Urinary incontinence means the involuntary leakage of urine through the urethra. It is quite a common problem among elderly people, especially women.
Types
Stress Urinary Incontinence (SUI): Urine leaks while coughing, laughing, running, or jumping, and this leak is not related to the desire to pass urine.
Urge Incontinence (OAB-Overactive Bladder): sudden and intense urge to urinate and urine leaks; this may be related to the high frequency of urination and urgency.
Overflow incontinence: inability to empty the bladder completely, resulting in leakage of urine. These patients may have poor flow, straining, and prolonged voiding time.
Total incontinence: The bladder cannot store urine and leaks all the time without the knowledge of the patient.
Causes
Stress Incontinence
- Multiple pregnancies and childbirths leading to muscle weakness
- Menopause, causing low estrogen, makes the muscles weaker
- Hysterectomy and other pelvic surgical procedures/prostate surgery
- Advanced age and obesity
Urge incontinence
- Urinary infection
- Neurological conditionse.g.Parkinsonism, stroke, spinal diseases or injuries
- Enlarged prostate, urinary bladder stone
Overflow incontinence
- Enlarged prostate gland
- Urinary stones
- Stricture Urethra
- Diabetic cystopathy or neurogenic bladder
Total incontinence
- Birth Defects
- Spine injury impairs the nerve signals between the brain and the bladder
- Fistulous connection between the bladder and vagina
Checkout: What are the Common Urinary Problems in the Elderly?
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Risk factors linked to urinary incontinence:
Obesity, Smoking, advanced age, Diabetes, Spinal cord injury, and neurologic diseases Prostate enlargement, prostate surgery, or pelvic surgery / radiation in the pelvic area.
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Evaluation of patient
Bladder diary: The person records how much he drinks, how much urine is passed, and the number of episodes of incontinence.
Physical exam: The doctor may check the strength of the pelvic floor muscles and examine whether the prostate gland is enlarged.
Urinalysis: To rule out infection in urine.
Postvoid residual (PVR) measurement: This assesses how much urine is left in the bladder after urinating.
Pelvic ultrasound may help detect any abnormality.
Stress test: The patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
Urodynamic testing: This determines the bladder pressure and urinary sphincter muscle tone.
Cystogram: An X-ray procedure provides an image of the bladder.
Treatment of Incontinence
Treatment of incontinence depends upon the type of leakage diagnosed by the urologist.
Medical treatment includes fluid management, lifestyle management, bladder behavior therapy, Kegels exercises, weight loss, antibiotics for UTI, drugs to control bladder overactivity, increasing tone of sphincter muscles, drugs for prostate, etc.
Surgical treatment depends on the cause and may range from prostate or stricture surgery, stone surgery, bladder neck suspension surgery, bulking agents, vaginal tapes, botox injections in the bladder, and artificial sphincters.