Home
My Account
About Us
Forum
Contact us
الواجهة العربية
epharmaweb.com
Medical News Medical News
Aricles Articles
Events Events
Guidelines Guidelines
Videos Library Videos Library
Diseases Diseases
Follow us : facebook twitter Digg Linkedin Boxiz
Newsletter

Please select the categories you are intersted in:
News Articles Guidelines Events Videos Journals' abstracts

Latest Subscribers
Advanced Search »



Urinary incontinence

Definition


Disease: Urinary incontinence Urinary incontinence
Category: Genito-urinary diseases

Disease Definition:

The loss of bladder control is a common and embarrassing problem known as urinary incontinence. This condition varies in its severity. At the mildest cases, it may be an occasional leakage when a person sneezes or coughs, but at the most severe cases, it may be such a sudden and strong urge to urinate, that the person may not be able to reach the toilet.

 

A person with urinary incontinence should see a doctor, especially if the condition is affecting his/her daily activities. Urinary incontinence can be eliminated with simple lifestyle changes or medical treatments.
 

Work Group:


Symptoms, Causes

Symptoms:

Some of the types of urinary incontinence are:

 
Stress incontinence:

When the sphincter muscle of the bladder becomes weakened, stress incontinence occurs. This happens if a person exerts pressure on his/her bladder by sneezing, exercising, coughing, lifting heavy things or laughing. Removal of the prostate gland in men may cause stress incontinence, while in women, pregnancy, childbirth and menopause may end up causing it.

 
Urge incontinence: 

In this type of urine incontinence, the involuntary loss of urine is preceded by an intense urge to urinate. In this type, the bladder muscle will contract, giving only a few seconds to one minute to reach the toilet. In case a person has this type of urine incontinence, they will have the need to urinate frequently, including throughout the night. In case urge incontinence doesn’t have a known cause, it is called overactive bladder, but if it does have a known cause, it may be one of the following:

  • Alzheimer’s disease
  • Bowel problems
  • Urinary tract infections
  • Stroke
  • Injury or nervous system damage associated with multiple sclerosis
  • Bladder irritants
  • Parkinson’s disease
 
Overflow incontinence:

Overflow incontinence is the inability to empty the bladder, causing a person to frequently dribble urine. When a person with overflow incontinence tries to urinate, only a weak stream of urine will be produced. They may feel like their bladder never empties completely. This condition may occur in people with:

  • A damaged bladder
  • Prostate gland problems (in men)
  • Blocked urethra
  • Nerve damage from diabetes
 
Mixed incontinence:

Mixed incontinence is when a person experiences symptoms of more than one type of urinary incontinence, for instance, urge incontinence and stress incontinence.

 
Functional incontinence:

In case a physical or mental impairment keeps older adults from making it to the toilet in time, functional incontinence occurs. One example is when a person with arthritis can’t unbutton his/her pants quickly enough.

 
Gross total incontinence:

In some cases, gross total incontinence occurs when a person is born with an anatomical defect. Additionally, injuries to the spinal cord or urinary system or an abnormal opening (fistula) between the bladder and an adjacent structure, such as the vagina, may also end up causing gross total incontinence. The bladder of people with this type of urine incontinence doesn’t have storage capacity, resulting in a continuous leakage of urine, or periodic uncontrollable leakage of large volumes of urine. 

 

Urinary incontinence increases the risk of falls in older adults as they rush to make it to the toilet. It may indicate a more serious underlying condition, particularly when it’s linked with blood in the urine. It may also cause a person to restrict their activities and limit social interactions in order to avoid embarrassment. All these are important factors that may affect a person’s quality of life. So, no matter how embarrassing it may be to talk to a doctor about urinary incontinence, but it’s quite important in order to put a stop to this condition.
 

Causes:

Everyday habits, physical problems or underlying medical conditions may be the cause of urinary incontinence. This condition isn’t considered a disease, but rather a symptom. Additionally, in order to find out the exact cause of it, a thorough evaluation by the doctor may be necessary.

 

TEMPORARY URINARY INCONTINENCE:

Certain medications, foods and drinks may cause temporary urinary incontinence, such as:

 
Alcohol:

Alcohol may cause an urgent need to urinate because it acts as a bladder stimulant and a diuretic.

 
Overhydration:

The bladder may not be able to deal with large amounts of fluids, especially if they were taken in a short period of time.

 
Dehydration:

The urine may sometimes become very concentrated if a person doesn’t consume enough liquids to stay hydrated. In some cases, a person’s urinary incontinence may become worse and their bladder irritated due to the collection of concentrated salts.

 
Caffeine:

Caffeine may cause a sudden need to urinate because it is a bladder stimulant and a diuretic.

 
Medications:

Problems with bladder control may be partly caused by blood pressure drugs, heart medications, muscle relaxants, sedatives, as well as other medications.

 
Bladder irritation:

Mentioned below are some of the substances that may aggravate the bladder:

  • Corn syrup
  • Sugar
  • Tea and coffee, whether with or without caffeine
  • Acid, such as tomatoes and citrus
  • Artificial sweeteners
  • Foods and beverages that contain lots of spices

In addition to all these, some of the other medical conditions that may cause urinary incontinence include:

 
Urinary tract infection:

A person may have strong urges to urinate in case an infection irritates their bladder. The only signs of a urinary tract infection may be these urges, resulting in episodes of incontinence. In addition to all this, urine that has a bad smell and having a burning sensation when urinating may be some of the other signs and symptoms of urinary tract infection.

 
Constipation:

The rectum and bladder share many of the same nerves because they are near each other. These nerves may become overactive and increase urinary frequency in case there’s hard and compacted stool in the rectum.

 

PERSISTENT URINARY INCONTINENCE:

Some physical problems or changes may cause persistent urinary incontinence. Some of them are:

 
Pregnancy and childbirth:

Due to the increased weight of an enlarged uterus as well as hormonal changes, pregnant women may experience stress incontinence. The muscles that are needed for bladder control may weaken due to the stress of a vaginal delivery. Additionally, the changes that occur during childhood may lead to a dropped or prolapsed pelvic floor in case the bladder nerves and supportive tissue become damaged. The bladder, uterus, rectum or small bowel may get pushed down from their usual position due to the prolapse, and end up protruding into the vagina. This may cause urinary incontinence. This type of incontinence may take years to develop, or it may develop right after delivery.

 
Changes with aging:

The capacity of the bladder to store urine will be decreased and the overactive bladder symptoms increased due to the aging of the bladder muscle. In case a person has blood vessel disease, the risk of developing an overactive bladder increases. To avoid the symptoms of overactive bladder, a person should maintain good overall health, such as treating high blood pressure, keeping their weight within a healthy range and stopping smoking. In women, estrogen helps keep the lining of the bladder and urethra healthy. When women start producing less estrogen, which happens after menopause, the tissues mentioned above may deteriorate, aggravating incontinence.

 
Hysterectomy:

The bladder and uterus in women are located close to each other and are supported by the same ligaments and muscles. There will be a risk of damaging the supporting pelvic floor muscles, leading to incontinence in case a woman undergoes any surgery that involves her reproductive system, such as hysterectomy, which is the removal of the uterus.

 
Interstitial cystitis:

This is a rare but painful bladder syndrome. It is a chronic condition that may sometimes end up causing painful and frequent urination as well as urinary incontinence.

 
Prostatitis:

This condition is the inflammation of the prostate gland, which is an organ the size of a walnut and is located just below the male bladder. Prostatitis is a common condition that may sometimes cause urinary incontinence.

 
Enlarged prostate:

Benign prostatic hyperplasia (BPH) is a condition that affects older men. After the age of 40, the prostate begins to enlarge in many men. This condition may cause urinary incontinence.

 
Prostate cancer:

Untreated prostate cancer may cause stress incontinence or urge incontinence in men. But in most cases, the treatments of prostate cancer, such as radiation or surgery, cause incontinence as a side effect.

 

Bladder stones or bladder cancer:

Bladder stones or bladder cancer may cause signs and symptoms such as pelvic pain, blood in the urine, burning with urination, incontinence and urinary urgency.

 

Neurological disorders:

Urinary incontinence may be caused in case the nerve signals that are involved in bladder control are interfered due to Parkinson's disease, a spinal injury, multiple sclerosis, stroke or a brain tumor.

 

Obstruction:

In some cases, urine leakage may be due to urinary stones, which are hard, stone-like masses that form in the bladder and can be found in the ureter, kidneys or the bladder. Additionally, the normal flow of urine may be obstructed, and incontinence may be caused, usually overflow incontinence, in case there's a tumor along the urinary tract. Some of the factors that may increase a person's risk of developing urinary incontinence may include:

 

Age:

The muscles in the bladder and urethra lose some of their strength as a person gets older. Because the amount of urine the bladder can hold is decreased with age, aging increases a person's chances of involuntary urine release. However, incontinence doesn't develop in all older adults, and except during infancy, incontinence isn't normal at any age.

 

Sex:

Normal female anatomy, pregnancy, childbirth and menopause are some of the factors that make women more likely to develop stress incontinence than men. However, urge and overflow incontinence are more likely to develop in men with prostate gland problems.

 

Smoking:

Episodes of incontinence may be caused or incontinence that has other causes may be aggravated due to the chronic cough that is associated with smoking. Overactive bladder may develop in smokers. Additionally, stress incontinence may be caused by the constant coughing that puts stress on the urinary sphincter.

 

Being overweight:

Extra pressure will be put on the bladder and surrounding muscles in case a person is overweight or obese. This may weaken them and allow urine leakage when a person sneezes or coughs.

 

Other diseases:

A person's risk of developing incontinence may increase due to diabetes or kidney disease.
 

Complications

Complications:

Some of the complications that a chronic urinary incontinence may cause include:

 

Urinary tract infections:

The risk of repeated urinary tract infections will increase due to incontinence.

 

Changes in work life:

A person's work life may be negatively affected by urinary incontinence. This condition may disrupt his/her concentration at work or keep them awake at night, causing fatigue. Additionally, the urge to urinate may keep them away from their desk.

 

Skin problems:

Skin infections, rashes and sores (skin ulcers) may result from the constantly wet skin that is caused by urinary incontinence.

 

Changes in personal life:

People with incontinence usually experience depression and anxiety. Because of the embarrassment caused by the leakage of urine, a person may avoid sexual intimacy. Additionally, the person's family may become frustrated with his/her many trips to the toilet.

 

Changes in activities:

A person may stop exercising, quit attending social gatherings and participating in normal activities due to urinary incontinence.

 

However, when treatment begins early, incontinence may be controlled or eliminated.
 

Treatments:

The type and severity of the incontinence, as well as the underlying cause will determine the treatment for urinary incontinence. Usually, a combination of treatments is used. Urinary incontinence can be treated either with conservative approaches, such as physical therapy and behavioral techniques, or more aggressive approaches, such as surgery. Usually, the least invasive approach will be suggested first, so that the patient will undergo physical therapy and behavioral techniques first, and then if these don't work, he/she will undergo other options. Getting the right diagnosis is essential for the success of treatment.

 

BEHAVIORAL TECHINIQUES:

Certain types of urinary incontinence can be relieved with lifestyle changes and behavioral techniques. These may include:

 

Scheduled toilet trips:

In this technique, instead of going to the toilet whenever having the urge to go, the person will go to the toilet according to the clock, usually every two to four hours. With this method, going to the toilet will be a routine.

 

Bladder training:

In order to control urge and other types of incontinence, a person may be recommended bladder training, either alone or with other therapies. In bladder training, the patient will learn how to delay urination after getting the urge to go. Initially, the person will try holding their urine at least ten minutes after having the urge to urinate. Lengthening the time between trips to the toilet until they're two to four hours apart is the goal of this treatment. Another method that could be tried is urinating once, and then trying again after a few minutes. This exercise teaches how to avoid overflow incontinence by teaching how to empty the bladder more completely. Yet another method is trying to relax while breathing slowly and deeply or becoming distracted with another activity whenever the patient feels the urge to urinate.

 

Fluid and diet management:

Sometimes, a person can regain control of their bladder by simply modifying their daily habits. The intake of caffeine, alcohol or acidic foods should be limited or avoided altogether. Some of the other lifestyle changes that may eliminate the problem of urinary incontinence include losing weight, increasing physical activity, reducing liquid consumption as well as other changes.

 

PHYSICAL THERAPY:

Some of the methods of physical therapy that may help in controlling this problem include:

 

Pelvic floor muscle exercises:

The pelvic floor muscles help in controlling urination. When pelvic floor muscle exercises are performed frequently, they may strengthen these muscles as well as the urinary sphincter. They may help urge incontinence and even more, stress incontinence. These exercises are also known as Kegels.

 

Electrical stimulation:

In order to stimulate and strengthen the pelvic floor muscles, electrodes will be temporarily inserted in this procedure into the patient's vagina or rectum. Although this method usually takes several months and multiple treatments to work, but it can be quite effective for urge incontinence and stress incontinence.

 

MEDICATIONS:

Medications are usually combined with behavioral techniques. Some of the commonly used medications include:

 
Anticholinergics:

Some examples include solifenacin, tolterodine, trospium, oxybutynin and darifenacin. These are prescription medications that calm an overactive bladder, helping with urge incontinence.

 

Topical estrogen:

Some symptoms of urinary incontinence may be reduced in case the tissues in the urethra and vaginal areas are rejuvenated and toned by applying low-dose topical estrogen in the form of a vaginal cream, patch or ring.

 

Imipramine:

One of the tricyclic antidepressants that could be used to treat mixed (stress and urge) incontinence is imipramine.

 

MEDICAL DEVICES:

Some of the many medical devices that are specially designed for women and could help in treating incontinence include:

 

Pessary:

A pessary is a stiff ring that is inserted into the vagina and worn all day long. In order to prevent the leakage of urine, this device helps hold up the bladder, which is located near the vagina. In case a person's incontinence is caused by a prolapsed or dropped bladder or uterus, a pessary may be the best option.

 

Urethral inserts:

In order to prevent the urine from leaking out, a small, tampon-like disposable device or plug may be inserted into a woman's urethra, which is the tube where urine exits the body. These inserts are prescription and aren't for everyday use. In case a woman has predictable incontinence during a certain activity, such as playing tennis, she could insert the device before playing and then remove it before urinating. In these cases, urethral inserts work best.

 

INTERVENTIONAL THERAPIES:

 

Sacral nerve stimulator:

This device will be implanted under the skin of the buttock. It is similar to a pacemaker and one of its wires is connected to an important nerve in bladder control called the sacral nerve that runs from the lower spinal cord to the bladder. Painless electrical pulses will be emitted through the wire in order to stimulate the sacral nerve and help control the bladder.

 

Botulinum toxin type A:

People with an overactive bladder may benefit from these injections into the bladder muscle. Although this method still hasn't been approved by the FDA for incontinence, but researchers have found it to be quite promising.

 

Radiofrequency therapy:

In this method, radiofrequency energy will be used to heat tissue in the lower urinary tract. This will reduce the chance of urinary leakage because once the tissue heals, it is usually firmer.

 

Bulking material injections:

Injected into the surrounding tissue of the urethra, bulking agents are materials such as carbon-coated zirconium beads, coaptite or collagen. This procedure requires minimal anesthesia, takes about five minutes and is usually done in the doctor’s office. These injections will help in reducing urine leakage and keeping the urethra closed. One of the not so good aspects of this method is that it needs to be repeated every 6 to 18 months.

 

SURGERY:

There are several effective surgical procedures for urinary incontinence in case other treatments don’t provide relief. Some of the common ones are:

 

Bladder neck suspension:

This procedure, which lasts about an hour, is done under general or spinal anesthesia because it involves an abdominal incision. The recovery time is about six weeks. This procedure will provide support to the urethra and bladder neck, which is the place where the bladder connects to the urethra and consists of thick muscle.

 

Artificial urinary sphincter:

Men who have weakened urinary sphincters due to treatment for an enlarged prostate or prostate cancer may greatly benefit from this device. This small device, which is shaped like a doughnut, is implanted around the neck of the bladder. Until the person is ready to urinate, the fluid-filled ring in the device will keep the urinary sphincter tightly shut. This ring deflates, allowing urine to flow from the bladder when the valve that is implanted under the skin is pressed.

 

Sling procedures:

In this procedure, to create a pelvic sling or hammock around the bladder neck and urethra, strips are used from the patient’s body tissue, synthetic material or mesh. The sling could be tension-free, conventional and adjustable. It will help in keeping the urethra shut, particularly when sneezing or coughing.

 

ABSORBANT PADS AND CATHETERS:

Products that ease the discomfort and inconvenience of urine leakage may be used until a treatment starts to take effect or if incontinence isn’t completely eliminated with medical treatments.

 

Catheter:

To drain the bladder, a doctor may teach his/her patient how to insert a catheter (soft tube) into the urethra several times a day in case the incontinence is due to the improper emptying of the bladder. This method is called self-intermittent catheterization. These catheters could be safely reused if they are properly cleaned. This method is especially effective for overflow incontinence.

 

Pads and protective garments:

Most of these products could be easily worn under everyday clothing because they aren’t bulky. Adult diapers, pads or panty liners could also be used. Additionally, a small pocket of absorbent padding worn over the penis and held in place by closefitting underwear, called a drip collector, could be quite helpful for men who have problems with dribbles of urine.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
Certificate:
Specialty: -

Expert's opinion:

For Specialists

Clinical Trials:

Not available

 

Latest Drugs:

--

 

Resources:







Forgot your password


sign up

Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist
Poll

Which of the following you are mostly interested in?

Cancer Research
Mental Health
Heart Disease & Diabetes
Sexual Health
Obesity and Healthy Diets
Mother & Child Health

Disclaimer : This site does not endorse or recommend any medical treatment, pharmaceuticals or brand names. More Details