Anuja Nalvade makes it a point to visit her aged parents in Pune every other weekend. During one such visit, Anuja notices that her mother is withdrawn and refuses to go out. On asking, her mother hesitantly replies that she is finding it difficult to control her bladder. She has a constant urge to urinate and often finds it difficult to reach the toilet in time. Anuja realises that her mother is probably suffering from symptoms of urinary incontinence and needs to see a doctor for treatment.
What is urinary incontinence?
Urinary incontinence happens due to loss of bladder control causing involuntary leakage of urine. While this problem may occur in people of any age or gender, it is more prevalent in women and is seen predominantly in the elderly.
Urinary incontinence symptoms can range from mild to severe in intensity. In its mild form, sneezing or coughing and stretching activities like exercise, lifting or bending can trigger a sudden urine leakage. When severe, the urge to urinate is so sudden that the person does not get enough time to reach a toilet.
More than a health problem, urinary incontinence is a social issue. Most of the time, those who are suffering from urinary incontinence symptoms do not think that the condition can be treated. They just accept bladder problems as a part of growing old. As this issue is sensitive, they do not address the problem and allow it to remain untreated. When it comes to women, generally they hesitate to report or seek treatment for urinary incontinence. Sometimes, patients wait for six to nine years before reporting and getting treatment.
The stigma of urinary incontinence causes a negative effect on the well-being of patients. They tend to withdraw from active social life and refuse to leave their homes fearing loss of dignity. Travelling becomes difficult either due to unavailability of rest room facilities or due to difficulty in accessing them. All these problems contribute to anxiety and hopelessness in people with urinary incontinence. It also results in depression, reduced self-esteem and decreased quality of life.
Types of urinary incontinence:
There are different types of urinary incontinence.
- Urge incontinence (overactive bladder): Some people suffer from a sudden urge to urinate which is immediately followed by an involuntary discharge of urine. This is because of inflammation or irritation which can cause the detrusor muscle lining the wall of the urinary bladder to contract involuntarily. An overactive bladder can even cause a frequent urge to urinate without the actual passing of urine; this symptom can become worse at night. Triggers like the sound of running water or a key being inserted in the front door could also prompt leaking. This happens when signals from the brain do not reach the bladder in time.
- Stress incontinence: Activities such as coughing, sneezing, laughing, exercising or lifting something heavy can increase intra-abdominal pressure. This strains the lower abdominal muscles around the bladder causing urine to spill in small quantities. Stress incontinence can also happen due to weakness or injury to the sphincter muscles around the opening of the bladder. Men who have undergone prostate surgery often suffer from stress incontinence. However, more women suffer from stress urinary incontinence than men. Pregnancy, childbirth or menopause are some of the causes of urinary incontinence in females.
- Mixed incontinence: A person may suffer from symptoms of both urge incontinence and stress incontinence. This usually happens in the elderly and is also more common in women.
- Overflow incontinence: This type of incontinence is more common in men suffering from an enlarged prostate. The bladder does not empty completely, and a small amount is retained in the bladder. Due to this, the person suffers from constant or frequent dribbling of urine. Overflow incontinence can also happen due to the obstruction of the bladder outlet or impaired contractions of the detrusor muscle.
- Functional incontinence: Sometimes, a physical or mental impairment keeps a person from making it to the toilet in time. The patient may not have any bladder dysfunction. Generally, individuals with severe arthritis or musculoskeletal conditions suffer from functional incontinence due to impaired mobility.
Risk factors for developing urinary incontinence
- Ageing: As you get older, the frequency of involuntary bladder contractions goes up. The bladder muscles lose contractility and this decreases the capacity of the bladder to store urine causing overflow incontinence.
- Pregnancy: Pregnancy can lead to urinary incontinence as the body undergoes many hormonal changes and the weight of the foetus on the pelvic floor muscles results in stress incontinence.
- Childbirth: Subsequent to multiple childbirths, the muscles supporting the urinary bladder undergo a lot of stress. Women suffer stress incontinence from resultant weak or damaged pelvic floor muscles.
- Menopause: The incidence of female urinary incontinence is higher in women after menopause. Once menopause sets in, women produce less estrogen which is responsible for keeping the lining of the bladder and urethra healthy. Weak or damaged tissues can aggravate urinary incontinence symptoms.
- Hysterectomy: Women are at a higher risk of suffering from urinary incontinence after reproductive organ surgeries like removal of the uterus as it may damage the supporting pelvic floor muscles.
- Neurological disorders: Disorders like multiple sclerosis, Parkinson's disease, stroke, brain tumour, spinal injury, diabetes and spinal disc problem could interfere with nerve signals which controls the bladder.
- Diuretics: Diuretics are substances that increase the production of urine. Heart and blood pressure medication, sedatives and muscle relaxants can have a diuretic component in them. Alcohol, carbonated drinks, sparkling water and certain foods could stimulate your bladder and increase your volume of urine. Some examples of foods that act as diuretic agents are artificial sweeteners, chocolate, chilli peppers, citrus fruits and foods which are high in spice and sugar.
Diagnosis of urinary incontinence:
Consult a doctor, preferably a urologist, if anyone in your family is suffering from urinary incontinence symptoms like frequent urination, involuntary urination or overactive bladder.
- Physical exam: Patients undergo a basic evaluation that includes a history and physical examination.
- Neurological exam: This test is done to rule out any neurological causes for incontinence.
- Cough stress test: This test is done to confirm a diagnosis of stress incontinence.
- Postvoid residual urine (PVR): The amount of urine remaining in the bladder is measured to assess for overflow incontinence.
- Lab tests: A urine analysis is done to check for signs of urinary tract infection.
- Cystoscopy or urethroscopy: The urologist uses a scope to look inside the bladder to identify any structural abnormalities.
Urinary incontinence treatment:
1. Incontinence products
These products help to provide relief to patients suffering from urinary urgency and dripping.
- Absorbent products like urinary incontinence pads or diapers
- Handheld urinals
- Urinary catheter that drains urine into a bag
2. Exercises for urinary incontinence and conservative therapies
- In the early stages, pelvic floor exercises or Kegel exercises are highly recommended to manage stress and urge incontinence. These exercises are mostly beneficial to women.
- Yoga exercises involve working on breathing, relaxation and muscle control to help tighten the pelvic floor muscles.
- Acupuncture has been found to be effective in reducing urinary urgency and improving bladder control.
3. Lifestyle changes:
Your doctor may suggest some lifestyle changes that can improve your condition.
- Add more fibre to your diet. Lack of fibre leads to constipation that puts pressure on the bladder.
- Avoid smoking. Heavy smokers are at a greater risk of developing an overactive bladder.
- Restrict your intake of alcohol and caffeinated beverages including tea, coffee and some sodas. They can worsen an overactive bladder.
- Avoid citrus fruits, tomatoes, hot peppers and spicy dishes as they may irritate your bladder.
- Avoid artificial sweeteners. These tend to aggravate urinary urgency and frequency.
4. Behavioural approaches:
- Bladder training: This method involves training yourself to pee at set intervals and gradually increase the duration to improve your capacity to hold urine.
- Double voiding: This technique involves passing urine, then waiting a few minutes and trying again. It is helpful to patients with overflow incontinence.
- Fluid and diet management, losing weight and increasing physical activity.
5. Urinary incontinence medication:
Your physician may prescribe drugs based on the type of incontinence you have. Commonly used medicines to treat urinary incontinence are:
- Alpha blockers
- Topical estrogen
Patients with urinary incontinence need to open up regarding their condition and seek remedies for urinary incontinence. It is possible to regain an active and confident social life with recommended therapies and lifestyle changes. Family members can contribute to their well-being by supporting and helping them cope with the condition.
About the expert:
Reviewed by Dr Antony Robert Charles on 28 August 2019
The expert is a Pediatric Surgeon & Pediatric Urologist who is currently practicing in Bangalore.
About the author:
Written by Dr Shyam Kumar on 12 August 2019
The author holds a degree in Homoeopathy with an MBA in Hospital Management and has worked across multiple disciplines including healthcare and technology. As a nature lover, he attended the world's first underwater CEO's conference to combat marine pollution.
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