Urinary Incontinence Q & A
Q1. What is urinary incontinence?
Urinary incontinence is defined as the involuntary leakage or loss of urine. It implies that your urine passes when you don’t want it to pass. Your control over the urinary sphincter is either weakened or lost. It is a very common problem affecting many people across the world.
According to the estimates by the American Urological Association, about 1/4th to 1/3rd of males and females in the USA suffer from urinary incontinence.
Q2. What are the symptoms of urinary incontinence?
Symptoms vary depending upon the types of incontinence. Its various types are:
- Stress incontinence: In this type of urinary incontinence, there is leakage of urine when you put extra pressure on your urinary bladder during the act of sneezing, laughing, coughing, lifting a heavy object or exercising.
- Urge incontinence: In this type, there is a sudden, strong urge to pass urine (urinary urgency) that is followed by incontinence of urine while you are going to the bathroom to pass urine. You may have symptoms of frequent urination, especially at night. It can be caused by a urinary tract infection, diabetes or a neurological disorder.
- Overflow incontinence: In this type of incontinence you experience constant or frequent dribbling of urine as your bladder doesn’t get emptied completely.
- Functional incontinence: In this type of incontinence, due to a mental or physical impairment you can’t reach the toilet in time and there is bladder leakage.
- Mixed incontinence: In this type of incontinence, you suffer from greater than one type of incontinence.
Q3. What are the causes of urinary incontinence?
Urinary incontinence is a symptom and not a disease by itself. It may be caused by an underlying medical illness or physical problems and your everyday habits.
Temporary urinary incontinence
Certain foods, medicines, and drinks may stimulate the bladder and increase urinary volume. These include:
- Sparkling water and carbonated drinks
- Artificial sweeteners
- Chili peppers
- Vitamin C in large doses
- Blood pressure and heart medicines, muscle relaxants and sedatives
- Foods that contain a high amount of spices, acids or sugar particularly citrus fruits
Certain medical conditions that can be easily treated can also cause urinary incontinence. These include urinary tract infection and constipation.
Persistent urinary incontinence
You can also suffer from urinary incontinence on a persistent basis, which can be caused by various physical changes or problems, including the following:
- Pregnancy: The changes in the hormonal levels and the pressure put on the bladder due to increased fetal weight can result in stress incontinence.
- Childbirth: Due to vaginal delivery, the bladder sphincter muscles can weaken and the bladder nerves and the supportive tissues can get damaged. All this can lead to prolapsed bladder resulting in urinary incontinence.
- Changes due to age: Due to increasing age the capacity of the bladder to store urine decreases leading to incontinence.
- Menopause: The estrogen hormone is produced in less quantity in menopausal women. Estrogen helps in keeping the lining of the urethra and bladder healthy and deterioration of the health of these tissues may worsen incontinence.
- Hysterectomy: Hysterectomy or removal of the uterus can damage the muscles of the pelvic floor that supports the bladder leading to urinary incontinence.
- Enlargement of the prostate: In older males an enlarged prostate, a condition referred to as benign prostatic hyperplasia (BPH) can lead to urinary incontinence.
- Prostate cancer: In males, untreated prostate cancer can result in urge incontinence or stress incontinence. However, more commonly, incontinence occurs as a side effect of prostate cancer treatments.
- Obstruction: A tumor present anywhere in the urinary tract may block your urine flow and result in overflow incontinence. Urinary stone can sometimes cause bladder leakage along with bladder pain and bladder spasms.
- Neurological disorders: Parkinson’s disease, multiple sclerosis, a brain tumor, a spinal injury or a stroke may interfere with the nerve signals that are involved in maintaining continence and bladder control; thereby, causing incontinence.
Q4. What are the risk factors of urinary incontinence?
The various factors that make you more prone to develop urinary incontinence are:
- Gender: Females are more at risk to develop stress incontinence due to their normal anatomy, pregnancy, delivery, and menopause. On the contrary, males who suffer from BPH are more at risk to develop overflow and urge incontinence.
- Age: Elderly people are more at risk to develop urinary incontinence.
- Being obese: The extra weight puts pressure on the bladder muscles, which makes them weak and causes bladder leakage on coughing and sneezing.
- Smoking: Using tobacco may make you more prone to develop urinary incontinence.
- Other diseases: Diabetes or neurological diseases raise your risk of developing incontinence.
- Family history: If you have a positive family history of incontinence particularly urge incontinence, then you are more prone to develop the condition.
Q5. What is the treatment of urinary incontinence?
Treatment for incontinence depends on the cause, type of incontinence and its severity. Your doctor at urogynecology department will usually suggest a combination of different treatments ranging from behavioral techniques, pelvic floor muscle exercises, medicines, medical devices to surgery in severe cases.
Some of the behavioral techniques or lifestyle changes to treat urinary incontinence include bladder training, double voiding, scheduling toilet trips, losing weight, reducing intake of alcohol, acidic foods and caffeine and reducing intake of fluids, particularly during the evening.
The doctors also recommend doing pelvic floor muscle exercises, also referred as Kegel exercises to strengthen your pelvic floor muscles.
The medicines that are commonly used in the treatment of urinary incontinence are:
Anticholinergics: These help to calm an overactive bladder and relieve urge incontinence. Some examples are oxybutynin, darifenacin, and trospium.
Mirabegron: They relax the muscles of the bladder.
Alpha blockers: These medicines relax the muscles of the bladder neck and muscles in the prostate gland. Some examples are tamsulosin, alfuzosin, and doxazosin.
In some cases, in females, medical devices such as a urethral insert or a pessary may be prescribed to treat urinary incontinence. A pessary is usually prescribed to females who have incontinence due to a prolapsed bladder. A pessary is a ring-shaped device that helps to hold the bladder and other pelvic structures in place and prevents bladder leakage.
Surgery may be done in cases in which other treatments fail to relieve the problem.
The Questionnaire for female Urinary Incontinence Diagnosis (QUID)
Do you leak urine (even small drops), wet yourself, or wet your pads or undergarments…
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