Incontinence

Incontinence

Loss of bladder to control urine is called urinary incontinence. It can happen to anyone, but is very common in older people. 

Many people with bladder control problems hide the problem from everyone, even from their doctor. There is no need to do that. In most cases urinary incontinence can be controlled and treated. If you are having bladder control problems, don’t suffer in silence. Talk to your doctor.

At least 1 in 10 people age 65 or older has this problem

It is estimated that 2/3 of women with Stress urinary incontinence (SUI) have not discussed the condition with their physicians. Some of the reasons why include: 
 
Embarrassment

A belief that it's a normal part of aging

The availability of absorbent products

Poor knowledge of management options

Low expectations for treatment

Symptoms can range from mild leaking to uncontrollable wetting. 
Women are more likely than men to have incontinence.

Aging does not cause incontinence. It can occur for many reasons. For example, Urinary tract infections, vaginal infection, or irritation, constipation certain medicines can cause bladder control problems that last a short time. Sometimes incontinence lasts longer. This might be due to problems such as:

 

  • Weak bladder muscles,
  • Overactive bladder muscles,
  • Blockage from an enlarged prostate,
  • Damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease, or diseases such as arthritis that can make walking painful and slow.

urinary incontinence is the inability to control urination. The term may be used interchangeably with Over Active Bladder (OAB). People who suffer from overactive bladder, or urinary incontinence, can't hold their urine - they wet themselves. It is often temporary, and it always results from an underlying medical condition.

Leaking urine is normal only in infants; it is not a normal result of aging. If you have this problem, you may be too embarrassed or upset to ask for help. Don't be

Incidence

Incontinence affects all ages, both sexes, and people of every social and economic level. It is also estimated that 15 to 30 percent of people over the age of 60 have incontinence. Women are twice as likely, than men to have this condition. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.

Older women more often than younger women, experience incontinence. But incontinence is not inevitable with age. Incontinence is treatable and often curable at all ages.
Incontinence is classified by the symptoms of or circumstances occurring at the time of urine leakage.


Stress Incontinence
Mixed Incontinence
Environmental Incontinence
Urge Incontinence
Overflow Incontinence
Nocturnal Incontinence

Stress Incontinence

If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence. It is the most common form of incontinence in women and is treatable.

Pelvic floor muscles support your bladder. If these muscles weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken.

Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.

Urge Incontinence

If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions.

Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Your doctor might call your condition "reflex incontinence" if it results from overactive nerves controlling the bladder.

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower).

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury -including injury that occurs during surgery - all can harm bladder nerves or muscles.

Mixed Incontinence

Mixed incontinence is often a combination of both conditions above - stress and urge incontinence

Overflow Incontinence

If your bladder is always full so that it frequently leaks urine, you have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women. Benign enlargement of prostate in an elderly male can lead to Acute/ Chronic Retention of urine in the overflow incontinence.

Environmental or Functional Incontinence

Environmental incontinence sometimes called functional incontinence occurs when people cannot get to the toilet or get a bedpan when they need it. The urinary system may work well, but physical or mental disabilities or other circumstances prevent normal toilet usage. A person with Alzheimer's disease, for example, may not think well enough to plan a timely trip to a restroom.

Nocturnal Incontinence

Nocturnal enuresis is incontinence that occurs during sleep. 

Types of Incontinence

TYPE

Definition

Mechanism

Disorder

Urge

Inability to delay voiding once the urge occurs.

Detrusor (Bladder) Hyperactivity

Idopathic (commonly in the elderly)
Genitourinary condition (Bladder inflammation, Stone.)

Stress

Loss of urine with increased abdominal pressure

Urinary bladder Sphincter failure

Weak or injured pelvic muscle, Sphincter weakness.

Overflow

Partial retention of urine behind the obstruction

Outlet obstruction,
Loss of nerve supply.

Obstructive bladder (enlarged prostate, Stricture, Cystocele)
Neuropathic (Diabetes, nerve injury)

Functional

Inability to get to the toilet in time.

Physical or Cognative Impairment

Dementia or delirium, physical limitations (lack of mobility), Psychological / Behavioral

Diagnosis

The first step toward relief is to see an urologist. An urologist specializes in the urinary tract, and some urologists further specialize in the female urinary tract.

To diagnose the problem, your symptoms and medical history is taken. Your pattern of voiding and urine leakage may suggest the type of incontinence. Other obvious factors that can help define the problem include straining and discomfort, use of drugs, recent surgery, and illness. If your medical history does not define the problem, it will at least suggest which tests are needed.

You shall be physically examined for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

The doctor will measure your bladder capacity and residual urine for evidence of poorly functioning bladder muscles. To do this, you will drink plenty of fluids and urinate into a measuring pan, after which the doctor will measure any urine remaining in the bladder. The doctor may also recommend one or more of the following tests,


Stress Test 
Ultrasound  
Urinalysis
Cystoscopy
Blood Tests
Urodynamics

Stress test--You relax, then cough vigorously as the doctor watches for loss of urine.

Urinalysis--Urine is tested for evidence of infection, urinary stones, or other contributing causes.

Blood tests--Blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.

Ultrasound--Sound waves are used to "see" the kidneys, ureters, bladder, and urethra.

Cystoscopy--A thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.

Urodynamics--Various techniques measure pressure in the bladder and the flow of urine.

Your doctor may ask you to keep a diary for a day or more, up to a week, to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim.

Treatment

Yes, many types of treatment are available for incontinence. Only a qualified specialist can recommend the treatment that is best for your condition.


Pelvic Muscle Exercises
Timed Voiding or Bladder Training
Implants  
Catheterization  
Electrical Stimulation
Medications
Surgery

Pelvic Muscle Exercises

Pelvic muscle exercises are intended to tone pelvic muscles and prevent leakage. Kegel exercises to strengthen or retrain the pelvic floor muscles and sphincter muscles can reduce or cure stress leakage.

Women of all ages can learn and practice these exercises. Success of the Kegel exercises can be attained by doing the exercises regularly and correctly through slow and focused movements. Bladder retraining (gradually prolonging the time between visits to the toilet), along with reasonable fluid intake, has helped many people with incontinence

Electrical Stimulation

Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

Timed Voiding or Bladder Training

Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak.

Biofeedback and muscle conditioning - known as bladder training - can alter the bladder's schedule for storing and emptying urine. Frequent urination may cause your bladder to weaken; therefore, bladder training helps you reduce the number of times you urinate, which assists in increasing your urinary capacity. These techniques are effective for urge and overflow incontinence.

Medications

Medications that may be taken as infrequently as once daily may be prescribed to treat overactive bladder. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.

Some of these medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk for cancers of the breast and endometrium (lining of the uterus). The doctor can inform you about the risks and benefits of long-term use of medications.

Implants

Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Implants can be injected by a doctor in about half an hour using local anesthesia.

Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to determine whether you would have an allergic reaction to the material.


Dr. Dilip Raja Surgeon

Surgery

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success.

Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

For severe cases of stress incontinence, the surgeon may secure the bladder with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.

In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under the skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing urine from the bladder to pass.

Catheterization

If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg.