All You Need to Know about Urinary Incontinence

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

These include:

  • 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.

D. Medication
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.

G. Surgery
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.