All About Urinary Incontinence
What Is Urinary Incontinence?
Urinary incontinence is the involuntary loss of urine, a condition which has a major impact on quality of life, personal hygiene and social wellbeing. The majority of incontinence sufferers are women,
What Causes Urinary Incontinence?
Control of urine is dependant on coordination amongst the smooth muscle tissue of the urethra, the canal through which urine is discharged; the bladder, which holds the urine; skeletal muscle; voluntary restraint and the nervous system. Urinary incontinence can result from human structural, functional or disease based factors. Bladder functions involve storing and voiding urine. Muscle control disorders derived at birth or acquired later in life can cause problematic urine storage or control. These causative factors may include weak muscles that hold the bladder in place, weak bladder muscles, overactive or under active bladder muscles or hormone disease. Acute or temporary incontinence may be caused by the act of childbirth, side effects from medication or a urinary tract infection. Chronic or recurring involuntary bladder control may be the result of birth defects, a weak bladder muscle, a blocked urethra (e.g. a tumor), spinal cord injury or pelvic floor muscle weakness. Cystocele – a hernia-like disorder – occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop and sag into the vagina and can result in urine leaking or incomplete emptying of the bladder.
Pelvic floor muscles are intended to support the region’s organs, which include the bladder, large intestine and uterus. Childbirth is one major cause of pelvic floor muscle weakness and incontinence. As a result of this weakness, the pelvic muscles are no longer able to provide the necessary support for the urethra and bladder neck, which drops when any downward pressure is applied.
There are several types of urinary incontinence: stress, urge, mixed, overflow and fistula.
- Stress – urine loss during physical activity, such as sneezing or coughing, which increases abdominal pressure
- Urge – urine loss with the urgent need to void and involuntary bladder contractions
- Mixed – combination of stress and urge continence
- Overflow – constant dribbling where bladder never completely empties
- Fistula – abnormal connection between the bladder or urethra and the vagina, which can occur following surgical or obstetrical trauma, pelvic cancer or radiation treatment.
Fibroids (myomas), which are generally benign (non-cancerous) tumors, can grow and multiply rapidly in the uterus and can cause frequent urination by placing pressure on the bladder.
Diagnosing Causes of Urinary Incontinence
Women with incontinence – depending on whether they have had a hysterectomy (removal of the uterus) or not – should be referred to an appropriate specialist for testing. diagnosis and treatment. Clinical research indicates that a hysterectomy, which may lead to damage of the pelvic nerves or pelvic support structure, can significantly increase the risk of urinary incontinence later in a women’s life. Patients should have a complete history, physical exam and abdominal area assessment. Uro-dynamic testing methods include measuring the amount of urine remaining in the bladder after urination (voiding) via catheterization (a tube through the urethra, vagina or rectum) or through an ultrasound bladder scan, by performing a cystoscopy in which a small tube with telescope is inserted into the bladder for inspection, by measuring the rate, length and stream of urination to determine any obstruction or by filling the bladder with water to determine bladder pressure or urinanalysis
Reconstructive Treatment Options
Various treatment measures exist, depending on the type of incontinence, including injections, medications or reconstructive surgery.
- Bladder augmentation – increases bladder’s holding capacity or decreases its muscle tensing capability
- Sling procedures – involve creating a sling out of tissue or synthetic material, which is attached to an abdominal or pubic area and which holds the bladder and urethra in place
- Burch procedure – involves, through a laparoscope (small lit telescope), anchoring with sutures the neck of the bladder to behind the pubic bone.
If uterine fibroids are diagnosed as the cause of urinary incontinence, a woman should discuss one of the following treatment options (please refer to All About Fibroids) with her physician:
- Hormone therapy
- Hysteroscopic myomectomy
- Laparoscopic myomectomy
- Uterine artery embolization
- Endometrial ablation
Temporary causes of incontinence include constipation, caffeine, alcohol and carbonated beverages. Patients can play a role in curbing their incontinence symptoms by avoiding overuse of diuretics, antidepressants, antihistamines and cough medications, stopping smoking, losing weight, retraining their bladder, exercising their pelvic muscles and eating whole fruits, vegetables and whole grains. There are also protective devices to help ease the social stigma of incontinence, including pads, disposable or reusable adult diapers or absorbent underwear.
A urogynecologist, a physician specially trained in determining the cause(s) of pelvic conditions, lower urinary tract disorders and pelvic floor dysfunction, will select the most appropriate therapeutic or operative procedure, depending on the patient’s needs and test results, and will provide appropriate and comprehensive management of the patient.
All treatment options for urinary incontinence must be discussed with a physician. However, it is important for a woman to understand that this problem does not have to control one’s quality of life forever.