Urinary incontinence is the loss of bladder control. A person leaks urine by accident. While it can happen to anyone, urinary incontinence, also known as overactive bladder, is more common in older people, especially women 

Types of urinary incontinence

Stress incontinence – when urine leaks out at times when bladder is under pressure; for example, when cough or laugh

Urge incontinence – when urine leaks as someone feel a sudden, intense urge to pee, or soon afterwards

Overflow incontinence (chronic urinary retention) – when  unable to fully empty the bladder, which causes frequent leaking

Functional incontinence- A physical or mental impairment keeps someone from making it to the toilet in time. For example, if the patient have severe arthritis, they may not be able to unbutton the pants quickly enough.

Mixed incontinence-  most often this refers to a combination of stress incontinence and urge incontinence.

Causes

Incontinence can happen for many reasons, including urinary tract infection vaginal infection or irritation, or constipation. Some medications can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

  • Weak bladder or pelvic floor muscles
  • Overactive bladder muscles
  • Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes or Parkinson’s disease 
  • Diseases such as arthritis that may make it difficult to get to the bathroom in time
  • Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina or anus. 

Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:

  • Prostatitis, a painful inflammation of the prostate gland
  • Injury or damage to nerves or muscles from surgery
  • An enlarged prostate gland, which can lead to benign prostrate  hyperplasia.

When to see a doctor

Consult a doctor if you have urinary incontinence or any signs of a bladder problem, such as:

  • Needing to urinate more frequently or suddenly
  • Cloudy urine
  • Blood in the urine
  • Pain while urinating
  • Urinating eight or more times in one day
  • Passing only small amounts of urine after strong urges to urinate
  • Trouble starting or having a weak stream while urinating.

Diagnosis

Medical history and physical exam :The doctor will take a detailed  medical history and also, he  will look at the genital area carefully for other health problems.

Urinalysis: A sample of  urine is checked for signs of infection, traces of blood or other abnormalities.

Bladder diary: For several days patient record how much water he drink, when urinated, the amount of urine  produced, whether he had an urge to urinate and the number of incontinence episodes.

Postvoid residual measurement: The patient asked to urinate (void) into a container that measures urine output. Then the doctor checks the amount of leftover urine in the bladder using a catheter or ultrasound test. 

Treatment

Bladder control training

Pelvic muscle exercises: (also known as Kegel exercises) strengthen the muscles that support the bladder, which can help to hold urine in the bladder and avoid leaks.

Double voiding:  help to learn to empty the bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.

Scheduled toilet trips: to urinate every two to four hours rather than waiting for the need to go.

Fluid and diet management: to regain control of the bladder. Patient may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

Pelvic floor muscle exercises

Pelvic floor muscle exercises helps to strengthen the muscles that help control urination. Also known as Kegel exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence.

To do pelvic floor muscle exercises, imagine that you’re trying to stop urine flow. Then:

  • Tighten (contract) the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
  • Work up to holding the contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

Medications

  • Medications that comes in a pill, liquid, or patch may be prescribed to help with bladder control problems. The drugs like Anticholinergics, Mirabegron, Alpha blockers are usually used.
  • Vaginal estrogen cream may help relieve urge or stress incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.

Medical devices

  • Urethral insert: a small, tampon-like disposable device inserted into the urethra before a specific activity, such as tennis, that can trigger incontinence. The insert acts as a plug to prevent leakage and is removed before urination.
  • Pessary: a flexible silicone ring that insert into the vagina and wear all day. The device is also used in women with vaginal prolapse. The pessary helps support the urethra, to prevent urine leakage.

Interventional therapies

  • Bulking material injections: A synthetic material is injected into tissue surrounding the urethra. The bulking material helps keep the urethra closed and reduce urine leakage. It may need to be repeated more than once.
  • Botox: Injections of Botox into the bladder muscle may benefit people who have an overactive bladder and urge incontinence.
  • Nerve stimulators: These are the  devices that use painless electrical pulses to stimulate the nerves involved in bladder control (sacral nerves). Either implanted under the skin in the buttock and connected to wires on the lower back or uses removable plug that is inserted into the vagina. Stimulating the sacral nerves can control overactive bladder and urge incontinence if other therapies haven’t worked.

Surgery

  • Sling procedures: Synthetic material (mesh) or strips of body tissue are used to create a pelvic sling. The sling helps to keep the urethra closed, especially when coughing or sneezing. This procedure is used to treat stress incontinence.
  • Bladder neck suspension: This procedure is designed to provide support to the urethra and bladder neck. It involves an abdominal incision, so it’s done during general or spinal anesthesia.
  • Prolapse surgery: In women who have pelvic organ prolapse and mixed incontinence, surgery may include a combination of a sling procedure and prolapse surgery.
  • Artificial urinary sphincter: A small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter shut until there’s a need to urinate. To urinate,  press a valve implanted under the skin that causes the ring to deflate and allows urine from the bladder to flow.

Absorbent pads and catheters

If medical treatments can’t eliminate the incontinence, can try products that help ease the discomfort and inconvenience of leaking urine:

  • Pads and protective garments: Most products are no more bulky than normal underwear and can be easily worn under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that’s worn over the penis and held in place by close-fitting underwear.
  • Catheter: If the incontinence is due to incomplete emptying of bladder, the doctor may recommend inserting a soft tube (catheter) into urethra several times a day to drain the bladder. The patient will be  instructed on how to clean these catheters for safe reuse.

Preventing urinary incontinence

It’s not always possible to prevent urinary incontinence, but there are some steps that may help to reduce the chance of it happening. These include:

  • Maintaining a healthy weight
  • Avoiding or cutting down on alcohol
  • Staying active – in particular, ensuring that your pelvic floor muscles are strong
  • Eat foods with fiber to help prevent constipation and avoid lifting heavy objects 

References

https://www.mayoclinic.org/          (Myoclinic)

https://www.urologyhealth.org/      (Urology care foundation)

https://www.nhs.uk/                       (NHS UK)

https://www.nia.nih.gov/                 (NIH)