Introduction to urinary incontinence
Urinary incontinence (UI) refers to the involuntary release of urine that may occur as a result of physiologic, pharmacologic, pathologic or psychological factors. The loss of urine is visible in the affected individuals and may pose a social or hygienic problem. Women are affected about three times more commonly than men till the age of 80 years. The incidence in men and women above the age of 80 years is almost similar. It has been estimated that about 10 million Americans are affected by urinary incontinence of which 85% are women. The incidence of urinary incontinence in India is about 12%, wherein 5–7% affected women are between the age groups 15–44 years and the remainig are above 45 years of age. 1, 2
Signs and symptoms of urinary incontinence
As described in the causes, the affected individual may suffer from involuntary loss of urine under different circumstances. It may occur when an individual laughs, coughs and performs exercises, and when there is a strong urge to urinate. The individual may also suffer from frequent dribbling of urine even with out urge to urinate. The affected individuals may avoid socializing due to the fear of urine loss in public.
Types and causes of urinary incontinence
Based on the causes four main types of urinary incontinence have been identified.
- Stress incontinence / genuine stress incontinence
- Overactive bladder / urge incontinence
- Mixed incontinence
- Overflow incontinence
Stress incontinence refers to the involuntary loss of urine during an increase in the intra-abdominal pressure produced due to activities such as coughing, laughing or exercising. This type of incontinence results from diminished activity of the urethral sphincter muscles, which normally help in retaining the urine.
Overactive bladder / urge incontinence
Overactive bladder/urge incontinence refers to involuntary loss of urine preceded by a strong urge to urinate, which is difficult to suppress, whether or not the bladder is full. This results from inability of the detrusor muscle (muscles in the wall of urinary bladder) in suppressing the urge and holding the urine within the bladder. This inability may be a result of certain nerve disorder such as multiple sclerosis or due to injury to the spinal cord. At times, the exact cause may not be identified.
Mixed incontinence as the name suggests, it is characterized by symptoms of both stress incontinence and urge incontinence and occurs due to the decreased activity of the urethral sphincter and inability of the detrusor muscle.
Overflow incontinence refers to a condition wherein the affected individual is unable to urinate completely leading to accumulation of urine within the bladder. This in turn leads to frequent or constant dribbling of urine along with involuntary loss of urine during coughing or laughing. There may also be features of urge incontinence. This type of incontinence may be caused due to a wide variety of causes such as nerve disorders, enlarged prostate, urinary tract infections, administration of certain medications, obstruction to the urinary tract or due to disorders such as diabetes and hypothyroidism.
Other infrequent causes include pelvic fracture trauma, complication of pelvic surgery, fistula in the urinary tract and decreased mobility in the older individuals.3,4
Risk factors for urinary incontinence
Urinary incontinence is a disorder with multiple factors, wherein some of them are transient and others are permanent. Various risk factors have been associated with increased incidence of urinary incontinence.
Some these are:
- Immobility / chronic degenerative diseases
- Morbid obesity
- Pelvic muscle weakness
- Childhood nocturnal enuresis
- Pregnancy / vaginal delivery
Diagnosis of urinary incontinence
The diagnosis of urinary incontinence is simply based on the signs and symptoms observed. However, a detailed analysis is required to identify the exact underlying cause that has resulted in urinary incontinence. A detailed personal and medical history is taken. The doctor may ask the affected individual to maintain a voiding dairy wherein he/she has to enter every incident of incontinence in a day over a period of few days. Physical examination is performed to check the reflexes of the muscles that help in urine retention. Cough stress test is a common test to identify the stress incontinence. Certain laboratory studies such as urinalysis and blood tests may be advised to identify the underlying disorders. In certain cases, advanced testing procedures such as urodynamic tests, endoscopic tests and imaging are advised when the exact cause has not been identified based on the initial findings.4
Treatment of urinary incontinence
The management of urinary incontinence depends on various factors such as age of the individual, type of incontinence, underlying cause and severity of the condition. It may range from minor modification in the medications being consumed to surgery for the correction of muscle actions. The correction of the underlying disorder relieves the condition in majority of the cases. In general, the treatment modalities can be categorized as behavior management (include lifestyle changes, physical therapy, bladder retraining and use of vaginal and urethral devices), administration of medications and surgical management.
The lifestyle changes include weight loss in obese patients, postural changes and decreasing the intake of caffeine.
Physical exercises such as Kegel’s exercises are advised to strengthen the pelvic muscles.
Medications specific for urinary incontinence include drugs such as pseudoephedrine and imipramine.
Surgical correction of the muscles to aid in urine retention may be advised in selected cases.1,4–6
Complications of urinary incontinence
Specific complications such as social inhibition, frequent urinary tract infections, and formation of kidney stones may be associated with urinary incontinence. Some other complications may be associated with the type of underlying disorder.
Prevention of urinary incontinence
The lifestyle changes advised before may help in reducing the incidence to a certain extent. Performing exercises such as Kegel’s exercise to strengthen the pelvic muscles during pregnancy and after delivery can prevent incontinence associated with pregnancy.
Management of urinary incontinence
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1. Thakar R, Stanton S. Management of urinary incontinence in women. BMJ 2000; 321; 1326–1331.
2. Klausner AP, Vapnek JM. Urinary incontinence in the geriatric population. Mount Sinai J Med. 2003; 70(1): 54–61.
3. Silva WA, Karram MM. Anatomy and physiology of the pelvic floor. Minerva Ginecol. 2004; 56(4): 283–302.
4. Moore KN, Saltmarche A, Query B. Urinary incontinence. Can Fam Physician. 2003; 49: 602–610.
5. Fantl JA, Newman DK, Colling J, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline No. 2, 1996 Update. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 96-0682. March 1996.Available at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.9995. Accessed on: 28 June 2008.
6. Smith PP, McCrery RJ, Appell RA. Current trends in the evaluation and management of female urinary incontinence. CMAJ. 2006; 175(10): 1233–1240.
Written by: healthplus24.com team
Date last updated: February 01, 2015