Urinary Incontinence in women
Urinary incontinence, also known as involuntary urination, is any leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. Urinary incontinence is often a result of an underlying medical condition.
About four million women around the world are affected by Urinary Incontinence. Coughing, sneezing, laughing, exercise or heavy lifting is often accompanied by involuntary leakage of urine. It is commonly associated with aging but can also affect women of all ages.
There is no more distressing lesion than urinary incontinence a constant dribbling of the repulsive urine soaking the clothes which cling wet and cold to the thighs, making the patient offensive to herself and her family and ostracizing her from society. Although countless women are bothered by a loss of bladder control, bowel symptoms, and pelvic discomfort, they are often not aware that these problems have a name much less how common they really are.
It is important to know that these are common treatable conditions and you do not have to live with it. There are many treatment options that can help you gain control over this condition. With proper medical care and treatment, you can regain your quality of life.
Types of Urinary Incontinence
1) Stress Urinary Incontinence
- Stress Urinary Incontinence is the unintentional passage of urine prompted by a physical movement during normal everyday activities.
- Stress Incontinence is much more common in women and affects women of all ages. It is most often caused by weakness of the pelvic floor which results from multiple childbirths, pelvic surgery, obesity or menopause.
2) Urge Urinary Incontinence
- Urinary Incontinence is having an urge to urinate that’s so sudden and strong that you don’t get to the toilet in time. Urge Urinary Incontinence is caused by an overactive bladder.
3) Mixed urinary Incontinence
- Some women may experience both Stress Urinary Incontinence and Urge Urinary Incontinence.
4) Overflow Urinary Incontinence
- Women experience involuntary urine leakage which results from an overfilled bladder without feeling the need or urge to void. This condition occurs in people who have a blockage of the bladder outlet, the muscle that expels urine from the bladder is too weak to empty the bladder normally.
- Overflow incontinence may also be a side effect of certain medications, lesions affecting sacral segments, or peripheral autonomic fibers result in atonic bladder with loss of sphincter coordination. This results in loss of bladder’s muscle contraction, difficulty in initiating micturition and overflow incontinence.
Mechanism of Continence and micturition
- Continence and micturition involve a balance between urethral closure and bladder’s muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intraabdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence. Normal voiding is the result of changes in both of these pressure factors: urethral pressure falls and bladder pressure rises.
- The body stores urine — water and wastes removed by the kidneys — in the urinary bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.
- During urination, bladder’s muscles contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
Incontinence may make you feel embarrassed. You tend to isolate yourself, or limit your work and social life, especially exercise and leisure activities. With proper treatment, you are expected be able to manage stress incontinence and improve your overall well-being.
Urethra is well supported,
consequently without urine leakage.
Urethra is not supported,
consequently urine leakage.
Diagnosis of Urinary Incontinence
1) A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.
2) The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.
3) A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.
Urinary Incontinence – Other tests may include:
- Urinalysis : Urine is tested for evidence of infection, urinary stones, or other contributing causes.
- A bladder stress test : The accidental release of urine (urinary incontinence) that may occur when you cough, sneeze, laugh, or exercise.
- A Bonney test : The test is done as part of the bladder stress test, after the doctor verifies that urine is lost with coughing. It is similar to the bladder stress test except the bladder neck is lifted slightly with a finger or instrument inserted into your vagina while the bladder stress is applied. This checks to see if incontinence is the result of the bladder neck being pushed down too far by the stress.
- Pad test, which can help show how much urine is leaking. You are given an absorbent pad that has been weighed. You wear the pad until urine leaks, and then you return the pad to be weighed again. The increased weight of the pad gives an estimate of how much urine leaked.
- Blood tests : Blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
- Ultrasound : Sound waves are used to visualize the kidneys, ureters, bladder, and urethra.
- Cystoscopy : A thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.
- Urodynamics : Your doctor might order urodynamic tests, which are used to assess the function of your bladder. Testing isn’t necessary in most women with uncomplicated stress urinary incontinence or in those who haven’t had prior surgery, pelvic radiation, spinal cord disease or advanced diabetes.
You are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced. You and your doctor should discuss the results of any tests and decide how they impact your treatment strategy.
How Do I Know If I Have Incontinence?
To determine if you may be living with incontinence ask yourself these questions:
- Do you leak urine continuously?
- Do you leak urine unexpectedly?
- Do you have trouble holding your urine as you hurry to the bathroom?
- Has this urine loss caused you to change your lifestyle?
- Do you currently wear pads or liners to protect against unplanned leaks?
- Does the urine loss occur during coughing, sneezing, laughing, bending, exercising or lifting?
- When planning a trip or outing, does the availability of restroom facilities affect your decision?
If you answered “Yes” to any of these questions, take the next step and talk with a doctor or another healthcare professional.
Urinary Incontinence affects your day-to-day activities. Please do not hesitate to see your doctor. In most cases, simple lifestyle changes or medical treatment can erase your discomfort or stop urinary incontinence.