What is Urinary Incontinence?
Urinary incontinence (or simply ‘incontinence), is when the bladder control is lost, which leads to issues like occasional urine leakage and in certain extreme cases inability to hold the urine even for a few minutes. Incontinence is not just socially embarrassing, it also disrupts a person’s normal lifestyle. And hence, when faced with the issue of incontinence, do not hesitate to consult with an expert urologist who can help with appropriate treatment.
Types and Symptoms of Urinary Incontinence
Incontinence can be caused due to a number of reasons, and are categorized as following:
- Stress incontinence: In this type, involuntary leakage of urine takes place when pressure is exerted on the bladder, for example, when sneezing, coughing, exercising, laughing, or lifting something heavy.
- Urge incontinence: In this type, the person feels a sudden and extreme urge to urinate, which frequently to involuntary urination. This is especially problematic during the night as it disrupts sleep.
- Overflow incontinence: In this type, the bladder doesn’t completely get empty and leads to constant dripping of urine.
- Functional incontinence: This type of incontinence is actually caused as a result of any physical or mental issues which delay a person to reach the toilet in time.
- Mixed incontinence: This is when the patient experiences more than one of the above types of incontinence.
Causes of Urinary Incontinence
The exact cause of urinary incontinence can be determined by a thorough examination by your doctor. The point to note here is that incontinence in itself is not a disease but a symptom of an underlying condition. It can be caused by lifestyle habits, another disease or physical issues.
Let’s take a look at some of the most common causes of urinary incontinence:
- Urinary Tract Infection (UTI): UTIs cause bladder irritation leading to strong urination urges, and at times incontinence. Common signs of UTI are burning while urinating and foul-smelling urine.
- Constipation: Bladder and the rectum share many nerves, due to which hardening of stool in the rectum increases the nerve sensitivity making them overactive and causing incontinence.
- Pregnancy and Childbirth: The hormonal changes that take place during pregnancy can cause stress incontinence. Additionally, vaginal delivery can affect the pelvic floor, weaken bladder control muscles, damage bladder nerves, as well as push the bladder, uterus, rectum, etc. towards the vagina- all of which contribute to urinary incontinence.
- Ageing: With age, the capacity of the bladder can reduce, causing the need to urinate frequently.
- Hysterectomy: Surgeries involving women’s reproductive system (such as Hysterectomies) can affect the pelvic floor leading to incontinence. This is because the bladder and uterus share many of the same ligaments and muscles.
- Enlarged prostate and Prostate Cancer: In case of men, incontinence can be caused due to prostate enlargement (benign prostatic hyperplasia) as well as untreated prostate cancer or even prostate cancer treatment side effects.
- Tumors and Stones: Stones in bladder and tumors in the urinary tract are also responsible for causing urine obstruction or increased urination.
- Neurological disorders: Stroke, brain tumour, multiple sclerosis, spinal injury, Parkinson’s disease, etc. which affect the nerve signals may also lead to urinary incontinence.
- Food Habits: Certain foods, drinks, and medications have a diuretic effect and can lead to increased urination. These include tea, coffee, alcohol, carbonated drinks, spicy food, medicines for blood pressure and heart conditions, etc.
Tests and Diagnosis of Urinary Incontinence
- Urinalysis: In this, a urine test is conducted to check for infection and other possible abnormalities.
- Post-Void Residual Measurement: In this, the patient is required to void the bladder (urinate) into a measuring container, after which the doctor checks how much urine is left in the bladder. This is done using an ultrasound test or a catheter. If the amount of leftover urine in the bladder is high, it could indicate a urinary tract obstruction or issue with bladder muscles.
- Urodynamic Testing: In this, a catheter is inserted into the urethra to fill the bladder with water, and a pressure monitor records the bladder pressure. This test helps to determine the type of urinary incontinence as well as measure the bladder strength and health.
- Pelvic Ultrasound: In this, the ultrasound of the genitals or urinary tract or genitals is done to reveal any abnormalities.
- Cystogram: In this, a catheter is inserted into the urethra and bladder and a special dye is injected. After this, X-ray images are taken as the patient urinates to expel this fluid, which then highlight any issues with the urinary tract.
- Cystoscopy: In this, a thin tube with a tiny lens is inserted into the urethra to see (and remove) and abnormalities present in the urinary tract.
Treatment of Urinary Incontinence
Depending upon the type, severity and cause of the incontinence, treatment is decided. Following are some of the main types of treatments for treating urinary incontinence, one or more of which may be used by the doctor.
A. Behavioral Techniques
These techniques are basically used to change certain lifestyle and toilet habits so that more effective bladder control can be gained without the requirement of any medicines or invasive treatments.
Such techniques include bladder training (practicing resisting the urge to urinate), double voiding (learning how to completely empty the bladder), and fluid and diet management (reducing intake of diuretics such as caffeine, alcohol, spicy foods, etc.).
B. Pelvic Floor Muscle Exercises
Pelvic floor muscle exercises, also called Kegel exercises, help in strengthening the muscles that control urination. These are useful in dealing with stress as well as urge incontinence. To ensure that the patient does these exercises correctly for maximum effect, a physical therapist or biofeedback techniques may be recommended by the doctor.
C. Electrical Stimulation
Another way of strengthening the pelvic floor muscles is through gentle electrical stimulation by inserting electrodes into the rectum or vagina. This is usually effective for stress as well as urge incontinence, but requires several sessions lasting for months.
There are certain types of medicines including alpha blockers and topical estrogen. These medicines help in calming an overactive bladder and make it easier to empty bladder more completely.
E. Interventional Therapies
Among the various types of comparatively less invasive interventional therapies are Botox injections, nerve simulators, and bulking material injections. These therapies help with different types of incontinences and are generally prescribed only when first line treatment such as medications are not successful.
F. Catheters and Absorbent Pads
These products are used to reduce the inconvenience caused by incontinence, in case medical management is not proving to be effective:
- Catheter: For cases in which the bladder doesn’t empty completely on its own, a soft tube called catheter is inserted into the urethra to drain the bladder. The patients are taught to use and clean the catheters.
- Absorbent Pads: These can be used under everyday clothes and help deal with the issue of frequent urine leakage.
Finally, if no other treatments work, the doctor may resort to one of the many available surgical procedures for treating urinary incontinence. Some of these include: Sling Procedures, Bladder Neck Suspension, Prolapse Surgery, Artificial Urinary Sphincter, etc.
For most bladder cancers, surgery is a big part of the treatment. Depending on the stage of the cancer, the type of surgery required depends upon the stage of cancer. When the bladder cancer has progressed to an advanced stage, a part of or the complete bladder may need to be removed. This type of surgery is known as Cystectomy.
Types of Cystectomy
Following are the main types of Cystectomy procedures:
1. Partial Cystectomy: This type of procedure can be done for those cases in which the cancer is not very large and present only in a single site. In such a case, just the cancerous portion along with a small part of the bladder can be removed instead of the whole bladder.
As a result, the patient can keep his bladder and doesn’t require any reconstructive surgery. Though, due to the removal of bladder portion, the amount of urine it can hold is less, leading to the issue of frequent urination. An important point to note about partial cystectomy is that there are chances of the cancer developing in another part of the bladder wall.
2. Radical Cystectomy: When the cancer is large or has spread to more than one parts of the bladder, radical cystectomy operation is required. In this, the entire bladder and nearby lymph nodes are removed. Additionally, the prostate and seminal vesicles in men and the ovaries, fallopian tubes, uterus, cervix, and a small portion of the vagina in women may also have to be removed.
Both open as well as laparoscopic (keyhole) surgeries can be opted for a cystectomy, however, the advantages of laparoscopic are definitely higher.
Robotic Radical Cystectomy
Laparoscopic surgeries have been preferred by surgeons and oncologists for the last many years due to their minimally invasive and nerve-sparing features. With the advent of robotic surgery in the last decade, minimally invasive surgery has been propelled to an even higher level. While the traditional open surgeries would lead to significant blood loss, increased risks and complications, and tissue and nerve damage, robotic surgeries have overcome these disadvantages.
Robotic radical cystectomy, done is most of the robotic surgery centres using the da Vinci surgical method, is an advanced and more efficient method of surgery for bladder cancer. The surgeon controls the robotic arms to conduct a more precise and effective surgery. To learn more about how robotic surgery works, please click here.
Advantages of Robotic Cystectomy
The robotic surgery for bladder cancer has the following main advantages over open surgery:
1. Smaller incisions that do not damage that delicate nerves and muscle tissues.
2. Smaller scars
3. Lesser pain
4. Lesser blood loss
5. Faster recovery time leading to shorter hospital stay
6. Lesser risk of post-operative risks and complications
It is important to note that any type of surgery has inherent risks and side-effects, however, with robotic surgery, these complications can be greatly reduced.
To learn more about the possible treatments for bladder cancer and other bladder related issues, please contact our experts here.
May 2016 is Bladder Cancer Awareness Month.
The following infographic covers some important facts and information about Bladder Cancer. Do spread the word!
Many people receive a lot of misinformation related to kidney functionality and kidney diseases, and are therefore, not suitably aware of how this disease affects our lives. In this post we compare some of the most common myths surrounding kidney diseases and the actual facts about them.
Myth: Kidney disease is rare.
Fact: Kidney disease affects millions across the globe every year, and is quite common. Almost 10% of the world’s population suffers from Chronic Kidney Disease.
Myth: Kidney disease tests are expensive and cumbersome.
Fact: The diagnostic tests required to determine kidney disease are very simple and painless. One is a simple urine test which checks for protein in the urine, while the other is a blood test which checks for GFR (Glomerular Filtration Rate). Both are pretty affordable and accurate.
Myth: If there are no obvious discomforts like difficulty in passing urine, it means the kidneys are fine.
Fact: Kidney diseases don’t present any symptoms until they have progressed to very advanced stages. And hence, the lack of any external symptoms is no guarantee that a person doesn’t have a kidney disease; it should be thoroughly ruled out by conducting appropriate medical tests.
Myth: Kidney disease cannot be prevented for at-risk groups.
Fact: At-risk groups include those with high blood pressure, diabetes, family history of kidney failure, over 60 years of age, and people of Asian, Hispanic, American Indian, Pacific Islander and African-American ethnicities. However, not everyone who falls into these risk groups will develop a kidney disease. By following a healthy lifestyle including balanced diet, regular exercise to maintain weight, controlled blood pressure and blood sugar, and by quitting smoking, among other things, the kidneys can be kept healthy thereby reducing your chances of getting kidney disease.
Myth: Dialysis is the only treatment for kidney disease.
Fact: Dialysis is required by only those patients whose kidney disease has progressed to advanced stages or those who have kidney failure. Otherwise those patients whose disease is diagnosed in early stages usually require only diet modification, exercise and medication.
Myth: Dialysis is a painful and exhaustive process which restricts the patient from working or travelling.
Fact: The dialysis process by itself is painless, and generally the only discomfort caused is by the needles which are inserted in the graft or fistula. Certain patients may experience headaches, cramps, nausea, etc. but this can be avoided by taking proper diet and fluid restrictions. Also, the patients undergoing dialysis feel sufficiently fine to work or travel if they take proper care of themselves and follow the doctor’s advice correctly.
[Image credit: hywards at FreeDigitalPhotos.net]
Chronic Kidney Disease (CKD) is a term used to describe the slow loss of kidney function in a person. Normal kidneys are able to filter wastes and extra fluids from the blood, which then get excreted in the urine. But due to chronic kidney disease this normal functionality is impaired, and when the disease progresses further, it can lead to the building up of dangerous levels of fluid, electrolytes and wastes in the body. When the level of kidney function falls below a certain level, it is called kidney failure.
Chronic Kidney Disease: Quick Facts
- Diabetes and high blood pressure are the two leading causes of kidney disease.
- Kidney disease is likely to cause kidney failure in men more than in women.
- African Americans, Hispanics, Pacific Islanders, and American Indians are at increased risk.
- Kidney disease can develop at any age, but affects the elderly more. Around 50% of people aged 75 and above are estimated to have CKD.
- In the developing countries, around 1 million people die annually due to untreated kidney disease.
- Generally, kidney transplant success rates are very good, with around 85-90% success rate for deceased donor transplant and 90-95% rate for live donor transplant.
- Almost 8-10% of the adult population suffers from some type of kidney damage.
- There are five stages of kidney disease, stage 5 being the End-Stage-Renal-Disease (ESRD), also known as kidney failure.
Causes of Kidney Disease
There are a number of conditions and diseases that can lead to CKD, such as diabetes, high blood pressure, polycystic kidney disease, interstitial nephritis, family history, etc. Out of these, diabetes and high blood pressure are two main causes contributing to around 2/3rd of all CKD cases. Kidney disease can make a person develop various health complications including weak bones, anemia, nerve damage, and heart diseases and stroke. Most often these problems manifest very gradually and therefore, aren’t easily noticed. As a result, chronic kidney disease can get significantly worse before it can be diagnosed and treated. In many situations, this can lead to kidney failure in the patient which can prove to be fatal without dialysis or kidney transplant.
Some of the other, less prevalent causes of CKD are glomerulonephritis (inflammations) or pyelonephritis (infections). CKD can also be caused due to inherited conditions (such as polycystic disease), enlarged prostate, kidney stones, malformations in a baby when in the mother’s womb, tumors, frequent urinary infections, lupus and other diseases that affect body’s immune system.
Certain drugs like analgesics (pain-killers), if taken over a prolonged period of time, can also lead to kidney disease.
Symptoms of Chronic Kidney Disease
Chronic kidney disease usually doesn’t present any symptoms until it has advanced to a much later stage. In the advanced stages, kidney disease can cause:
- Fatigue, weakness, lethargy
- Pain during urination
- Foamy/Pink/Dark urine (blood in urine)
- Need to urinate more often
- Fluid retention leading to swelling of ankles, face, hands, abdomen, ankles, feet, eyes
- Increase in thirst
- Loss of appetite
- Difficulty in concentrating
- Difficulty in sleeping
- Muscle cramps
- Dry, itchy skin
Diagnosis and Treatment
Chronic kidney disease can be diagnosed by means of certain tests and procedures such as:
Blood tests: These can include a blood creatinine test to determine the Glomerular Filtration Rate (GFR), a blood urea nitrogen (BUN) test, a fasting blood glucose test and some other tests that check for the amount of waste products and electrolytes in the blood.
Click here to learn more about GFR and its correlation to Chronic Kidney Diease.
Urine tests: These are used to measure the amount of protein in urine (ideally none), by means of Urinalysis (UA) and a urine test for microalbumin.
Imaging tests: A renal ultrasound and/or angiogram may also be conducted by the doctor to check any obstructions to the kidney or reasons for restricted blood flow.
Kidney biopsy: This procedure may also be used by the doctor to find out the reason for kidney disease, particularly after a kidney transplant if there is the possibility of organ rejection. The biopsy process involves removing a sample of kidney tissue by inserting a thin, long needle through your skin and into the kidney.
Early screening of kidney disease is recommended to those who are suffering from high blood pressure or diabetes. Unless the disease has reached the advanced stages, it can be managed by means of medications and leading a healthy lifestyle.
In patients suffering from either diabetes or high blood pressure, it is crucial to control the sugar levels and blood pressure respectively, in order to prevent further damage to the kidneys. By properly assessing the extent of damage to the kidneys as well as the contributory factors, the doctor will create a comprehensive treatment plan.
With inputs from:
The Urinary System plays a very important role in the human body. It produces Urine, a waste fluid excreted by Kidneys, which it stores, and later, passes it out of the body. Urinary System works closely with the Lungs, the Skin, and Intestines to maintain the balance of chemicals in our body. Adults excretes about 1.42 liters of water per day while children would excrete lesser amount, which depends on the amount of fluid consumed by them. If a person is under medication, the amount of Urine excreted would differ.
THE PROCESS OF URINATION
Kidneys are the primary organs of the Urinary System. Blood passes through Kidney, where the proteins are broken down and Urea is separated through Nephrons, the filtering units. Each Nephron has a ball of blood capillaries called Glomerulus and a tube called the Renal Tube. Urea, along with water, and other waste particles, passes through Nephrons and the Renal Tubes, and then out of the Kidneys through two thin tubes called Ureters which are about 8-10 inches long.
This is not one-time process but, Urine is emptied in the bladder, every 10-15 seconds. Urinary Bladder is a hollow organ like a balloon. It stores Urine till it reaches its capacity that is 16 ounces. The body takes 2-5 hours to produce that much of Urine. A tube which allows Urine to pass out of the body is called Urethra.
The only difference in Male Urinary System and a Female Urinary System is the length of Urethra. Females have 1.5 inches long Urethra and Male have 8 inches long Urethra.
SIGNALS FOR URINATION
Nerves in the Bladder are responsible for sending signal to the brain to cause Urinating sensation. When Bladder reaches the maximum storage limit, Nerves emits signals that are captured by the Brain.
Brain encrypts the message that the Bladder is full and the urge to empty it intensifies. Urinating causes relaxation in muscles that tightens while emitting signals.
COMMON DISEASE IN URINARY SYSTEM
If at any point of time, during the entire process, Urine is forced back into the Kidneys, the Urine can cause a Kidney Infection. Or, when bacteria enters a Urinary Tract, it can affect the Urethra, the Kidneys, or even the Bladder causing Urine Infection. This condition is known as a Urinary Tract Infection (UTI). Such type of infection is more common in Females but can also occur in Males. Infections, including yeasts, would cause disorders in body’s reproductive Organs. While Urologists’ treat the Male Reproductive Organs, Gynecologists’ treat the Female Reproductive Organs. One of the ways to treat the infection is to use Antibiotics. But please consult your Doctor before resorting to any medication.
TYPES OF URINARY TRACT INFECTIONS, KIDNEY DISEASES, AND FAILURE
INTERNAL CYSTITIS (IC) – This is a painful chronic Bladder syndrome, wherein the Bladder loses its elasticity. It results in the Bladder being unable to hold adequate Urine.
PROSTATITIS – This infection occurs from the swelling of prostate gland and can cause urgency in Urination. Person suffering from this infection urinates more frequently compared to others along with strong pain during Urination and pain in the Pelvic Regions. It occurs only in Males as Female Reproductive System does not consist Prostrate Glands. Severity of the disease is Prostate Cancer.
KIDNEY STONES – Sometimes consuming something adulterated causes clumps of Calcium Oxalate to form in the Urinary tract, popularly known as Kidney Stones. They causes pain in the back and sides. It can even cause hematuria, resulting in blood in urine.
KIDNEY FAILURE – Medically known as Renal Failure, it is a chronic condition wherein Kidneys are unable to filter the waste from blood. It may be caused by trauma or damage to Kidneys. Renal diseases may lead to Chronic Kidney disorders and might require dialysis or even Kidney Transplantation.
BLADDER CANCER – Difficulty in urination or frequent urination are possible symptom of Bladder Cancer. It can be caused by excessive smoking too.
Please note: Before you react to any uneasiness in your body, do always consult your Doctor for a proper diagnosis.
RENAL CELL CARCINOMA – RCC is a type of Kidney Cancer which might be caused by excessive smoking, hypertension or obesity.
URINARY INCONTINENCE – excessive stress in females can cause the problem of Urine leakage, also known as Urinary Incontinence, and it has a profound impact on quality of life.