Urinary incontinence is a common medical problem in our society. It is highly impacted in such patients day to day activities. They get accident their self and leak while coughing laughing and sneezing. Some of them stop socializing due to embarrassment and fear of leaking accidentally. What is incontinence ?
Incontinence is the involuntary leakage of urine from the bladder which can be connected with other medical problems but it is usually associated with an over active bladder. It is an embarrassing problem which affects males and females of all ages but probably more women than men. It is perceived as an age thing but this is not necessarily the case. Fecal incontinence can also occur in older people, more so in women. The condition is not as common as urinary incontinence. It can be caused by chronic constipation, inflammatory bowel disease, nerve damage to the annul region, the after effects of a stroke and diabetes.
We encounter in clinical practice about 3 main type of incontinence. 1. Urge incontinence 2. Stress incontinence 3. Overflow incontinence
1. Urge incontinence- Typically the person makes frequent visits to the bathroom during the day and night and wetting if the bathroom cannot be reached in time.
This is happen due irritable bladder as a result of Detrusor instability. It may be associated with urinary tract infection or diabetes. If it is associated with neurological symptoms or signs need prompt investigations.Otherwise patient can be treated with treating if any precipitating factor , bladder training and smooth muscle relaxation drugs such as propantheline or tricyclic antidepressants.It requires urodynamic studies. Intravesical treatment options are also available such as hydro static bladder distension , urinary diversion and other techniques.
2.Stress incontinence– typically the person can leak when laughing, coughing or sneezing and must visit the bathroom often to avoid wetting and avoids lifting and exercising worried that leakage or wetting will result.
This may happen Pregnancy, child birth, menopause, hysterectomy, BPH and Prostatectomy , drugs. Obesity ,diebetes, Smoking, menopause , UTI, chronic constipation, past history of instrumental deliveries, abdominal mass , and Drugs are risk factors.
Investigation– Frequency/volume chart, UFR, Urine Culture, USS for exclude incomplete emptying and consider urodynamic studies.
pelvic floor exercise, Pessary to correct VG prolapse , Loosing of weight , HRT / VG cream for menopause , stop smoking to reduce cough are included in the treatments. SSRI is helping to reduce symptoms. Slinging or bladder neck elevation surgery may be needed if patient has had genuine stress incontinence.Inflammable artificial urinary sphincter is a new technique.
Overflow incontinence,- typically the person makes frequent visits to the bathroom, can take a long time to urinate, will only urinate in small amounts without actually emptying the bladder, leak all the time and may continually feel the need to urinate but can’t. Unlike other type this is more common in male.Most common cause in male is enlarge prostate. Blocage of urethra , week bladder muscles, injury to nerve that affect bladder, nerve damage due to diseases such as diabetes alcoholism Parkinson multiple sclerosis’s and other neurological illnesses and some medications like some anticonvulsants. Full neurological examination and per rectal examination is important and treatment depend on the cause for the illness.