Dr. Faozat Aragbaye
Urinary incontinence is the involuntary leakage of urine. It means control over urinary sphincter is either lost or weakened.
Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life.
The causes and the type of incontinence are closely linked.
- pregnancy and childbirth
- menopause, as reduce oestrogen can make the bladder muscle weaker.
- hysterectomy and some other surgical procedures.
The following causes of urge incontinence have been identified:
- cystitis, an inflammation of the lining of the bladder.
- neurological conditions, such as multiple sclerosis (MS), stroke, and Parkinson’s disease.
- enlarged prostrate.
This happens when there is an obstruction or blockage to the bladder. The following may cause an obstruction:
- an enlarged prostate gland.
- a tumour pressing against the bladder.
- a urinary stones.
- urinary incontinence surgery which went too far
This can result from :
- an anatomical defect present from birth
- a spinal cord injury that impairs the nerve signals between the brain and the bladder.
- A fistula, when a tube or channel develops between the bladder and a nearby area, usually the vagina.
- some medications, especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives and muscle relaxants.
- urinary tract infections(UTIs)
The following are risk factors linked to urinary incontinence:
- Age- the muscles in the bladder and urethra weaken with age
- Gender–women have higher chance of experiencing stress incontinence than men, especially those that have had children.
- Obesity – extra pressure is placed on the bladder and surrounding muscles.
- Some diseases and conditions- diabetes, kidney disease, spinal cord injury, and neurological diseases, for example, stroke.
- Prostrate disease.
The main symptom is the unintentional release (leakage) of urine. The leakage of urine may be occasional, minor and it may be small to moderate amount of urine more frequently.
- Stress incontinence. Urine leaks when there is exertion of pressure on the bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
- Urge incontinence. There is sudden intense urge to urinate followed by an involuntary loss of urine. Urge incontinence may be caused by a minor condition such as infection, neurologic or diabetes.
- Overflow incontinence. Constant dribbling of urine due to a bladder that doesn’t empty completely.
- Functional incontinence. A physical or mental impairment that keeps one from reaching the toilet in time, for example, arthritis.
- Mixed incontinence. A person may experience more than one type of urinary incontinence.
Diagnosis starts with a thorough history and physical examination. A simple manoeuvre that can demonstrate incontinence, such as coughing can be recommended for the patient.
Other tests that may be recommended include:
.· Bladder diary
- Post-void residual measurement.
- Urodynamic test.
.· Pelvic ultrasound
Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed. If there is underlying condition causing the symptoms, the condition would be treated.
The following treatment may be recommended:
- Behavioural techniques.
. Blader training-delay urination after having urged to go. This will lengthen the time between trips to the toilet.
. Double voiding-urinating, then waiting a few minutes and try again.
. Schedule toilet trips – urinating every two to four hours rather than waiting for the need to go.
. Fluid and diet management – reducing liquid intake avoid consumption of alcohol, losing weight or increasing physical activity.
- Pelvic floor muscle exercises
- Electrical stimulation
- Medical devices.
- Interventional therapies
- Absorbent pads and catheters
Urinary incontinence is not always preventable . However to help decrease the risk , the following are recommended:
- Maintain a healthy weight.
- Practice pelvic floor exercises.
- Avoid bladder irritants, such as caffeine, alcohol and acidic foods.
- Eat more fibre that can prevent constipation, a cause of urinary incontinence.
- Don’t smoke or seek help to stop smoking.