Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is the loss of a person’s ability to control his or her bladder. This is a common problem that ranges from occasionally leaking urine when the bladder gets compressed when coughing, sneezing or bearing down to having a urinary urge that is so sudden and tough that one fails to seek relief on time.

If urinary incontinence is affecting the person’s activities of daily living, he/she must seek medical consultation. Simple lifestyle modifications or medical interventions could address this problem or totally stop it from occurring.

Urinary Incontinence is stigmatized, under-diagnosed, underreported and an under-treated condition that is erroneously thought to be normal in the aging process. Based on expert analysis, 25 million adults in the US alone experience transient or chronic Urinary Incontinence. The National Association for Continence estimated that 75 to 80 percent of those affected are women.

Symptoms of Urinary Incontinence

These are the different types of urinary incontinence:

• Stress Incontinence. This happens when a person exerts pressure or stress on the bladder by laughing, exercising, coughing, sneezing or when lifting heavy objects.
• Urge Incontinence. It is a sudden and deep urge to urinate, which then proceeds to involuntary urination. Urge Incontinence may be caused by different disease process such as urinary tract infection, Parkinson’s disease, Alzheimer’s disease, stroke, injury or nerve damage associated with Multiple Sclerosis. Urge incontinence with an unknown cause can also be referred to as overactive bladder.
• Overflow Incontinence. If a person has a frequent or constant dribbling of urine, he/she may have overflow incontinence, which is the bladder’s inability to empty. This may be caused by nerve damage, a blocked urethra, damaged bladder, from diabetes, multiple sclerosis or spinal cord injury. Overflow incontinence could also be caused by prostate gland abnormalities in men.
• Mixed Incontinence. Experiencing more than one type of urinary incontinence. An example is having urge incontinence and stress incontinence at the same time.
• Functional Incontinence. An incontinence caused by a client’s physical or mental impairment. An example is a client with arthritis may not be able to lay down his/her pants quickly enough which causes her to involuntarily urinate.
• Total Incontinence. This term is used to describe continuous excretion of urine, morning and evening, of the periodic involuntary excretion of large volumes of urine.

What Causes Urinary Incontinence?

Urinary incontinence is a symptom. It could be caused by impractical habits, medical conditions or other physiological problems. A thorough assessment by a healthcare provider could help determine the cause of the incontinence.

Causes of temporary urinary incontinence

Certain diet and medication regiments could cause temporary urinary incontinence. Simple habit modifications can prevent discomfort from incontinence.

• Decrease alcohol intake.
• Do not drink more than the recommended fluid intake in a short period of time.
• Modify caffeine intake to a moderate.
• Carbonated drinks, tea and coffee – with our without caffeine – and other bladder irritants should be limited.
• Some drugs for heart problems and blood pressure may contribute to increased fluid output.

Easily treated medical conditions could also cause urinary incontinence

• Urinary tract infection irritates the bladder, causing incontinence.
• Constipation from compacted stools can interfere or cause the nerves of the bladder to be overactive, thus leading to incontinence.

Other causes of persistent urinary incontinence

• Pregnancy and childbirth
• Physiological changes from aging
• Hysterectomy
• Painful bladder syndrome (interstitial cystitis)
• Prostatitis
• Enlarged prostate (Benign Prostatic Hyperplasia)
• Prostate cancer
• Bladder cancer or bladder stones
• Neurological disorders
• Obstruction

Diagnosis of Urinary Incontinence

Common tests and diagnostic tools for urinary incontinence include, but are not limited to, the following:

• Bladder diary. A physician may ask the client to keep a bladder diary for a limited period of time. The client would then record his or her fluid intake and output, the episodes of urges to urinate, and the number of times that the client manifested incontinence.
• Urinalysis. A urine sample of the client would be given to the laboratory to check any abnormalities like infection, blood and specific gravity.
• Blood test. A sample of blood would be drawn from the client to check the blood for various elements or components that may be causing urinary incontinence

If further information is required, the client would undergo additional diagnostic episodes, including:

• Postvoid residual measurement
• Pelvic ultrasound
• Stress test
• Urodynamic testing
• Cystogram
• Cystoscopy

Treatment of Urinary Incontinence

Behavioral techniques

These techniques and lifestyle modifications do well in certain types of incontinence. These are usually the only treatment needed for the client.

• Bladder training. This involves learning to delay urination even after the person has felt the urge to urinate.
• Scheduled toilet trips. This is a scheduled or a timed urination, which is going to the toilet at the allotted time rather than waiting for the urge to urinate.
• Fluid and diet management. In other cases, the person’s habits are simply modified to regain the control of his/her bladder. The person may need to reduce his or her alcohol intake and cut down on caffeine and acidic foods.

Other therapies include physical therapy (pelvic floor muscle exercises, Kegel exercises and the like), electrical stimulation, medications (anticholinergics, topical estrogen, and tricyclic antidepressants), medical devices (urethral insert and Pessary), bulking material injections, Botulinum toxin type A, nerve stimulators and different surgeries.

How to Prevent Urinary Retention

Urinary incontinence cannot always be prevented. The risk of having incontinence may be decreased though through these different methods:

• Maintaining ideal body weight. Being overweight contributes in the pressure of the bladder.
• Smoking cessation. Counseling and group activities could help a client get help on quitting.
• Practice Kegel exercises. To strengthen the urethral muscles.
• Avoid bladder irritants. To avoid irritating the bladder to cause urinary incontinence.
• High fiber intake. To prevent constipation.
• Exercise. Adequate physical activities reduce one’s risk of developing incontinence.

References
http://www.nafc.org/index.php?page=facts-statistics
http://www.mayoclinic.com/health/urinary-incontinence/DS00404/DSECTION=prevention