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Urinary Incontinence

Urinary Incontinence –Causes, Diagnosis and its Treatment

 

Introduction

Urinary incontinence is a condition wherein patient can pass urine involuntarily. This leakage of urine can happen either frequently through the day or can happen under duress. It is not a disorder in itself and is usually a result of underlying medical issues. Urinary continence is common in both men and women, but women are known to suffer from it more frequently. Due to the social stigma attached to the concept of involuntary urination, many people suffering from urinary incontinence never admit to having the condition. However, if permitted to remain uncontrolled or untreated, this condition can have a lasting negative effect on one’s lifestyle and psychology.

Risk Factors

A leading risk factor of urinary incontinence is the resulting psychological impact and the hampering of a free lifestyle. As this condition is indicative of other medical conditions pertaining to kidney functioning, nerves and muscles of bladder or other glandular activity, the associated risks are very high. Women are likely to experience urinary incontinence post pregnancy and childbirth, while men experience this condition mostly due to debilitating life choices such as substance abuse or obesity. Urinary incontinence can also be an early symptom of medical conditions pertaining to nerve damage or muscle deterioration.

Causes

  1. Pregnancy and childbirth: Most women experience some level of urinary incontinence during pregnancy as the extended uterus puts increased pressure on bladder. However, after a vaginal birth which may have been traumatic, some women lose a certain degree of control over their pelvic muscles and subsequently experience leakage of urine under stress.
  2. Enlarged prostate gland:This is the most commonly seen cause of urinary incontinence in men as an enlarged prostate can exert pressure on urinary bladder. In some cases, even the chemical and radioactive treatment employed for treating prostate gland can lead to urinary incontinence.
  3. Obesity: Obesity and excessive fat tissue around the stomach can also pressurise the organs, thereby weakening bladder control. Obesity can especially be the cause of stress incontinence.
  4. Polyuria: Excessive urine production due to pre-existing diabetes mellitus or primary polydipsia can also be an underlying cause of urinary incontinence.
  5. Nerve degeneration: Diseases or conditions such as Parkinson’s diseases, multiple sclerosis and spina bifida; which lead to nerve degeneration can also cause urinary incontinence. Even injury to spinal cord or nerve damage in pelvic region can result in lack of control over bladder function.

Diagnosis

Considering that most people suffering from urinary incontinence tend to avoid reporting it, diagnosis and treatment of the condition may be quite delayed in most cases. There are however, two recognised conditions of urinary incontinence and can be diagnosed based on patient’s medical history and incidence of condition –

  • Stress incontinence: Involuntary urination under conditions that put pressure on bladder such as coughing, strenuous exercise and even laughing.
  • Urge incontinence: Leakage of urine almost immediately or right after the urge to urinate.

There are many temporary forms of incontinence which can be nocturnal, structural (pertaining to anatomic variations) or functional (pertaining to psychological or physical inability to reach a bathroom in order to urinate), transient (pertaining to certain medications) and overflow incontinence which can result in constant dribbling of urine.

Various tests can be employed by urologists to determine the cause and extent of urinary incontinence. These include –

  1. Visual examination by putting patient under stressful condition like coughing and observe the extent of incontinence.
  2. Analysis of urine for urinary infections, stones, etc.
  3. Ultrasound to evaluate and diagnose the kidneys, urethra, ureters and urinary bladder for tumours or other malignancies which may be affecting bladder control.
  4. Blood plasma evaluation for diabetes mellitus and polyuria detection.
  5. Medical history consideration for possible nerve damage in pelvic area
  6. Cystoscopy and urodynamics are advanced diagnostic techniques used to monitor urine flow and diagnose the underlying cause of urinary incontinence

Treatment

As urinary incontinence is a resulting condition and actually indicates underlying medical problems pertaining to the urinary system and nervous system, the treatment for this condition depends on the differential diagnosis. If the underlying cause is pregnancy or childbirth in women, then pelvic muscle exercises are recommended. Changes in lifestyle such as reduction in caffeine and alcohol intake are also advised to manage urine production. Obesity being yet another reason for urinary incontinence, weight loss is also advised to people suffering from urinary incontinence. However, with the underlying cause being muscle or neural dystrophy, surgical and medical attention is the only way to fix urinary incontinence. Medications such as fesoterodine, tolterodine and oxybutynin are commonly prescribed for managing incontinence. Bladder repositioning and sling procedures are also adopted to provide better muscular support to the urethra, thereby alleviating stress incontinence. If all else fails, then collecting systems as well as absorbent devices are available in market to help people manage chronic incontinence.