.::: Introduction.

     .::: Types.
     .::: Causes and risk factors.
     .::: Screening and diagnosis.

     .::: Treatment.

     .::: Prevention.

     .::: Points to remember.

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     .::: Introduction:

Do you have trouble in controlling your urine? Do you leak urine when you cough or sneeze? Do you suddenly need to go to the toilet so badly that you're not sure you're going to make it in time — and sometimes you don't? Does a fear of wetting yourself and smelling of urine keep you from activities? Do you need to wake up many times in the night to pass urine?
The loss of bladder control — known as urinary incontinence — is an all too common, often embarrassing and frustrating problem for millions of people. If you answered yes to any of the above questions, you may count yourself among them.
It is estimated that anywhere between 25-70% of women suffer from this problem. However the prevalence of urinary incontinence in the community has been severely underestimated. This is because 40% of women feel embarrassed to talk about this problem to their doctors and >60% of women perceived urine loss as a normal consequence of ageing. Less than half the individuals living in the community with urinary incontinence seek treatment.

Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.

Older women, more often than younger women, experience incontinence. But incontinence is not a normal part of aging. Incontinence is treatable and often curable at all ages. If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. If you are having troubles please overcome your embarrassment and do not hesitate to see your doctor.

In many situations, incontinence can be eliminated. Even if the condition can't be completely eliminated, modern products and ways of managing urinary incontinence can ease your discomfort and inconvenience.

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     .::: Types:

Urinary incontinence is the inability to control the release of urine from your bladder. The problem has varying degrees of severity. Some people experience only occasional, minor leaks — or dribbles — of urine. Others wet their clothes frequently. For a few, incontinence means both urinary and fecal incontinence — the uncontrollable loss of stools.

Main types of urinary incontinence:

    Stress incontinence. This is loss of urine when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. It has nothing to do with psychological stress. The problem is especially noticeable when you let your bladder get too full. Stress incontinence is the most common type of incontinence, often affecting women. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to this type of incontinence.
SUI can have a major impact on all aspects of well being. Since SUI is mainly prevalent in young and middle aged women who have an active professional or social life, this might have a greater impact. These women may experience limitations in terms of physical (playing sports, lifting heavy weights) occupational and social activities because of fear of leakage of urine and related consequences(e.g.smell of urine, wetness, visibility of pads etc). SUI can also affect a woman's sex life, social activities and interpersonal relationships.

    Urge incontinence. This is a sudden, intense urge (desire) to urinate, followed by an involuntary loss of urine. Your body may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. Some people with urge incontinence have a strong desire to urinate when they hear water running or after they drink only a small amount of liquid. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury. In urge incontinence, the bladder is said to be "overactive" — it's contracting even when your bladder isn't full. When a person has frequency, urgency, nocturia with or without urge incontinence he or she is said to have an Overactive bladder.

    Overflow incontinence. If your bladder is always full so that it frequently leaks urine, you have overflow incontinence. With overflow incontinence, you may feel as if you never completely empty your bladder — or that you need to empty your bladder, but can't. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.

    Mixed incontinence. This means having more than one type of incontinence, typically stress incontinence and urge incontinence. Usually one type is more bothersome than the other is. The cause of the two forms may or may not be related Though SUI is the most common type of incontinence; typically people walking into a referral centre have mixed incontinence. Women with mixed incontinence have to be carefully managed as both types of incontinence have a devastating impact on quality of life.

    Functional incontinence. Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly. Someone with Alzheimer's disease may not think well enough to plan a timely trip to the bathroom. This type of incontinence is called functional incontinence.

 
    Nocturnal enuresis. This is the medical term for nighttime bed-wetting. Some children, mainly boys, who are otherwise toilet-trained wet the bed at night for a variety of reasons. Adults can lose control of their bladder at night, too, possibly because of medications. The aging bladder also is more likely to have difficulty storing urine at night because of an abnormally high production of urine during nighttime. Click here to read more about nocturnal enuresis.

Urinary incontinence isn't a disease itself. It indicates some underlying problem or condition that likely can and should be treated. A thorough evaluation by your doctor can help determine what's behind your incontinence.

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     .::: Causes and risk factors:

Urinary Incontinence can be temporary or persistent. Temporary causes can be managed by simple treatment and examples include:

  • Drinking a lot of fluid.

  • Not drinking enough fluid.

If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.
 

  • Overdoing the caffeine as caffeine is diuretic that make your bladder to fill more quickly.
 

  • Consuming foods and beverages that irritate your bladder like Carbonated drinks, tea and coffee — with or without caffeine — , Citrus fruits and juices and artificial sweeteners.
 

  • Use of certain drugs such as diuretics, tranquillizers and sedatives.
 

  • Infection of the urinary tract.

Persistent urinary incontinence can be caused by:
 

  • Pelvic floor muscle weakness: This is the most common cause of urinary incontinence in women. The weakness mainly occurs after multiple vaginal deliveries especially if instrument like vacuum or forceps has been used. Weakness also occurs in women who have gone through the menopause (post-menopausal women).
 

  • Damage to the nerves that control bladder function. Some operations might interfere with the nerve supply to the bladder such as hysterectomy, major gynecological operations, operations for rectal masses or tumors…
 

  • Medical Conditions such as Alzheimer's or Parkinson’s disease, a stroke, Multiple sclerosis or spinal cord injury.
 

  • Physical limitations that affect mobility and ability to reach the toilet in time, for example, having arthritis.
 

  • An enlarged prostate in men.
 

  • Bladder cancer. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer. Other signs and symptoms of bladder cancer include blood in the urine and pelvic pain.

There is some other factors increase the risk of developing urinary incontinence:
 

  • Sex. Women are twice as likely as men are to have incontinence.
 

  • Age. As you get older, the chance to have incontinence is more. However, that doesn't mean that you'll have incontinence just because you're getting older. Incontinence isn't normal at any age — except during infancy.
 

  • Obesity. Being overweight puts constant and higher pressure on your bladder and surrounding muscles, weakening them and allowing urine to leak out when you cough or sneeze. So obesity is a risk factor for incontinence, especially for women.
 

  • Smoking. A chronic cough can cause episodes of incontinence or aggravate incontinence with other causes. Constant coughing puts stress on your urinary sphincter. Longtime smokers often experience stress incontinence for this reason.

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     .::: Screening and diagnosis:

The first step in diagnosing urinary incontinence is to see your doctor for a complete history and physical examination.
Your doctor will ask about your symptoms and medical history. Urinary Questionnaire will be completed.

A complete physical examination, focusing on your abdomen and genitals, also may give clues to your incontinence.

 
Common tests

Common tests for urinary incontinence include:
 

   Bladder diary. Your doctor may ask you to complete voided diary at home over three days. You simply record how much you drink and the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes. Click here to see a copy of bladder diary.
 

   Urinalysis. A sample of your urine is sent to a laboratory, where it's checked for signs of infection, traces of blood or other abnormalities.
Specialized testing
If further testing is needed, Women might be referred to a doctor who focuses on urologic problems in women (urogynecologist). At the specialist's office, you may undergo additional testing such as:
 

   Bladder Scan. A bladder scan is usually done to see the volume of residual urine remaining in the bladder after a woman voids. Residual urine of more than 100ml usually indicates that there is a voiding problem.

   Pelvic ultrasound. Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.

   Urodynamic testing.

 Evaluates the function of the bladder and urethra through the placement of small catheters into the urethra and vagina. The bladder is slowly filled with saline during which time we can evaluate bladder sensitivity and pressure within your bladder is recorded. Then you will be asked to bear down and cough to determine your ability to hold urine without leaking. Lastly, you will be asked to void so that we may determine the way in which you empty your bladder. Duration of procedure is approximately 45 to 60 minutes and it is done in the office.

Sometimes, urodynamics is done together with x-ray screening, where live images produced on a TV monitor show the doctor what is happening when your bladder is filling and emptying. The screening is known as video-urodynamics.

After the test:
     • You are advised to drink plenty of fluids for the next 24 hours to help flush your bladder to prevent urine infection.
     • Infection is rare, but do seek medical attention if you have symptoms like fever or persistent pain when passing urine. You may experience a bit of discomfort like pain or slight bleeding when passing urine, but it should settle within 48 hours. Sometimes we give antibiotic prophylaxis foe those patients at high risk to develop infection.


   Cystogram. In this special X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, your doctor injects a fluid containing a special dye. As you urinate this fluid back out of your body, images show up on a series of X-rays. These images help reveal problems with your urinary tract.
 

   Cystoscopy. In this procedure, your doctor will see the inside of your urethra and bladder via a thin tube with a tiny lens(cystoscope).
 

Once the tests are complete, your doctor can explain the results and discuss treatment options with you.

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     .::: Treatment:

         See both surgical and non surgical treatment of urinary incontinence

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     .::: Prevention:

Incontinence may or may not be something you can prevent. Oftentimes the cause of incontinence is out of your control. However, you may be able to decrease your risk of urinary incontinence with these steps:
 

        Maintain a healthy weight. As obesity is a risk factor for urinary incontinence.
 

        Practice Kegel exercises. Because pregnancy and childbirth can weaken the urinary sphincter and pelvic floor muscles, doctors may advise pregnant women to do Kegel exercises during pregnancy and after delivery as a preventive step.
 

        Avoid bladder irritants. Avoiding or limiting certain foods and drinks may help prevent incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do.
 

        Eat more fiber to prevent constipation, which can be a cause of incontinence.
 

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     .::: Points to remember:

         • Urinary incontinence is common in women.
         • All types of urinary incontinence can be treated.
         • Incontinence should not be viewed as inevitable or as a normal part of aging.
         • Incontinence can be treated at all ages.
         • You need not be embarrassed by incontinence.
         • You should see the specialist once the problem started and don’t wait too long.

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