Urinary incontinence is essentially the loss of bladder control, in which a person experiences a sudden and strong urge to go the bathroom or involuntarily leaks urine when even small amounts of pressure are applied to the bladder.
The severity of the condition varies from person to person and it is caused by a wide range of factors. Although this condition is common in older people, it is not an inevitable consequence of aging, meaning that anyone, regardless of their age can have the condition.
For most patients, medical treatment or simple lifestyle changes can reduce and help manage the condition.
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Types of Urinary Incontinence
Stress Urinary Incontinence (SUI)
This is the most common type of urinary incontinence and typically occurs in older women. It is caused when pelvic floor muscles flex and become stretched.
As a result, applying even the slightest amount of pressure to the bladder results in involuntary urine leakage. This can be triggered by sneezing, bending, walking, or even coughing. The severity varies from person to person, with the leak ranging from a few droplets to a tablespoon or more.
Overactive Bladder (OAB)
OAB, otherwise known as “urgency incontinence” is also common and affects approximately 40% of women and 30% of men in the United States.
This occurs when the brain sends signals to the bladder to empty even when it is full. As a result, a person experiences a sudden and strong urge to urinate even when the bladder is empty.
More often OAB is found in women after menopause and in men with prostate problems. It can be caused by a wide variety of things including diet, but fortunately, there are treatments designed to relax bladder muscles.
Mixed Incontinence (SUI and OAB)
Some people with SUI often feel a sudden and involuntary urge to urinate, meaning that they are suffering from both conditions.
Overflow Incontinence
In this case, the body produces more urine than the bladder can hold, which consequently causes urine to leak. However, it can also be caused by a bladder blockage or the failure of bladder muscles to contract as they should. It is characterized by frequent episodes of passing small amounts of urine.
Causes
Not all cases of urinary incontinence are permanent or long-term. The severity and duration depend on the underlying causes. Some cases may be temporary, while others will remain permanent. Some of the most common causes of incontinence include:
- Urinary tract infections (UTIs). These are a common cause of both types of incontinence and they should be addressed immediately to prevent long-term effects.
- Vaginal infections: These can also result in temporary incontinence and require urgent treatment to prevent the development of the condition.
- Medications: Some medications can also cause this condition. If you notice a sudden urge to urinate or your bladder doesn’t hold urine after taking certain drugs, it is always advisable to consult your doctor.
- Age: Older people are at a higher risk of developing incontinence since muscle flex and relax with age.
- Restricted mobility: Failure to exercise regularly can make bladder muscles weak and this can cause urine leakage in severe cases.
Symptoms
Symptoms are different depending on the type of incontinence. Below, are the most common symptoms for each condition:
SUI
The most common symptom of this type is leaking urine when performing physical activities. The amount of urine that is leaked depends on the severity of the condition.
OAB
The most common symptom is a sudden and strong urge to pass urine, over which you have no control. This causes the bladder to leak urine involuntarily.
Mixed incontinence (SUI and OAB)
The symptoms of this condition are those of both SUI and OAB. This means that a person leaks urine and also experiences a strong and sudden urge to urinate.
Overflow Incontinence
Constant dribbling and frequent small urinations are the major symptoms of this type of incontinence. Typically, the bladder is not able to empty even when it is full.
Treatments
There are many devices and products that collect and hold urine. They help manage urinary retention and urinary incontinence. With urinary retention, your bladder does not completely empty. With urinary incontinence (UI), you have urine leakage that you cannot control.
Products and devices can help men and women of all ages. For some people, they are the only way to manage bladder problems. These devices can also give older and disabled people more freedom.
Diagnosis
Diagnosis includes an assessment of the patient to identify under what circumstances the leaks occur, then a clinical examination is conducted.
In particular, an anatomical examination of the small pelvis is performed to verify that there is no malformation or prolapse. Different quick and simple tests can be undertaken to determine the causes of incontinence.
- A urinalysis is requested, looking for a possible infectious origin.
- It is also recommended to keep a diary, i.e. to note the time and volume (with a measuring cup) of voiding for two days.
A urologist will then perform further examinations. He can check the emptying of the bladder by ultrasound.
A urodynamic work-up is prescribed in case of a surgery: this involves checking the pressure in the bladder and the urethra using a probe.
Treatment
Rehabilitation of the perineum as a first treatment
Perineal rehabilitation is always offered as the first treatment for incontinence. It involves, with the help of the physiotherapist, strenthening the pelvic floor muscles and improving the elasticity of the perineum.
It also includes behavioral methods aimed at relearning, as the case may be, urinating regularly (so as not to end up with a bladder that leaks), or spacing your urination (in case of too frequent urges to urinate).
Perineal rehabilitation is effective in all types of incontinence.
Drugs to relax the bladder
Drug treatment is available only in the case of SUI incontinence. Drugs are used to calm the hypersensitivity of the bladder, but the side effects include a dry mouth, constipation and more.
Sometimes, people find it difficult to cope with the side effects. However, a new class of B3-agonist drugs, without the side effects of anticholinergics, is available today and can be used in certain cases.
If vaginal dryness is a problem, a prescription of vaginal estrogens is generally recommended, in combination or not with hormonal treatment if the woman is menopausal.
The use of absorbent protections
Several types of products provide comfort to carry out daily activities.
The majority of incontinent people choose to use absorbent protective products, which are available to suite everyone’s preference: briefs, full diapers, and shells for men.
Men can wear a penis case. It is a kind of condom that is connected to a collection bag. If well fixed, it does not cause urine leakage or odors. In addition to absorbent protection, women with mild to moderate incontinence can use a special tampon to prevent urinary leakage for a few hours, for example during physical activity.
Surgery as a last resort for urinary incontinence
Surgery, when possible, is a solution in the event of perineal rehabilitation failure. But it is only offered to people who feel they can no longer handle their urinary incontinence. Four surgical solutions are possible, depending on the causes and type of incontinence.
- The insertion of a sub-urethral strip is a benign procedure which consists of placing a strip under the urethra to keep it in a good position.
- Two adjustable peri-urethral balloons, filled with medical saline, can be placed on either side of the urethra: by exerting pressure, they replace the function of the sphincter muscle.
- The installation of an artificial urinary system is a more invasive operation in the event of a weak sphincter muscle. These are the muscles, which open and close the urethral channel.
- A neuromodulator for bladder nerves is offered to people with SUI incontinence. It is more of a “bladder pacemaker” acting on the nerves of the bladder.
Another recent solution is the injection of botulinum into the bladder, but the effects are temporary (a few months). The intervention is performed under light anesthesia using endoscopy.
