Urinary Incontinence (UI) also known as Involuntary Urination is the leakage of urine in an unrestrainable or uncontrolled manner. This means a person urinates when he/she does not want to.
How Does the Urinary System Work?
The urinary system generates, stores and dispenses urine. The organs of the urinary system include the kidneys, renal pelvis, ureters, bladder, and urethra. Often, the kidney is differentiated from the other organs because of its numerous functions in the body. The function of the urinary system is to unburden the body of waste (in liquid), help to retain chemicals (such as potassium and calcium) and to keep water in the body at equipoise. Urine, a liquid waste product consisting of urea, salt and water is discharged by the kidneys through the ureter into the urinary bladder, where it is stored. (Small amount of urine is emptied into the urinary bladder from ureters about 10 to 15 seconds). The renal pelvis is the enlarged upper end of the ureter. The Urethra is the tube that conveys the urine from the bladder to the exterior of the body. A problem with one or more of these organs can lead to urinary incontinence.
The normal urine volume considered for adults is about 27 to 68 fluid ounces (800 to 2,000 millilitres) per day based on the normal daily fluid intake of 68 ounces (2 litres). However, a person can exceed this volume from time to time but when it becomes persistent for some time, it is necessary to go see a doctor. A careful assessment or examination by the doctor can help determine what’s behind incontinence.
What Causes Urinary Incontinence?
It is a common problem that affects many people which can be due to underlying medical conditions, physical problems, psychological factors, environmental issues or everyday habits. However, it is not a disease. Some medications or drugs can also cause one to have urinary incontinence.
Urinary incontinence takes place more in women than in men. This is because pregnancy, childbirth and menopause put women at higher risk of urinary incontinence which arises from problems with the muscles or nerves. It is also noteworthy that as people get older, the tendency for urinary incontinence to occur increases. Nevertheless, it can be avoided or it must not certainly occur, as urinary incontinence isn't an inevitable consequence of aging.
Urinary incontinence also occurs more often in children under the age of 3 due to the inability of children to control their bladder, which is considered normal but as children get older, they learn to control their bladder.
Examples of some other causes of urinary incontinence that is not due to an underlying disease include intoxication, unavailability of bathrooms/loo, coughing, sneezing, extreme anxiety or intense laughter, which leads us to the varying types of urinary incontinence.
Types of Urinary Incontinence
Stress incontinence: This is the inability to control or hold urine during physical activity, or the leakage of urine during physical activity, such as coughing, laughing, sneezing, lifting something heavy, exercising or having sexual intercourse. For most patients, only a few drops are lost.
Urge incontinence: Also known as unstable or overactive bladder (OAB), or detrusor instability, is an acute desire to urinate that cannot be held off. It is associated with an inadvertent loss of urine due to contraction of the bladder muscle (detrusor) when it is expected to be relaxed.
Overflow incontinence: This is when there is a forced or unintentional release of urine from the bladder that is overfull, which usually happens when the bladder doesn’t empty urine appropriately and then gets filled up very fast due to the residual volume. This occurs mostly in men than women. In this type of incontinence, the need to urinate may or may not be felt before leaks happen.
Functional incontinence: This is when urine leaks out due to physical, intellectual or environmental issues, such as a person being confused or not been able to quickly locate the bathroom or reluctancy in using the convenience due to anxiety or mobility issue.
Mixed incontinence: This is the combination of two distinct types of incontinence, usually stress and urge incontinence.
Reflex incontinence: This is an accidental loss of urine due to neurological impairment or spasm of the bladder muscle. The latter makes reflex incontinence much similar to urge incontinence but in reflex, an increased amount of urine leaks, with little or no caution.
Total incontinence: Here, the bladder can hardly store urine. This either means that the person leaks urine continuously, or has periodic uncontrollable leaking of large amounts of urine. A person with this condition may be born with a defect, may have an injury to the spinal cord or urinary system, or may have a hole (fistula) between the bladder and, for example, the vagina.
The main symptom is the unintentional release of urine. Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently. When and how this occurs will depend on the type of urinary incontinence.
If urinary incontinence affects your daily activities, don't hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.
The inability to retain urine can sometimes lead to discomfort, embarrassment, and sometimes other physical problems.
Skin problems - a person with urinary incontinence is more likely to have rashes, skin infections and sores because the skin is constantly wet or damp.
Urinary tract infections - long-term use of a urinary catheter significantly increases the risk of infection.
Prolapse - part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. This is usually caused by weakened pelvic floor muscles.
Impacts on your personal life - urinary incontinence can affect your social, work and personal relationships. Embarrassment can cause people to withdraw socially, and this can lead to depression.
The risk factors linked to urinary incontinence include:
Being overweight: This puts extra pressure on the bladder and surrounding muscles. It weakens the bladder muscles, making leakage more likely when the person sneezes or coughs.
Gender: Women have a higher chance of experiencing stress incontinence than men. Pregnancy, childbirth, menopause and normal female anatomy account for this difference.
Old age: The muscles in the bladder and urethra weaken with age.
Family history: If a close family member has urinary incontinence, especially urge incontinence, your risk of developing the condition is higher.
Smoking: This can lead to a chronic cough, which may result in episodes of incontinence.
Some diseases and conditions: Diabetes, kidney disease, spinal cord injury, and neurologic diseases, for example, a stroke increase the risk.
Prostate disease: Incontinence may present after prostate surgery or radiation therapy.
Diagnosing Urinary Incontinence
It's necessary to determine the type of urinary incontinence one has, and your symptoms often tell your doctor which type you have. The information gotten will guide treatment decisions.
Your doctor is likely to start with a thorough history by asking questions and physical exam conducted. You may then be asked to do a simple maneuver that can demonstrate incontinence, such as coughing.
After that, your doctor will likely recommend:
A bladder diary: The person records how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
Urinalysis: A sample of your urine is checked for signs of infection, traces of blood or other abnormalities.
Blood test: This can assess kidney function.
Postvoid residual (PVR) measurement: This assesses how much urine is left in the bladder after urinating.
Pelvic ultrasound: Provides an image and may help detect any abnormalities.
Stress test: The patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
Urodynamic testing: This determines how much pressure the bladder and urinary sphincter muscle can withstand.
Cystogram: An X-ray procedure provide an image of the bladder.
Cystoscopy: A thin tube with a lens at the end is inserted into the urethra. The doctor can view any abnormalities in the urinary tract.
Treatment and Lifestyle Management for Urinary Incontinence
A recommended treatment plan will depend on the type of incontinence. An underlying medical condition may require medication, surgery, or other treatments.
In certain situations, your doctor may not be able to cure your bladder incontinence, but there are steps you can take to manage such condition.
For example, your doctor may advise you to:
maintain a clear and well-lit path to the bathroom
take scheduled bathroom breaks
adjust your diet or fluid intake
use absorbent undergarments or pads
keep a bedside potty in your bedroom
Other lifestyle management include:
Delaying the event, Double voiding and, Bathroom scheduling: This can be considered as a bladder training, in a bid to control the urge to urinate to help regain control over the bladder. This involves urinating, then waiting for a couple of minutes, then urinating again. Setting times during the day for urinating e.g. every 2 hours.
Exercising: It may be necessary to take into consideration, substituting exercises that can cause leaks such as jumping or running with cycling, spinning or swimming. Taking part in pelvic floor exercises or bladder training, which can help to increase your bladder control, can be encouraged.
Know your medicines: Many medicines can make you pass urine more often until they wear off. Talk to your doctor about the medicines you take. You may be able to plan and schedule the best time to take them.
Lose weight: If you're overweight or obese, consider losing the excess weight. Carrying extra weight also keeps more pressure on the bladder. Losing weight can greatly improve stress incontinence.
Also, problems with urine leakage may require you to take extra care to prevent skin irritation:
Use a washcloth to clean yourself
Allow your skin to air-dry
Avoid frequent washing and douching because these can overwhelm your body's natural defenses against bladder infections
Consider using a barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine
Ask your doctor about special cleansers made to remove urine that may be less drying than other products.
Preventing Urinary Incontinence
One can’t prevent all cases of urinary incontinence, however, to help decrease your risk of developing it, there are steps you can take. Living a healthy lifestyle is key.
For example, try to:
maintain a healthy weight
get plenty of exercises, which should include pelvic floor exercises
avoid bladder irritants, such as caffeine, alcohol and acidic foods
eat a balanced diet
avoid smoking or seek help to quit smoking
....making effort to "STAY WELL"
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