Urinary Incontinence - Symptoms, Causes and Treatment

Urinary Incontinence

Urinary incontinence is usually an embarrassing problem that impacts several people’s lives. It is a medical condition where you experience a loss of bladder control and leak urine. The severity of the condition can range from occasional urine leakage while sneezing or coughing to a strong urge to urinate but unable to get to a toilet in time. Urinary incontinence is more commonly seen in older adults and women after giving birth or those going through menopause.

There are several types of urinary incontinence based on different causes and triggers. Knowing the type of incontinence is essential for diagnosing and treating urinary incontinence. 

1. Stress Incontinence: Urine leak while exerting pressure on your bladder during activities such as laughing, coughing, sneezing, running, jumping, exercising, and lifting something heavy. Women who have given birth or men who have had prostate surgery are at a higher risk of developing stress incontinence. 
2. Urge Incontinence: Urine leak after a sudden, intense urge to urinate. It happens too quickly for you to make it to the bathroom. It can be caused by an overactive bladder (OAB) resulting from an infection, nerve damage, weak pelvic muscles, or more severe neurological disorders or diabetes conditions. 
3. Overflow Incontinence: Frequent or constant urine dribbling due to a bladder that doesn’t empty completely. Overflow incontinence is common in people with chronic conditions such as multiple sclerosis, diabetes, or stroke. 
4. Functional Incontinence: It involves a physical or mental barrier that prevents a person from making it to the bathroom in time. Functional incontinence can result from muscular issues like arthritis, cognitive issues like dementia, or neurological issues like stroke. 

Mixed Incontinence: Combination of more than one type of incontinence, leading to urine leakage. It usually refers to a combination of stress and urge incontinence. 

Urinary incontinence can be caused due to various reasons and may vary depending on whether you are a man or a woman. Some causes are temporary or short-term that go away once treated. Some other causes of incontinence are due to long-term or chronic medical conditions, which usually do not go away even with treatment. 

Causes of temporary urinary continence include:-

Urinary Tract Infections (UTIs): Infections inside the urinary tract can irritate your bladder, causing pain and increasing your need to urinate more often. Once the UTIs are treated, the frequent urge to urinate usually disappears. 

Constipation: Hard and dry stool in your rectum can cause bladder control issues, increasing the frequency of urination. 

Beverages: Certain drinks and food can make you urinate more frequently. If you stop drinking these beverages, your need to urinate typically decreases. These drinks and food items include:-

Caffeine

Alcohol

Chocolate

Artificial sweeteners

Chilli peppers

Food that is high in acid, spice, or sugar

Medications: Urinary incontinence can result from side effects of certain sedatives, muscle relaxants, heart and blood pressure medications, and antidepressants. 

Pregnancy: The uterus places extra pressure on the bladder during pregnancy. Usually, incontinence goes away in the weeks after delivery. 

Long-term or chronic causes of urinary incontinence include:-

Menopause: After menopause, the hormone levels in a woman’s body rapidly change, deteriorating the lining of the urethra and bladder. As a result, it aggravates urinary incontinence. 

Enlarged prostate: Incontinence can usually result from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia (BPH). 

Prostate cancer surgery: During the surgery, the sphincter muscle can become damaged, leading to stress incontinence. 

Diabetes: Your body produces more urine when you have diabetes. The increase in urine amount can cause leakage issues. 

Pelvic floor disorders: A problem in the pelvic floor muscles can affect how your organs work, including the bladder. 

Neurological disorders: Disorders such as Parkinson’s disease, brain tumour, spinal injury, a stroke, or multiple sclerosis can affect the nerves involved in bladder control, causing urinary incontinence. 

Urinary incontinence can be caused due to various reasons and may vary depending on whether you are a man or a woman. Some causes are temporary or short-term that go away once treated. Some other causes of incontinence are due to long-term or chronic medical conditions, which usually do not go away even with treatment. 

Causes of temporary urinary continence include:-

1. Urinary Tract Infections (UTIs): Infections inside the urinary tract can irritate your bladder, causing pain and increasing your need to urinate more often. Once the UTIs are treated, the frequent urge to urinate usually disappears. 
2. Constipation: Hard and dry stool in your rectum can cause bladder control issues, increasing the frequency of urination. 
3. Beverages: Certain drinks and food can make you urinate more frequently. If you stop drinking these beverages, your need to urinate typically decreases. These drinks and food items include:-
4. Caffeine
5. Alcohol
6. Chocolate
7. Artificial sweeteners
8. Chilli peppers
9. Food that is high in acid, spice, or sugar
10. Medications: Urinary incontinence can result from side effects of certain sedatives, muscle relaxants, heart and blood pressure medications, and antidepressants. 
11. Pregnancy: The uterus places extra pressure on the bladder during pregnancy. Usually, incontinence goes away in the weeks after delivery. 

Long-term or chronic causes of urinary incontinence include:-

1. Menopause: After menopause, the hormone levels in a woman’s body rapidly change, deteriorating the lining of the urethra and bladder. As a result, it aggravates urinary incontinence. 
2. Enlarged prostate: Incontinence can usually result from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia (BPH). 
3. Prostate cancer surgery: During the surgery, the sphincter muscle can become damaged, leading to stress incontinence. 
4. Diabetes: Your body produces more urine when you have diabetes. The increase in urine amount can cause leakage issues. 
5. Pelvic floor disorders: A problem in the pelvic floor muscles can affect how your organs work, including the bladder. 
6. Neurological disorders: Disorders such as Parkinson’s disease, brain tumour, spinal injury, a stroke, or multiple sclerosis can affect the nerves involved in bladder control, causing urinary incontinence. 

1. The primary symptom of urinary incontinence is the leakage of urine.
2. If you have incontinence, you may have small or large amounts of constant or occasional urine leakage.
3. You may experience urine leakage when you laugh, cough, sneeze, or exercise.
4. You may even have to get up in the middle of the night to urinate (nocturia) or have an urge to urinate but can’t make it to the bathroom on time.

Determining the type of urinary incontinence is important for your healthcare professional to make treatment decisions. The diagnosis of urinary incontinence starts with a thorough evaluation of your medical history. Tests to diagnose your condition may include:-

1. Physical exam: Your doctor may check for any physical cause of incontinence during this exam. For women, it includes a pelvic exam, and for men, this includes checking the size of the prostate. 
2. Ultrasound of your bladder: An ultrasound uses sound waves to create images of the bladder. The imaging test helps your doctor look for the contents of your bladder and evaluate its emptying ability. 
3. Urinalysis: The test involves taking urine samples to check for blood or infections. 
4. Stress test: Your provider will ask you to cough to check if urine leaks from this activity. The doctor may also ask you to perform other activities to check the same. 
5. Urodynamic testing: In this test, the doctor may fill your bladder with fluid to check how much your bladder can hold and how well your sphincter muscle is working. 
6. Cystoscopy: The doctor inserts a thin, flexible tube with a camera (cystoscope) into your urethra to closely look at your urinary tract. 
7. Pad test: The doctor may ask you to wear a pad to check how much urine leaked. 
8. Bladder diary: Your healthcare provider may ask you to record how much you drink, how many times you urinate, the amount of urine produced, and the number of incontinence episodes for a few days. 

The treatment for urinary incontinence differs depending on the type of urinary incontinence and its underlying cause. A combination of treatments can be used to treat incontinence. 

1. Behavioural Techniques
   1. Bladder training: It involves delaying urination after an urge to go. The technique aims to lengthen the time between urinating to every 2.5 to 3.5 hours. 
   2. Scheduled toilet trips: It involves scheduling urination after every two to four hours rather than waiting for the urge to go. 
   3. Double voiding: It is a technique to help you learn to completely empty the bladder and avoid incontinence. It involves urinating, waiting for a few minutes, and then trying again. 
   4. Fluid management: The technique involves avoiding acidic foods, alcohol, and caffeine. 
2. Kegel Exercises: Kegel exercises are used to build strength in your pelvic floor muscles. To perform Kegel exercises:
   1. Imagine trying to stop your urine flow.
   2. Tighten the muscles to stop the flow of urine mid-stream and hold for 10 seconds.
   3. Aim to perform at least three sets of ten repetitions every day. 
3. Electrical Stimulation
   1. The doctor temporarily inserts electrodes into your rectum or vagina to strengthen pelvic floor muscles. This treatment method can be effective for urge and stress incontinence, but you may require multiple treatment sessions over several months. 
4. Medical Devices: Some devices that can help women with incontinence include:-
   1. Pessary: A flexible silicone ring inserted into the vagina to be worn all day. The device helps support the urethra and prevent urine leakage. 
   2. Urethral insert: This small, tampon-like disposable device is inserted into the urethra before activities such as tennis. It prevents leakage and is removed before urination. 
5. Medications: Medications used to treat urinary continence include:-
   1. Mirabegron: The medication relaxes the bladder muscle and increases the amount of urine that your bladder can hold. It also helps in completely emptying your bladder at one time. 
   2. Anticholinergics: These medications, such as fesoterodine, oxybutynin, and trospium chloride, help urge incontinence by calming your overactive bladder. 
   3. Topical oestrogen: Applying topical oestrogen in the form of a patch, ring, or cream can help reconstruct tissues in the urethral and vaginal regions. 
   4. Alpha-blockers: Medications, such as doxazosin and tamsulosin, can help relax bladder neck muscles and muscle fibres in the prostate, making it easier for men to empty their bladder. 
6. Interventional Therapies- Interventional therapies for urinary incontinence include:-
   1. Bulking material injections: The therapy involves injecting a permanent synthetic material into the urethra to help increase the size of the urethra’s lining. It is especially effective for women with stress incontinence. 
   2. Botox injections (Botulinum toxin injections): Botox injections can help relax the bladder muscles for urge incontinence. The therapy is generally prescribed only when other treatments fail to provide results. 
7. Surgery- Surgery for urinary incontinence may be performed when other treatments do not work. The surgical options include:-
   1. Sling procedures: The procedure is typically used to treat stress incontinence. In this procedure, the doctor either uses a synthetic material or a strip of your own tissue to create a pelvic sling that supports the urethral channel.