Urinary incontinence is the condition when there is the involuntary leakage of urine. It means a person will urinate when they do not want to. Meaning there is no control over the urinary sphincter as it is either lost or weakened.
Urinary incontinence is a common problem that affects many elderly people. According to the American Urological Association, around one-third of men and women in the US experience urinary incontinence. Urinary incontinence is all the more common among women than men. An estimated 30 percent of females between 30 to 60 years suffer from it, compared to 1.5-5 percent of men.
What is Urinary Incontinence?
Urinary incontinence happens when you cannot prevent urine from leaking out. It could be due to stress factors, like coughing, and it can happen during and after pregnancy. The problem is more common with conditions such as obesity. With age, the chances of it happening increases.
Bladder control and urinary incontinence can be prevented or reduced with Kegel exercises. Kegel exercises can effectively strengthen your pelvic floor muscles. Hence it has become a first-line treatment for urinary stress incontinence and other pelvic-related issues.
Symptoms of Urinary Incontinence
1 Stress incontinence
Urine leaks out when you exert pressure on your bladder. This could happen during coughing, laughing, sneezing, exercising or lifting something heavy. This is the most common kind of urinary disorder, especially among women who have gone through pregnancy or have gone through menopause. It means physical pressure and not mental stress. When the muscles and bladder involved in urinary control are under sudden extra pressure, then you may urinate involuntarily.
2 Urge incontinence
Also known as reflex incontinence or referred to as overactive bladder. This is the second most common type of urinary incontinence. It is a condition when there is a sudden and intense urge to urinate. At the moment, urine leaks just before or after.
There is a sudden, involuntary contraction of your muscular wall of the bladder that creates the urge and it is impossible to stop. You will have a very short time before the urine is released to make any decision and act accordingly. The conditions include a sudden change in position, the sound of running water or during sex. Your bladder muscles can activate involuntarily because the damage has been caused to the nervous system, the bladder’s nerves, or the muscles themselves.
If you have this problem, you could experience frequent or constant urine dribbling because your bladder is not empty. Your inability to empty the bladder completely actually results in leaking. This is more common in men with a damaged bladder, prostate gland problems or a blocked urethra.
An enlarged prostate gland obstructs the bladder. Your bladder is unable to hold as much urine as the body is making. You need to urinate frequently. Else you might experience dribbling or a constant dripping of urine from the urethra.
4 Total incontinence
Your bladder cannot store urine any longer. This either means that your urine leaks continuously or has periodic uncontrollable leaking of large amounts. This problem occurs in case you have any complex problems.
5 Functional incontinence
Urine escapes because you cannot reach the bathroom in time. With functional incontinence, you know that there is a need to urinate, but you cannot make it to the bathroom in time as you have a mobility problem.
Some of the common causes of functional incontinence could be confusion, dementia, poor eyesight, having difficulty in unbuttoning the pants, depression, anxiety, or even anger. Functional incontinence is more prevalent among the elderly and is noticeable in nursing homes.
Urinary Incontinence Treatment
Treatment for this condition depends on several factors, such as the patient’s age, the type of incontinence, general health, and overall mental state.
- Stress incontinence – Pelvic floor exercises, also called Kegel exercises, would help to strengthen the urinary sphincter and pelvic floor muscles. These are the two primary muscles that help control urination.
- Bladder training – Bladder training is very helpful as you can regain control over your bladder. You learn how to delay urination after you get the urge to go. The goal of the training is to lengthen the time between the trips to the toilet till you have control over the process.
- Delaying the event – The aim of this training is to control the urge. You will learn how to delay your urination whenever there is an urge to do so.
- Double voiding – This training involves urinating, then waiting for a few minutes and then urinating again. Through this method, you learn to empty your bladder more completely to avoid overflow incontinence.
- Toilet timetable – Your bathroom timings are scheduled at set times during the day, for example, every 2 hours.
3 Medications for urinary incontinence
If medications are used to treat the problem, it is usually in combination with other techniques or exercises.
The following medications are generally prescribed to treat the condition:
- Anticholinergics. These can calm overactive bladders and might help patients with urge incontinence.
- Mirabegron (Myrbetriq). This medicine is used to treat urge incontinence. The medication relaxes your bladder muscle and can increase the amount of urine your bladder can hold. It is also helpful in increasing the amount you are able to urinate at one time. As a result, you can empty your bladder more completely.
- Topical estrogen. If you apply a low-dose of topical estrogen in the form of a vaginal cream, a ring or patch, it may help tone and rejuvenate the tissues in the urethra and vaginal areas.
4 Medical devices
The following medical devices are specifically designed for females.
- Urethral inserts: A woman will insert the device before activity, and you can take it out when you want to urinate. It is basically a small, tampon-like disposable device that you insert into the urethra before a specific activity that might trigger incontinence. The device acts as a plug to prevent leakage and is removed before urination.
- Pessary: The device is a flexible silicone rigid ring inserted into the vagina and worn all day. It helps to hold the bladder up, thus preventing leakage. The device is also used by women with vaginal prolapse. The pessary helps support the urethra with the aim to prevent urine leakage.
- Radiofrequency therapy: Tissues present in the lower urinary tract are heated. When it heals, it usually becomes firmer, often resulting in better urinary control.
- Botox: Botox is injected into your bladder muscle. This can help those of you with an overactive bladder.
- Bulking agents: These are injected into your tissue around the urethra. This helps to keep the urethra closed.
- Sacral nerve stimulator: This is implanted just under the skin of the buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping to control the bladder.
Surgery is your only option if other therapies do not work out. If you are planning to have children, you should discuss surgical options with your doctor before making any decision.
- Sling procedures: A mesh is inserted just below the neck of your bladder to help support the urethra and stop urine from leaking out.
- Colposuspension: The bladder neck is lifted, which can help relieve stress incontinence.
- Artificial sphincter: An artificial sphincter, or valve, is inserted. This controls the flow of urine from the bladder into your urethra.
Causes – Urinary Incontinence
There is a close link between causes and the type of incontinence.
1 Stress incontinence
- pregnancy and childbirth
- menopause, as falling estrogen can make your muscles weaker
- hysterectomy and some other kind of surgical procedures
- obesity and age
2 Urge incontinence
The following causes could cause the problem:
- Cystitis, is an inflammation of the lining of your bladder.
- Neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson’s disease.
- Enlarged prostate, which can cause the bladder to drop, and the urethra to become irritated
3 Overflow incontinence
This condition occurs when there is an obstruction or blockage to your bladder. These are the reasons which might cause an obstruction:
- If you have an enlarged prostate gland.
- A developed tumor pressing against the bladder.
- Urinary stones.
- If you have constipation.
- Urinary incontinence surgery, which went too far.
4 Total incontinence
This can result from the following scenarios:
- A spinal cord injury that harms the nerve signals between your brain and the bladder.
- An anatomical defect present from birth.
- A fistula – when a tube or channel develops between your bladder and a nearby area, like the vagina.
Risk factors linked to urinary incontinence:
- Smoking: You need to quit smoking. Else this can lead to a chronic cough. Which might result in episodes of incontinence.
- Obesity: This automatically puts extra pressure on your bladder and surrounding muscles. This results in weakened muscles, making leakage more likely when you cough or sneeze.
- Gender: Compared to men women have a higher chance, especially if they have had children.
- Old age: Your muscles in the bladder and urethra weaken with age.
- Some diseases and conditions: Common diseases like diabetes, kidney disease, spinal cord injury, and neurologic diseases, for example, a stroke – all could increase the risk.
- Prostate disease: This problem may present after prostate surgery or radiation therapy.