urinary incontinence
What is urinary incontinence?
Urinary incontinence is the loss of bladder control or the inability to control urination (urination). There are different types of urinary incontinence. These are:
- Stress incontinence: occurs when stress or pressure on the bladder causes urine to leak. This can happen when you cough, sneeze, laugh, lift something heavy, or do physical activity. Its causes include weakness of the pelvic floor muscles and a bladder that is out of its normal position.
- Urge incontinence: Occurs when you have a strong need (urgency) to urinate and some urine leaks out before the person can get to the bathroom. It is often related to an overactive bladder. Urge incontinence is more common in older people. Sometimes it can be a sign of a urinary tract infection. It can also occur in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
- Overflow incontinence: occurs when the bladder does not empty completely. This causes too much urine to remain in the bladder. This form of urinary incontinence is more common in men. Some of its causes include tumors, kidney stones, diabetes, and certain medications.
- Functional incontinence: occurs when a physical or mental disability, trouble speaking, or some other problem prevents you from getting to the bathroom in time. For example, a person with arthritis may have trouble unbuttoning their pants, or a person with Alzheimer’s may be unaware of their need to schedule bathroom visits.
- Mixed incontinence: means you have more than one type of incontinence. In general, it is a combination of stress and urge incontinence.
- Transient incontinence: This is a loss of urine caused by a temporary (transient) situation such as an infection or a new medication. Once the cause is removed, the incontinence goes away.
Wetting the bed: is the loss of urine during sleep. This is more common in children, but it can happen to adults too.
Diagnosis
During your medical consultation, the doctor will look for clues that allow you to identify the factors that contribute to your problem. Your citation will likely consist of the following:
- Medical history
- Physical exam, which may include a rectal exam and a pelvic exam for women
- Testing a urine sample for infections, traces of blood, or other abnormalities
- Brief neurological exam to identify pelvic nerve problems
- Urinary stress test, in which the doctor observes the loss of urine when you cough or strain
Common cases of urinary incontinence do not usually require additional testing. However, in some cases, the doctor may order tests to evaluate the function of the bladder, urethra, and sphincter (urodynamic studies).
How is it treated?
Your doctor may recommend a combination of strategies to treat incontinence. If an underlying cause or contributing factor is identified, such as a urinary tract infection, the patient will also receive treatment for that condition.
To treat stress urinary incontinence, your doctor may suggest surgical interventions designed to make the sphincter close better or to support the neck of the bladder. Surgery options include the following:
- Sling procedure: This is the most common operation performed on women with stress urinary incontinence. The surgeon uses the patient’s own tissue, a synthetic material (mesh), or animal or donor tissue to create a sling or a kind of support that serves to support the urethra.
The sling procedure is also done for men who have mild stress urinary incontinence, and for some it can relieve symptoms. - Injectable fillers: In this procedure, synthetic gels or polysaccharides are injected into the tissues surrounding the upper part of the urethra. These materials increase the size of the area around the urethra so that the sphincter can close better.
- Retropubic Colposuspension: In this surgical procedure, sutures are placed in the pubic ligaments to lift and support the tissues near the bladder neck and upper urethra. This surgery can be done laparoscopically or through an incision in the abdomen.
- Inflatable artificial sphincter: This surgically implanted device is used to treat men. A cuff is placed around the top of the urethra, replacing the function of the sphincter. The cuff is connected by tubing to a pressure-regulating balloon in the pelvic region and to a manually operated pump in the scrotum.