All you need to know about urinary incontinence

It is a very common and embarrassing problem affecting millions worldwide.

WHAT IS IT?

1. Leakage of urine without own control
2. Severity ranges from occasionally dribble to leaking large amounts disturbing social and personal life
3. It is NOT a normal part of aging or an inevitable consequence of childbirth
4. It is a symptom with many possible causes and you should NOT hesitate to see your doctor.
5. In most instances, it is treatable

Urinary incontinence isn't a disease, it's a symptom. 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.

TYPES AND SYMPTOMS Of various types of leakage include

1. Stress incontinence
2. Urgency incontinence
3. Overflow incontinence
4. Functional incontinence
5. Mixed incontinence
6. Gross total incontinence

Stress incontinence

1. This is loss of urine when you exert pressure (stress) in your tummy by coughing, sneezing, laughing, exercising or lifting something heavy.
2. It has nothing to do with psychological stress
3. It occurs due to weakness in muscles & ligaments supporting bladder and rectum.

It most commonly affects women. Physical changes resulting from pregnancy, childbirth and menopause can cause SUI


4. In men, removal of the prostate gland can occasionally lead to this type of incontinence.

Urge incontinence

1. This is a sudden, intense desire to urinate, followed by leakage of urine without control. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach toilet.
2. With urge incontinence, you may also need to urinate often; you even may have to wake at night several times.
3. Some people have a strong desire to urinate when they hear water running or after they drink only a small amount of liquid.
4. Simply changing posture (sitting to standing, changing sides) may cause you to leak urine.
• It is as much of a problem with men as with women. Aged people suffer more frequently; however, no age is exempt.

5. At times, medical conditions which irritate bladder (e.g. infection, stone, tumor, prostate enlargement) or affect nerve supply of bladder (e.g. multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury to brain or spine) may lead to this symptomatology.
6. If you MUST visit a doctor in case you have such symptoms.

Overflow incontinence

1. If you frequently or constantly dribble urine, you may have overflow incontinence.
2. Often, you pass urine with difficulty in weak stream and feel as if you never completely empty your bladder.
3. This type of incontinence is common in people with a damaged bladder or blocked urinary passage.
• It is more common in men; however, women are NOT exempt from it.

4. Common causes include neglected prostate enlargement (men), stricture, nerve-damage from diabetes and injury to spine. Some medications can cause or increase the risk of developing overflow incontinence.

Mixed incontinence

If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence. Usually one type is more bothersome than the other is.

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 enough. Someone with Alzheimer's disease may not plan well enough to make a timely trip to the toilet.

SUMMARY OF CAUSES OF INCONTINENCE

Temporary urinary incontinence	Persistent urinary incontinence
Alcohol (beer, wine, whisky, etc.)	Pregnancy / childbirth (weakening of muscles and ligaments in pelvis)
Caffeine (Tea, coffee , cola, etc.)	Changes with Ageing / menopause
Excessive drinking of any liquid in short time	Removal of uterus
Medication (Sleeping pills, water pills, antidepressants, certain heart medications, cough / cold medications)	Obesity
Bed-ridden status	Prostate diseases (prostatitis, enlargement, cancer)
Constipation / urinary infection	Bladder diseases (stone, cancer)
High impact sports – gymnastics, weight lifting	Neurological diseases (Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury)

WHEN TO SEEK MEDICAL ADVICE

You may feel uncomfortable discussing incontinence with your doctor. But seeking medical advice for incontinence is important for several reasons:

Physical

1. It may indicate a more serious underlying condition, especially if it's associated with blood in your urine.
2. It may increase the risk of falls in older adults as they rush to make it to the toilet. This may result in fracture of hip and wrist.

Psychological

1. Urinary incontinence may be causing you to restrict your activities and limit your social interactions to avoid embarrassment.

You should always consult a qualified doctor in case of leakage of urine unless it is so minimal and occasional that you do not feel bothered about it.

COMPLICATIONS

Complications of chronic urinary incontinence include

• Skin problems. rashes, skin infections and sores from constantly wet skin.
• Urinary tract infections.
• Changes in your activities. You may stop exercising, quit attending social gatherings or even refrain from laughing because you're afraid of an accident. You may even reach the point at which you stop traveling.
• Changes in your work life. Your urge to urinate may keep you away from your desk or cause you to have to get up often during meetings. It may even disrupt your concentration at work. It may also affect your sleep, so you're tired most of the time.
• Changes in your personal life. – most distressing – Your family may not understand your behavior or may grow frustrated at your many trips to the toilet. You may avoid sexual intimacy because of embarrassment caused by urine leakage. It's not uncommon to experience anxiety and depression along with incontinence.

TESTS AND DIAGNOSIS

1. Most of the times, a qualified doctor will be able to diagnose type of incontinence simply medical history, physical examination and some tests (voiding diary, urinalysis, blood biochemistry with / without ultrasound).
2. Only occasionally, more specialized testing is required i.e. computerized test called Urodynamics, and endoscopy of bladder to ‘see’ any abnormality in urinary tract.

The good news - incontinence isn't something you necessarily have to live with. Most cases of incontinence can be eliminated or controlled.

TREATMENT

1. Depends on the type of incontinence, the severity of your problem and the underlying cause
2. Your doctor will recommend the approaches which are least invasive and best suited to your condition.
3. Often a combination of treatments is used.
4. Most people treated for urinary incontinence see a dramatic improvement in their symptoms.
5. Treatment options for urinary incontinence fall into four broad categories
1. Behavioral techniques and exercises (especially early and mild cases)
2. Medications (along with the above)
1. Devices
2. o Surgery

Reserved only for severe cases and upon failure of medical therapy

You should not be apprehensive about the word ‘surgery’; with recent advances, in most instances the operations are relatively minor, do not require ‘cuts’ on the body, and can be performed on day-care basis.

PREVENTION

1. Incontinence is not always preventable. However, you may be able to decrease your risk of urinary incontinence with these steps:
2. Maintain a healthy weight: avoid Obesity
3. Don't smoke. Get help in quitting if you do smoke.
4. Practice pelvic exercises during and after pregnancy as advised by the doctor
5. Avoid bladder irritants which you are aware irritate your bladder more (coffee, beer, citrus juices, etc.).
6. Eat more fiber (salad, whole wheat bread / roti)
7. Be active. Physical activity reduces your risk of developing incontinence.