OVERVIEW

The ability to always have complete control over ourselves and everything around us is one of man’s greatest desire. The human biology has gifted us with some voluntary actions (walking, sleeping, passing out stool and urine, etc.) which can be executed at our own convenience.

Urinary incontinence is a condition which deprives you of the voluntary action on when and where to void your urine. This condition is mostly diagnosed with increasing age due to the fact that it is underreported, it is as twice as more common in females as compared to males irrespective of the age group.

It does not only emerge as a medical problem but also an emotional, social, and psychological disturbance which can affect the entirety of a person’s life and daily activities.

DEFINITION

Urinary incontinence refers to the involuntary leakage of urine or an inability to controls one’s own urine.

TYPES OF URINARY INCONTINENCE

There are different types of urinary incontinence classified based on the process which leads to the loss of urinary control. The types;

1. Stress Incontinence: This type of incontinence is mostly due to activities leading to increased intra-abdominal pressure such as sneezing, coughing, laughing, jumping or even lifting. The predisposing factors to this condition are predictable.

2. Urge Incontinence: There is an abrupt and heightened urge to urinate which precedes an involuntary loss of urine. There is an increase in nocturnal urination and increase urinary frequency because their bladder is overactive.

3. Mixed Incontinence: There is mostly a combination of more than one type of incontinence. Mostly there is a combination of urge incontinence and stress incontinence.

4. Overflow Incontinence: A constant leakage and spilling of urine due to overfilling the bladder beyond its limit of compliance.

5. Functional Incontinence: This is caused by medications or health conditions resulting in urinary involuntarily. One knows they have to urinate but is not able to make it in time to the washroom.

6. Reflex Incontinence: This is when the bladder contracts involuntarily as soon as it is filled due to a reflex. The bladder is said to be spastic and it’s mostly due to spinal injury above the twelve thoracic vertebrae level.

CAUSES

1. Things that weaken the pelvic floor muscles and the bladder.

a. Childbirth.
b. Pregnancy.
c. Menopause.
d. Surgery (Caesarian section, hysterectomy).
e. Prostate cancer.
f. Benign Prostate Hypertrophy.
g. Age.

2. Things that cause bladder irritation.

a. Urinary tract infection.
b. Constipation.
c. Pelvic lying appendicitis.
d. Overreactive bladder.

3. Neuromuscular problems.

a. Stroke.
b. Multiple sclerosis.
c. Injury to the spinal cord.

4. Substances that increase urine output and cause temporal incontinence.

a. Alcohol.
b. Artificial sweeteners.
c. Chocolate.
d. Caffeine.

PATHOPHYSIOLOGY

Urination is a well-controlled mechanism. The urinary system consists of the kidneys, ureters, bladder, and urethra. The filtrate from the kidneys is passed through the ureters into the bladder for temporal storage, once the bladder is near full or full, one develops the desire to pass out urine through the urethra which is the normal physiology.

The storage and discharge of urine work on a well-demarcated and balanced scale. The bladder muscles work hand in hand with the urethra sphincters especially the internal sphincter. During the filling of the bladder, the pressure inside of it is lesser than the pressure in the urethra.

This ensures the relaxation of the detrusor muscle of the bladder. Contraction of the internal sphincter keeps the bladder closed and prevent urine release.

Anything that offsets this balance will reduce the continence of the sphincter and affect bladder control. Conditions that irritate the bladder or weaken the strength of the detrusor muscle of the bladder causing it to contract or leak urine involuntarily.

Conditions that affect the neuronal control of the muscles in the bladder also cause contractions of the bladder as soon as it gets filled and this lead to the relaxation of the urethral sphincter causing urine escape and leakage.

RISK FACTORS

1. Old age.
2. Being a female.
3. Multiple childbirths.
4. Obesity.
5. Menopause.
6. Family history of incontinence.
7. Smoking and alcoholism.
8. Having neuromuscular conditions or other chronic diseases like diabetes.

CLINICAL MANIFESTATIONS

1. Constant desire to urinate.
2. Very weak and poor streaming of urine.
3. Continuous dribbling of urine after urination.
4. Difficulty to withhold urine before entering a washroom.
5. Painful urination and strain in order to empty the bladder.
6. Leaking urine in an attempt to sneeze, cough or laugh.

COMPLICATIONS

1. Recurring urinary tract infections.
2. Emotional and psychological problems.
3. Stress causing inefficiency at work.
4. Skin Infections due to the constant exposure of the skin to urine.

DIAGNOSIS

1. Physical examination and patient history.
2. Urinalysis.
3. Stress test to check if urine will leak after a sneeze or cough.
4. Ultrasound of the kidneys.
5. Cystoscopy to examine the bladder.
6. Urodynamic testing to check for the pressures in the bladder and how the urethra is also working. This helps to determine the efficacy of the bladder in storing urine and the support of the urethra to the storage of urine.
7. X-ray of the bladder.

PROGNOSIS

The outcome of this condition is mostly based on the type. If the cause of urinary incontinence is found and treated, most people will return with a normal urine outflow without leakage. Complications like skin rashes that occur can be treated accordingly without any serious damages. Lifestyle changes, medications, and surgical approaches when needed can help to effectively manage urinary incontinence.

PREVENTION

1. Avoid smoking.
2. Quit alcoholism.
3. Take in cellulose or fiber-rich diets to avoid constipation.
4. Exercise to reduce body weight.
5. Engage in Kegel exercise to strengthen the pelvic floor.
6. Avoid taking foods or drinks that irritate the bladder.

TREATMENT

1. Lifestyle changes.
a. Kegel exercises to strengthen the pelvic floor.
b. Training of the bladder to regain control by a process called timed voiding.
2. Drugs (Anticholinergic drugs to reduce contractions of the bladder).
3. Neuromodulations: Nerves are activated from the spine to signal the bladder to gain control.
4. Vaginal devices insertions: A device is inserted into the vagina to help keep the urethra in place to prevent the leakage.
5. Absorbing products and collecting materials to collect urine leakages.
6. Surgery.

SUMMARY

1. Urinary incontinence affects people from the age between 50 and 60 going.
2. It affects women more than men.
3. Pregnancy and menopause are the most common known causes of urinary incontinence.
4. Traumatic events that cause spinal injuries can cause urinary incontinence.