, working out, or lifting anything heavy, urine leaks.
Urge incontinence. A sudden, strong urge to urinate strikes, followed by an uncontrollable leak of urine. It’s possible that you’ll need to urinate frequently, even at night. A mild condition like an infection or a more serious one like diabetes or a neurological issue can both contribute to urge incontinence.
Overflow incontinence. You often or continuously urinate because your bladder doesn’t entirely empty.
Functional incontinence. You cannot get to the bathroom quickly due to a physical or mental impairment. For instance, you might not be able to unbutton your jeans quickly enough if you have severe arthritis.
Mixed incontinence. You have more than one form of urine incontinence; this typically means that you have both urge and stress incontinence.

Discussing incontinence with your doctor could feel uncomfortable, but it’s essential to prioritize medical attention if incontinence happens regularly or significantly diminishes your quality of life. This is important because urinary incontinence has the potential to:

Point to an underlying condition that is more severe.
Lead to you limiting your hobbies and social connections
Older people who rush to the bathroom have a higher risk of falling
Have a negative effect on your quality of life

Causes

Consistent routines, underlying medical conditions, or physical factors can all play a role in causing urinary incontinence. Your doctor will conduct a comprehensive assessment to determine the underlying cause of your incontinence.

Temporary urinary incontinence

Drinks, diet, and drugs that stimulate the bladder and increase urine production are known as diuretics. They consist of:

Vitamin C in high doses
Drinks such as carbonated or sparkling, caffeine, chocolate, alcohol, or artificial sweeteners.
Foods heavy in acid, sweetness, or spice
Sedatives, muscle relaxants, and drugs for high blood pressure and the heart
Chili peppers

Another disorder that is easily managed and may contribute to urinary incontinence is:

Urinary tract infection. Strong impulses to urinate and, occasionally, incontinence can result from infections irritating your bladder.
Constipation. The bladder and the rectum are close neighbors and have many similar nerves. These nerves become overactive as a result of hard, compacted feces in your rectum, which raises the frequency of your urination.

Persistent urinary incontinence

Originating from underlying physical factors or changes, urinary incontinence, being a persistent condition, can encompass:

Childbirth. Following vaginal delivery, a weakened pelvic floor, also known as prolapse, can occur. This can adversely affect the muscles necessary for bladder control and damage the bladder’s nerves and supportive tissues. Prolapse can lead to the protrusion of the bladder, uterus, rectum, or small intestine into the vagina due to their displacement from their usual positions. Such protrusions might be associated with incontinence.
Age changes. Bladder muscle aging can diminish the capacity of the bladder to retain urine. As you age, there is an increase in the frequency of involuntary contractions of the bladder.
Menopause. Estrogen, a hormone that aids in maintaining the health of the lining of the bladder and urethra, is produced less by women after menopause. Damage to these tissues might make incontinence worse.
Pregnancy. Stress incontinence can be brought on by hormonal changes and the fetus’s increased weight.
Obstruction. Overflow incontinence can result from a tumor anywhere along the urinary system blocking the normal flow of urine. Urine leakage can occasionally result from urinary stones, which are hard, stone–like masses that develop in the bladder.
Neurological disorders. Urinary incontinence can be brought on by multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor, or a spinal injury that disrupts the nerve signals that control bladder function.
Enlarged prostate. Incontinence frequently results from benign prostatic hyperplasia, an enlargement of the prostate gland that is more common in elderly men.
Prostate cancer. Men who experience urge or stress incontinence may also have untreated prostate cancer. However, incontinence is more frequently a side effect of prostate cancer therapy.

Risk factors

Several factors influence your susceptibility to experiencing urinary incontinence:

Age. Your bladder and urethra’s muscles deteriorate in strength as you age. Your bladder’s capacity decreases as you age, increasing the likelihood of an unintentional urine leak.
Gender. Stress incontinence is more common in women. This discrepancy can be attributed to normal female anatomy, menopause, pregnancy, and childbirth. However, men who have issues with their prostate gland are more likely to experience urge and overflow incontinence.
Heredity. Your chance of acquiring urine incontinence increases if a close relative has it, particularly urge incontinence.
Obesity. Being overweight puts more strain on the muscles that surround and support your bladder, weakening them so that pee can seep out when you cough or sneeze.
Some diseases. Your risk of incontinence may rise if you have diabetes or neurological disorders.
Smoking. Use of tobacco products may make you more susceptible to incontinence.

Diagnosis

Recognizing the specific type of urinary incontinence you’re dealing with is essential, and often your symptoms can provide valuable insights for your doctor. This understanding will play a role in determining the most suitable treatment options.

Your medical provider will likely commence with a thorough physical examination and medical history assessment. Subsequently, you might be requested to carry out a prompt activity, like a cough, which can reveal instances of incontinence.

Your doctor will probably then advice:

Bladder diary. You keep a log of your daily activities for a few days, noting how much you drink, when you urinate, how much urine you make, if you had the need to urinate, and how many times you experience incontinence.
Urinalysis. Your urine sample is examined for any abnormalities, blood traces, or other indicators of infection.
Postvoid residual measurement. A container is provided for you to urinate (void) into in order to measure your urine flow. The remaining urine in your bladder is then measured by your doctor using an ultrasound or catheter. If you have a lot of pee in your bladder after urinating, you may have a blockage in your urinary tract or an issue with your bladder’s nerves or muscles.

In cases where more extensive information is required, your healthcare provider might suggest more comprehensive assessments like urodynamic testing, cystoscopy, and pelvic ultrasound. These examinations are typically conducted when surgical options are being considered.

Treatment

The approach to treating incontinence is influenced by its type, severity, and underlying cause. Sometimes, a combination of treatments may be necessary. If an underlying condition is identified as the root cause of your symptoms, your doctor will prioritize addressing that matter.

Your physician might suggest beginning with less invasive treatments and progressing to alternative options if these initial methods prove ineffective.

Behavioral techniques

The following may be recommended by the doctor:

Make a scheduled of urinating every two to four hours instead of delaying until the urge arises.
Bladder training, to postpone urination once you feel the desire. Initially, you might try to resist the urge to urinate for 10 minutes at a time. The objective is to increase the interval between bathroom visits until you only need to urinate every 2.5 to 3.5 hours.
Double voiding, to assist you in learning to completely empty your bladder in order to prevent overflow incontinence. Double voiding entails urinating, waiting a little while, and then attempting again.
Controlling your intake of food and drinks, to take back command of your bladder. Alcohol, caffeine, and foods high in acid may need to be restricted or avoided. Losing weight, upping physical exercise, or cutting back on liquid intake can all help.

Pelvic floor muscle exercises

To strengthen the muscles that aid in urine control, your doctor might advise that you perform these exercises frequently. These methods, sometimes referred to as Kegel exercises, are particularly helpful for stress incontinence but may also reduce urge incontinence.

As you perform pelvic floor exercises, visualize yourself trying to halt the flow of pee. Then:

For five seconds, tighten (contract) the muscles you would use to stop peeing. Then, let them loosen for five seconds. (If this seems too challenging, begin by holding for two seconds and then relaxing for three.)
Practice holding each contraction for 10 seconds to eventually do so.
Aim to complete at least three sets of 10 reps each day.

Your healthcare provider might recommend collaborating with a pelvic floor physical therapist or experimenting with biofeedback techniques. These approaches can aid you in identifying and engaging the appropriate muscles effectively.

Medications

Commonly prescribed medications for managing incontinence include:

Topical estrogen. Toning and rejuvenation of tissues in the urethra and vaginal areas may be aided by the topical application of low–dose estrogen in the form of a vaginal cream, ring, or patch.
Anticholinergics. These drugs can control an overactive bladder and possibly aid with urge incontinence. These include trospium chloride, oxybutynin, tolterodine, darifenacin, fesoterodine, and solifenacin.
Alpha blockers. These drugs relax the muscles in the prostate and the bladder neck, making it simpler for men with urge incontinence or overflow incontinence to empty their bladder. Examples include doxazosin, silodosin, alfuzosin, and tamsulosin.
Mirabegron. This medicine can increase the amount of urine your bladder can hold and is used to treat urge incontinence. It relaxes the bladder muscle. Additionally, it might increase the amount of urine you urinate at a time, which would help you completely empty your bladder.

Electrical stimulation

To stimulate and strengthen your pelvic floor muscles, temporary electrodes are inserted into either your rectum or vagina. This mild electrical stimulation can be beneficial for both urge incontinence and stress incontinence, although multiple sessions spaced over several months might be necessary.

Medical devices

Devices made to cure incontinence in women include:

Pessary, a flexible silicone ring that fits around your vagina and is worn continuously. Women who have vaginal prolapse can also utilize the device. The urethra is supported by the pessary, which helps to stop urine leakage.
Urethral insert, a tiny, disposable item shaped like a tampon that is put into the urethra prior to a certain activity that can cause incontinence, such playing tennis. The insert serves as a stopper to stop leaks and is taken out before to urinating.

Interventional therapies

The following are some interventional treatments for incontinence:

Bulking material injections. The urethral surrounding tissue is injected with a synthetic substance. The bulking substance prevents urine leaks by keeping the urethra tight. In general, more intrusive procedures like surgery are more effective than this method for treating stress incontinence. It might be necessary to repeat it more than once.
Botox. People with overactive bladders and urge incontinence may benefit from Botox injections into the bladder muscle. People are often only given Botox prescriptions if other treatments have failed.
Nerve stimulators. The sacral nerves, which control bladder function, are stimulated by two different types of devices using painless electrical pulses. One version connects to wires on the lower back through an implant beneath the skin in the buttock. A detachable plug that is put into the vagina is the alternative. If various treatments have failed to reduce overactive bladder and urge incontinence, the sacral nerves can be stimulated.

Surgery

If alternative treatments prove ineffective, various surgical approaches can target the underlying causes of urinary incontinence:

Sling procedures. A pelvic sling is made from synthetic material (mesh) or strips of your body’s tissue and is placed beneath your urethra and the bladder neck, which is the area of enlarged muscle where the bladder joins to the urethra. When you cough or sneeze, the sling especially helps keep the urethra tight. Stress incontinence is treated using this technique.
Prolapse surgery. Surgery may combine a sling treatment with prolapse surgery in patients who have pelvic organ prolapse and mixed incontinence. Even when pelvic organ prolapse is repaired, symptoms of urine incontinence may not always get better.
Artificial urinary sphincter. To maintain the urinary sphincter closed until there is a need to urinate, a tiny, fluid–filled ring is inserted around the bladder neck. You deflate the ring and let pee from your bladder flow when you squeeze a valve implanted beneath your skin.
Bladder neck suspension. Your urethra and bladder neck, a region of thickened muscle where the bladder joins to the urethra, are intended to receive support from this surgery. Since it requires an abdominal incision, general or spinal anesthetic is used during the procedure.

Absorbent pads and catheters

If medical treatments are unsuccessful in resolving your incontinence, you can utilize measures to alleviate the discomfort and inconvenience of urine leakage:

Pads and protective garments. The majority of products are discreetly wearable beneath everyday clothing and maintain a similar profile to regular underwear. For men experiencing issues with urine dribbles, a drip collector is an option—a compact pouch of absorbent padding worn over the penis and held in position by snug–fitting undergarments.
Catheter. Your doctor could advise you to learn how to insert a soft tube (catheter) into your urethra several times a day to drain your bladder if you are incontinent because your bladder doesn’t empty properly. You’ll be shown how to properly clean these catheters so they may be reused.

Diseases & Conditions Urinary incontinence

Urinary incontinence

Overview

Symptoms