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Urinary Incontinence

By Dr. Vijay Kumar in Urology

Aug 27 , 2021 | 1 min read

Urinary Incontinence means involuntary leakage of urine through urethra. It is quite a common problem in elderly persons especially women.

Types 

Stress Urinary Incontinence (SUI): Urine leaks while coughing, laughing, running or jumping and this leak is not related to the desire to pass urine.

Urge Incontinence (OAB- Overactive Bladder): Sudden and intense urge to urinate and urine leaks, this may be related to high frequency of urination and urgency.

Overflow incontinence: Inability to empty the bladder completely resulting in leakage of urine. These patients may have poor flow, straining and prolonged voiding time. 

Total incontinence: Bladder cannot store urine and leaks all the time without knowledge of patient.

Causes

Stress Incontinence

  • Multiple Pregnancy and childbirth leading to muscle weakness
  • Menopause causing low estrogen makes the muscles weaker
  • Hysterectomy and other pelvic surgical procedures/ Prostate surgery
  • Advanced age and obesity

Urge incontinence

  • Urinary infection
  • Neurological conditionse.g.Parkinsonism, stroke, spinal diseases/injury
  • Enlarged prostate, urinary bladder stone

Overflow incontinence

  • Enlarged prostate gland
  • Urinary stones
  • Stricture Urethra
  • Diabetic Cystopathy/ Neurogenic bladder

Total incontinence

  • Birth Defects
  • Spine injury impairing the nerve signals between the brain and the bladder
  • Fistulous connection between the bladder and vagina

Checkout: What are the Common Urinary Problems in Elderly?

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Risk factors linked to urinary incontinence:

Obesity, Smoking, advanced age, Diabetes, Spinal cord injuryand neurologic diseases, Prostate enlargement, Prostate surgery or pelvic surgery / radiation in pelvic area.

Evaluation of patient

Bladder diary: The person records how much he drinks and how much urine is passed and the number of episodes of incontinence.

Physical exam: The doctor may check the strength of the pelvic floor muscles and examine whether the prostate gland is enlarged.

Urinalysis: To rule out infection in urine.

Postvoid residual (PVR) measurement: This assesses how much urine is left in the bladder after urinating.

Pelvic ultrasound: May help detect any abnormality.

Stress test: The patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.

Urodynamic testing: This determines the bladder pressure and urinary sphincter muscle tone.

Cystogram: An X-ray procedure provide an image of the bladder.

Treatment of Incontinence

Treatment of incontinence depends upon the type of leakage diagnosed by the Urologist.

Medical treatment includes fluid management, lifestyle management, bladder behavior therapy, Kegels exercises, weight loss, antibiotics for UTI, drugs to control bladder overactivity, increasing tone of sphincter muscles, drugs for prostate etc.

Surgical treatment depends upon the cause and may range from Prostate or Stricture surgery, Stone surgery, Bladder neck suspension surgery, bulking agents, Vaginal tapes, Botox injection in bladder and Artificial Sphincters.