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Urinary And Stress Incontinence - It's Treatment

Alternative names :- Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary

Urinary incontinence is defined as the involuntary loss of urine. It occurs if bladder muscles suddenly contract or muscles around the urethra suddenly relax. Stress incontinence is the loss of urine as a result of physical activity. Urinary incontinence occurs in men and women, but the prevalence in women is two times greater, occurring in 15% to 30% of women. Stress incontinence, the most common form in women. is believed to account for one-half of all cases of urinary incontinence in women. Older women are more likely to suffer from urinary incontinence than younger women

What causes Urinary incontinence?

Pregnancy and childbirth. menopause. and the structure of the female urinary tract contribute to the increased incidence of urinary incontinence in women. After pregnancy and childbirth. pelvic floor muscles may weaken. These are the same muscles that squeeze around the urethra to make it close. Decreased levels of estrogen also lead to lower muscular pressure around the urethra. As a result. complete closure of the urethra may not occur, or may not be maintained during physical activity. Urinary incontinence has also has been linked to hormone replacement therapy.

Other factors that may cause or contribute to urinary incontinence include:

  • local causes, such as infection, bladder stones, and pelvic masses
  • neurologic causes, such as stroke, multiple sclerosis, birth defects, and spinal injury
  • medications, such as diuretics, beta blockers and antidepressants
  • medical conditions, such as hypothyroidism, diabetes, and depression.

Signs and symptoms of Urinary incontinence

Leakage of urine is the major sign of urinary incontinence. Urinary incontinence is also associated with nocturia, frequent urination (more than 8 times in 24 hours), and the sudden, uncontrollable urge to urinate moderate or large amounts of urine. Stress incontinence is usually associated with loss of small amounts of urine while coughing, laughing, sneezing, jogging, lifting, and other movements that put pressure on the bladder. It may worsen during the week before menses, and commonly increases after menopause. Frequency and nocturia aren't common symptoms of stress incontinence.

Urinary incontinence and stress incontinence have also been associated with:

  • disroption of daily activities
  • sleep deprivation
  • depression
  • social isolation
  • loss of self-esteem
  • altered relationships.

The Types of Urinary Incontinence

Stress Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
Urge Leakage of large amounts of urine at unexpected times, including during sleep.
Functional Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.
Overflow Unexpected leakage of small amounts of urine because of a full bladder.
Mixed Usually the occurrence of stress and urge incontinence together.
Transient Leakage that occurs temporarily because of a condition that will pass (infection, medication).
 
  • Urinary incontinence is common in women.
  • All types of urinary incontinence can be treated.
  • Incontinence can be treated at all ages.
Diagnosis information

Diagnostic tests used to evaluate urinary incontinence include:

  • The cotton-tipped applicator test can be used to evaluate urethral motility. A sterile cotton swab is inserted 1-1/4"(3 cm) into the urethra. When the patient with urinary incontinence coughs, the angle of the cotton swab changes by more than 45 degrees. This is thought to be evidence of poor muscular support.
  • Evaluation of the post void residual is done by measuring bladder capacity and how much urine remains in the bladder after urination. A post void residual of less than 50 ml is considered normal.
  • The cough test, which involves having the patient cough as the clinician directly observes for leakage of urine.
  • Simple cystometry can evaluate for detrusor instability associated with urge incontinence.
  • Urinalysis and culture are typically used to role out infection as the cause of urinary incontinence.
  • Ultrasound is used to visualize the kidneys, ureters, bladder, and urethra.
  • Cystoscopy, which involves insertion of a thin tube with a camera into the urethra. allows the clinician to see inside the urethra and bladder.
  • Urodynamics measure pressure in the bladder and flow of urine.

Treatment of Urinary incontinence

Treatment strategies for urinary incontinence should always begin with the least invasive method. Commonly, a less invasive method is successful and more invasive techniques such as surgery can be avoided. It's important to note that noninvasive techniques require participation and commitment from the patient. These techniques include:

  • Kegel exercises, which can be performed by the patient to exercise and strengthen the pelvic floor muscles, can be done with or without insertion of weighted cones into the vagina.
  • Electrical stimulation of the pelVic muscles using electrodes in the vagina and rectum can strengthen the muscles similarly to actually exercising them.
  • Biofeedback involves the use of a diary or electronic deVice to document contraction of bladder and urethral muscles. It can help the patient become aware of her body's functioning and allow her to gain control of these muscles.
  • Timed voiding and bladder training are techniques that allow the patient to empty her bladder before incontinence occurs. These are effective for overflow and urge incontinence.
  • A pessary is a rubber or silicon device inserted into the vagina that exerts pressure on the urethra. The application of a pessary can lead to less stress leakage.

Pharmacologic agents can also be used to treat urinary incontinence associated with detrusor instability. Anticholinergics, such as oxybutynin (Ditropan) and tolterodine (Detrol), block involuntary contractions of the bladder. Tricyclic antidepressants, such as imipramine (Tofranil), exert anticholinergic and musculotropic effects. They also increase bladder outlet resistance. Hormones, such as estrogen, help muscles function normally and are effective in treating postmenopausal women with stress incontinence.

In some instances, more invasive treatments may be necessary to relieve the condition. These include:

  • implants into the tissue surrounding the urethra
  • surgery to pull the bladder up, secure the bladder, or implant an artificial sphincter. (Surgery to treat stress incontinence increased nearly 45% from 19BB to 1998.)

Special considerations and Prevention

It's important for health care proViders to screen patients, especially women, for urinary incontinence. Patients may be too embarrassed to admit their symptoms. Reassure patients that it's a common disorder and typically can be treated with fairly conservative measures. In addition:

  • Educating women on appropriate hygiene practices is also crucial because genitourinary infections can contribute to or worsen urinary incontinence.
  • Sometimes extra weight causes bladder control problems. A good meal plan and exercise program can lead to weight loss.
  • Some drinks and foods may make urine control harder. These include foods with caffeine (coffee, tea, cola, or chocolate) and alcohol.
  • Bladder irritants, such as acidic fruits or fruit juices, tomato products, and spicy foods may contribute to urinary incontinence and should be avoided.


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