Incontinence

Urinary Incontinence

Poor bladder control or urinary incontinence is a medical condition that is generally linked with pregnancy, childbirth, menopause or a variety of prolonged conditions like asthma, diabetes or arthritis.

Urinary incontinence can vary from a few leaks anytime you laugh, cough or exercise to the complete inability to control your bladder, wetting yourself.

Additional symptoms you can suffer from including the periodic need to urgently visit the toilet, sometimes associated with leaks.

Types of Urinary Incontinence

These are the different types of UI:

• Stress Incontinence – urine leaks while you apply pressure on your bladder when coughing, sneezing, laughing, exercising or lifting something heavy.
• Urge Incontinence – a feeling of a sudden, intense urge to urinate followed by an involuntary loss of urine. The need to urinate is frequent and occurs throughout the night.
• Overflow Incontinence – frequent or continuous dribbling of urine because of a bladder that doesn’t fully unload.
• Functional Incontinence – a physical or mental disability that prevents you from getting to the toilet in time.
• Mixed Incontinence – you have more than one type of urinary incontinence.

Causes of Urinary Incontinence

Urinary incontinence is a symptom that can be caused by a variety of underlying medical conditions. A careful evaluation by your physician can determine the reason behind the incontinence.

Stress Incontinence

Stress incontinence is generally a consequence of weak or damaged muscles that prevent urination, for example, the pelvic floor muscles and the urethral sphincter. When the abdominal muscles tighten (like when you’re sneezing or lifting something heavy), the pressure created overrides weak muscle control and forces urine to leak out of the body.

Urge Incontinence

In certain cases the detrusor muscles contract excessively, causing an urgent need to go to the toilet. This is known as having an “overactive bladder”. The cause of contraction of the detrusor muscle is not clear, but probably causes include:

• too much alcohol or caffeine
• poor fluid intake
• constipation
• urinary tract infections
• bladder tumors
• neurological conditions

Overflow Incontinence

Overflow incontinence, also referred to as chronic urinary retention, is generally a result of a blockage or obstruction to your bladder. Your bladder would fill up normally, but since it is obstructed, you are unable to drain it completely, even if you try.

As a result, pressure in the bladder increases as urine accumulates, leading to frequent leaks.

Bladder obstruction occurs as a result of:

• an enlarged prostate gland in men
• bladder stones
• constipation

Overflow incontinence can also be a result of detrusor muscle malfunction, meaning your bladder is unable to drain completely when you urinate. Consequently, the bladder becomes stretched.

Detrusor muscles may not fully contract if:

• there is damage to the nerves
• you are taking some medications (for example diuretics, ACE inhibitors)

Functional Incontinence

Functional incontinence happens when your bladder is unable to hold any urine at all. It can make you pass a large amount of urine constantly, or pass urine every once in a while with frequent leaking.

Functional incontinence is caused by:

• bladder defect from birth
• spinal cord injury that interrupts nerve signals between the brain and bladder. See figure 1 below.
• a bladder fistula – a small tunnel-like hole formed between the bladder and an adjacent area

Risk Factors

Certain factors increase the likelihood of urinary incontinence developing, such as:

• pregnancy and vaginal birth
• obesity
• family history of incontinence
• aging

Urinary Incontinence Treatment

The treatment for urinary incontinence is based on the type of incontinence, its severity as well as the cause. A combination of treatments might be necessary.

Your physician will probably recommend the least invasive treatments first and proceed to other alternatives only if these treatments fail.

Behavioral Techniques

Bladder training – to hold off urination once you have the urge to go. Begin by attempting to hold off for 10 minutes each time you feel an urge to urinate. The goal is to increase the time between trips to the toilet until you’re urinating only every two to four hours.

Double voiding – to help you learn to drain your bladder more thoroughly to prevent overflow incontinence. Double voiding means urinating, and then waiting a short while and trying once more.

Scheduled toilet trips – to urinate every two to four hours instead of waiting for the need to go.

Fluid and diet management – regaining control of your bladder. Avoid alcohol, caffeine, or acidic foods. Cutting down on liquid intake, reducing weight or exercise may also relieve the symptoms.

Pelvic Muscle Floor Exercises

Your physician may suggest that you perform pelvic floor exercises regularly to enhance the strength of the muscles that regulate urination.

Generally known as Kegel exercises, these exercises are primarily helpful for stress incontinence but may also help urge incontinence.

To do these exercises, imagine that you’re trying to stop urine flow. Then,

• Stiffen (contract) the muscles you use to stop urinating and hold for five seconds, next relax for five seconds.
• Build up to holding the contractions for 10 seconds each time.
• Target a minimum of 3 sets of 10 repetitions every day.

To let you pinpoint and contract the right muscles, your physician may recommend you work with a physical therapist.

Other treatments include:

• Medications
• Medical devices
• Surgery – if non-surgical treatments aren’t working, a few surgical procedures can deal with the problems that cause urinary incontinence:
  • Sling procedure
  • Prolapse surgery
  • Bladder neck suspension
  • Artificial urinary sphincter

Bowel Incontinence

Bowel incontinence, also known as fecal incontinence, is an inability to control bowel movements, leading to the involuntary passage of fecal material.

This condition differs from patient to patient. In some cases, people feel an abrupt, urgent need to go to the toilet, and incontinence happens since they can’t get to the toilet in time. This is called urge bowel incontinence.

Other people experience no sensation before passing stool, referred to as passive incontinence or passive soiling, or they may pass a tiny bit of stool while passing wind.

Causes of Bowel Incontinence

Bowel incontinence is a symptom that reflects an underlying physical problem with parts of the body that control the passage of stools.

Several cases result from diarrhea, constipation, or weakening of the anal sphincter, a ring of muscle that controls the opening of the anus.

Bowel incontinence is also caused by long-term conditions like diabetes, dementia, and multiple sclerosis. Kindly refer to figure 2 below.