Urinary incontinence

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Urinary incontinence ( UI ), also known as unintentional defecation , is an uncontrolled urine leak. This is a common and troublesome problem, which may have a major impact on quality of life. It has been identified as an important problem in geriatric health care. The term enuresis is often used to refer to urinary incontinence especially in children, such as nocturnal enuresis (wetting).

Pelvic surgery, pregnancy, childbirth, and menopause are major risk factors. Urinary incontinence is often the result of underlying medical conditions but is less reported to medical practitioners. There are four main types of incontinence:

Urges incontinence due to overactive bladder
Stress incontinence due to poor bladder closure
Incontinence overflow due to poor bladder contractions or urethral blockage
Functional incontinence due to medication or health problems making it difficult to reach the bathroom

Treatments include surgery, pelvic floor muscle training, bladder training, and electrical stimulation. The benefits of drugs are small and long-term safety is not clear. This is more common in older women.

Video Urinary incontinence

Cause

Urinary incontinence occurs due to urological and non-urological causes. The urogenic causes can be classified as mismanagement or urethral dysfunction and may include detrusor overactivity, poor bladder adherence, urethral hypermobility or intrinsic sphincter deficiency. Non-urological causes may include infection, drugs or medication, psychological factors, polyuria, fecal impaction, and limited mobility.

The most common type of urinary incontinence in women is urinary incontinence stress and urinary incontinence. Women with both problems have mixed urine incontinence. After menopause, estrogen production decreases and in some women the urethral tissue will show atrophy with weaker and thinner urethral tissue. Urinary incontinence stress is caused by loss of urethral support which is usually a consequence of pelvic structural damage due to labor. It is characterized by leaking a small amount of urine with activity that increases abdominal pressure such as coughing, sneezing and lifting. In addition, frequent exercise in high-impact activities can cause athletic incontinence to develop. Encouraging urinary incontinence is caused by unimpeded detrusor muscle contractions. This is characterized by the leaking of large amounts of urine in relation to inadequate warnings to get to the bathroom on time.

Polyuria (excessive urine production) which, in turn, is the most common cause: uncontrolled diabetes mellitus, primary polydipsia (excessive fluid drinking), central diabetes insipidus and niprogenic diabetes insipidus. Polyuria generally causes urgency and urinary frequency, but does not cause incontinence.
Prostate enlargement is the most common cause of incontinence in men after the age of 40 years; sometimes prostate cancer can also be associated with urinary incontinence. In addition, drugs or radiation used to treat prostate cancer may also cause incontinence.
Disorders such as multiple sclerosis, spina bifida, Parkinson's disease, stroke, and spinal cord injuries can all interfere with the functioning of the bladder nerves.
Urinary incontinence is a probable outcome after a radical prostatectomy procedure.
Approximately 33% of all women experience UI after childbirth; women who deliver through the vagina are twice as likely to experience urinary incontinence as women who deliver by caesarean section.

Maps Urinary incontinence

Mechanism

Continence and micturition involves a balance between urethral closure and detrusor muscle activity. Urethral pressure usually exceeds the pressure of the bladder, resulting in urine remaining in the bladder. The proximal urethra and the bladder are both inside the pelvis. Increased intra-abdominal pressure (from coughing and sneezing) is transmitted to both urethra and bladder evenly, leaving the pressure difference unchanged, resulting in continence. Normal micturition is a result of changes in both of these pressure factors: urethral pressure falls and bladder pressure rises.

The body stores urine - water and waste discharged by the kidneys - inside the bladder, a balloon-like organ. The bladder is connected to the urethra, the channel through which the urine leaves the body.

During urination, the detrusor muscle in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, the sphincter muscles surrounding the urethra relax, leaving the urine out of the body. Incontinence will occur if the bladder muscle suddenly contracts (detrusor muscle) or muscles around the urethra suddenly relax (sphincter muscle).

Children

Urination, or urination, is a complex activity. The bladder is a muscle like a balloon located at the bottom of the abdomen. The bladder stores the urine, then releases it through the urethra, the channel that carries urine to the outside of the body. Controlling this activity involves nerves, muscles, spinal cord and brain.

The bladder is made up of two types of muscles: the detrusor, the muscle sac that holds urine and squeezes it empty, and the sphincter, the circular group of muscles in the lower part or neck of the bladder that automatically keeps contracted to hold urine in and automatically relax when the detrusor contracts to let urine enters the urethra. The third group of muscles under the bladder (pelvic floor muscles) can contract to keep the urine back.

The baby's bladder fills the set point, then automatically contracts and empties. As the child ages, the nervous system develops. The child's brain starts getting a message from the charging bladder and starts sending a message to the bladder so it does not automatically empty until the child decides that it is an empty time and place.

Failure in this control mechanism results in incontinence. The reasons for this failure range from simple to complex.

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Diagnosis

Careful taking of history is particularly important in urinary patterns and urine leakage because it indicates the type of incontinence encountered. Other important points include tension and discomfort, drug use, recent surgery, and illness.

Physical examination will focus on looking for signs of medical conditions that cause incontinence, such as tumors blocking the urinary tract, fecal impaction, and poor reflexes or sensations, which may be evidence of neurological causes.

The most common tests are measurement of bladder capacity and residual urine for evidence of malfunctioning bladder muscle function.

Other tests include:

Stress test - the patient relaxes, then coughs vigorously when the doctor notices the loss of urine.
Urinalysis - urine tested for evidence of infection, urinary stones, or other contributing causes.
Blood tests - blood taken, sent to the laboratory, and examined for substances associated with the cause of incontinence.
Ultrasound - sound waves are used to visualize the kidneys, ureters, bladder, and urethra.
Cystoscopy - a thin tube with a small camera is inserted into the urethra and used to view the inside of the urethra and bladder.
Urodynamics - various techniques of measuring pressure in the bladder and flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record urination patterns, record the time and amount of urine produced.

Research projects assessing the effectiveness of anti-incontinence therapy often measure urinary incontinence rates. Methods include a 1-h pad test, measuring leakage volume; using a blank diary, counting the number of incontinence episodes (leak episodes) per day; and assess pelvic floor muscle strength, measure maximum vaginal squeeze pressure.

Type

Stress incontinence, also known as incontinence, is basically due to insufficient pelvic floor muscle strength to prevent urinary secretion, especially during activities that increase intra-abdominal pressure, such as coughing, sneezing, or lowering.
Urge incontinence is the unintentional loss of urine for no apparent reason when suddenly feeling the need or desire to urinate.
Overflow incontinence: Sometimes people find that they can not stop their bladder from continuing to herd or continue herding for some time after they urinate. As if their bladder is constantly overflowing, hence the common name of overflow incontinence.
Mix incontinence is not uncommon in elderly female populations and can sometimes be complicated by urinary retention.
Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood (eg, ectopic ureter). Fistulas caused by trauma and obstetric and gynecological injuries are commonly known as obstetric fistula and can cause incontinence. This type of vaginal fistula includes, most often, vesicovaginal fistula and, more rarely, ureterovaginal fistulas. It may be difficult to diagnose. The use of standard techniques along with vaginogram or radiologists sees vaginal dome with gradual contrast media.
Functional incontinence occurs when a person recognizes the need to urinate but can not get to the bathroom. The loss of urine may be large. There are several causes of functional incontinence including confusion, dementia, poor vision, mobility or agility, unwillingness to the toilet due to depression or anxiety or alcohol-drunk. Functional incontinence can also occur in certain circumstances where there are no biological or medical problems. For example, a person may recognize the need to urinate but possibly in a situation where there is no nearby toilet or access to the toilet is restricted.
Nocturnal enuresis is a sleep episodic UI. That's normal in small children.
Transient incontinence is the transient incontinence most commonly seen in pregnant women when later resolved after childbirth.
Giggle incontinence is an unconscious response to laughter. Usually attack children.
Double incontinence. There are also associated conditions for defecation known as fecal incontinence. Due to the involvement of the same muscle group (levator ani) in bladder and bowel continencies, patients with urinary incontinence are more likely to have fecal incontinence in addition. This is sometimes called "double incontinence".
Coital Incontinence (CI) is a urinary leak that occurs during penetration or orgasm and may occur with a sexual partner or by masturbation. It has been reported in 10% to 24% of sexually active women with pelvic floor disorders.

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Management

Treatment options range from conservative care, behavior management, bladder retraining, pelvic floor therapy, collecting devices (for men), eraser-inclusions for incontinence (in men), drugs and surgery. The success of the treatment depends on the correct diagnosis. Weight loss is recommended in those who are obese.

Behavioral therapy

Behavior therapy involves the use of suppressive techniques (disorder, relaxation) and learning to avoid foods that can aggravate urinary incontinence. This may include avoiding or limiting consumption of caffeine and alcohol. Behavior therapy does not cure for urinary incontinence, but can improve a person's quality of life. Behavioral therapy has good benefits as monotherapy and in addition to drugs for symptom reduction.

Exercise

Exercising pelvic muscles as with Kegel exercises is the first line treatment for women with stress incontinence. Efforts to increase the time between urination, known as bladder training, are recommended in those with incontinence. Both of these can be used in those with mixed incontinence.

Small, increasingly heavy vaginal cones can be used to help with exercise. They seem to be better than no active treatment in women with stress urinary incontinence, and have similar effects to pelvic floor muscle training or electrostimulation.

Biofeedback uses gauges to help patients become aware of their body functions. Using an electronic device or diary to track when the bladder and urethral muscles contract, the patient can control these muscles. Biofeedback can be used with pelvic floor exercises and electrical stimulation to relieve stress and encourage incontinence.

Urine-based urine and bladder training are techniques that use biofeedback. In time of urination, the patient fills the vacancy chart and leaks. From the patterns that appear in the graph, the patient can plan to empty his bladder before he will leak. Biofeedback and muscle conditioning, known as bladder training, can change the bladder schedule to store and empty the urine. These techniques are effective for incontinence urge and overflow

A randomized controlled trial in 2013 found no benefit of adding biofeedback to pelvic floor muscle exercises in urinary stress incontinence, but observed improvements in both groups. In other randomized controlled trials the addition of biofeedback to pelvic floor muscle training for the treatment of urinary stress incontinence, improving pelvic floor muscle function, reducing urinary symptoms, and improving quality of life.

Preoperative pelvic floor muscle exercises (PFMTs) in men undergoing radical prostatectomy are not effective in reducing urinary incontinence.

Alternative exercises have been studied for urinary incontinence stress in women. Evidence is not enough to support the use of Paula methods, stomach muscle training, Pilates, Tai Chi, breathing exercises, postural exercises, and general fitness.

Device

Individuals who continue to experience urinary incontinence need to find management solutions that are appropriate to their own situation. The use of mechanical devices has not been well studied in women by 2014.

The collection system (for men) - consists of a shroud worn over a penis that drains urine into the bladder worn on the foot. These products come in a variety of materials and sizes for individual suitability. Studies show that uricylates and bladder are preferred over absorbent products - especially when it comes to 'limitations for daily activities'. Solutions exist for all levels of incontinence. The advantage with the collection system is that they are careful, the skin stays dry all the time, and they are comfortable to use both day and night. The drawback is that it needs to be measured to ensure the right fit and you need a health care professional to write a prescription for them.
Absorbent products (including shields, underwear, protective clothing, shorts, diapers, adult diapers, and underwear) are the most recognized product types to handle incontinence. They are generally easy to get at pharmacies or supermarkets. The advantage of using this is that they barely require installation or introduction by health care specialists. The disadvantage with absorbent products is that they can become bulky, leaky, have an odor and can cause skin damage.
The fixer-occluder device (for men) is tied around the penis, gently pressing the urethra and stopping the flow of urine. This management solution is only suitable for mild or moderate incontinence.
The inner catheter (also known as foleys) is very often used in hospital settings or if the user is unable to handle any of the above solutions on his own. The diameter catheter is usually connected to a bladder that can be worn on the leg or hanging by the side of the bed. Home-stay catheters need to be changed regularly by health care professionals. The advantage of a live catheter is, that urine is channeled out of the body keeping the skin dry. The disadvantage, however, is that it is very common to get a urinary tract infection when using a resident catheter.
Intermittent catheters are a single use catheter inserted into the bladder to empty it, and after their empty bladder is removed and discarded. Intermittent catheters are mainly used for retention (inability to empty the bladder) but for some people can be used to reduce/avoid incontinence.

Drugs

A number of drugs exist to treat incontinence including: fesoterodine, tolterodine and oxybutynin. While some seem to have small benefits, the risk of side effects is of concern. For every ten or so people treated only one person alone will be able to control their urine and all treatments have the same benefits.

Drugs are not recommended for those who experience stress incontinence and are only recommended in those who have an incontinence boost that does not improve with bladder training.

Surgery

Surgery can be used to help stress or overflow incontinence. General surgical techniques for stress incontinence include slings, vaginal tape-free tape, and bladder suspension among others. However, the use of transvaginal mesh implants and bladder sling remains controversial. Because of the risk of weakening painful side effects such as vaginal erosion, and by 2012 transvaginal mesh implants are classified as high-risk devices by the US Food and Drug Administration. The urrodynamic testing seems to confirm that surgical repair of dome prolapse can cure motor drive incontinence. In those with problems after prostate surgery there is little evidence of the use of surgery.

Urinary Incontinence Infographic Elements. Cartoon Character ...

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Epidemiology

Globally, up to 35% of the population over the age of 60 is expected to wet the bed. By 2014, urine leakage affects between 30% and 40% of people over 65 who live in their own homes or apartments in the US. Twenty-four percent of older adults in the United States have moderate or severe urinary incontinence that should be treated medically..

Bladder control problems have been found to be associated with a higher incidence of many other health problems such as obesity and diabetes. Difficulties with bladder control resulted in higher levels of depression and limited activity levels.

Incontinence is expensive both for individuals in the form of bladder control products and for health care systems and nursing home industries. Injury-related incontinence is a major cause of admission to assisted care and care facilities. More than 50% of nursing facility acceptance is associated with incontinence.

Children

Incontinence occurs less frequently after 5 years of age: About 10 percent of 5-year-olds, 5 percent of 10-year-olds, and 1 percent of 18-year-olds have episodes of incontinence. This is twice as common in girls as in boys.

Female

Bladder symptoms affect women of all ages. However, bladder problems are the most common among older women. Women over the age of 60 are twice as likely as men to have incontinence; one in three women over the age of 60 is estimated to have bladder control problems. One of the reasons why women are more affected is the weakening of pelvic floor muscles due to pregnancy.

Men

Men tend to experience incontinence less frequently than women, and male urinary tract structures contribute to this difference. This is common in the treatment of prostate cancer. Both women and men can become incontinent from neurological injuries, congenital defects, strokes, multiple sclerosis, and physical problems associated with aging.

While urinary incontinence affects older men more often than younger men, the onset of incontinence can occur at any age. Estimates in the mid-2000s show that 17 percent of men over the age of 60, an estimated 600,000 men, have urinary incontinence, with this percentage increasing with age.

Stress Incontinence|Causes|Symptoms|Treatment|Lifestyle Modifications

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History

Management of urinary incontinence with bearings is mentioned in the earliest known medical book, Ebers Papyrus (1500 BC).

Incontinence has historically been a taboo in Western culture. However, this situation changed when Kimberly-Clark aggressively marketed adult diapers in the 1980s with actor June Allyson as a spokesperson. Allyson was initially reluctant to participate, but her mother, who had incontinence, assured her that it was her job to remember her successful career. This product proved successful.