Incontinence of the Urine
An issue with bladder and sphincter control is known as urinary incontinence. It is the uncontrollably occurring urine leak. It’s time to consider treatment if your fear of urinating prevents you from engaging in activities you enjoy. Do not be ashamed to discuss this medical condition with your healthcare team. Options for treatment are waiting for you!
Urinary Incontinence: What Causes It?
Incontinence of the urine is not a disease. It is a sign of many different health conditions, including the following short- and long-term conditions.
Short-term medical conditions:
• UTI, or urinary tract infection
Constipation, or dry, hard stools
• Medication (including antidepressants, diuretics, antihistamines, and others)
Chronic health conditions:
• Stroke • Diabetes
Prostate enlargement or surgery for men with multiple sclerosis
• Women’s menopause or childbirth
Which Urinary Incontinence Types Exist?
Stress Urinary Incontinence (SUI)
One prevalent kind of urine leakage is stress urinary incontinence (SUI). Because of their weakness, the pelvic floor muscles—which support the pelvic organs—can no longer adequately support the bladder and urethra in people with SUI. The bladder may become so compressed from coughing, sneezing, bending, lifting, straining, or even laughing that it leaks.
Urgency Urinary Incontinence (UUI) or Overactive Bladder (OAB)
Frequent urination and an abrupt, intense urge to void are common symptoms of the Overactive Bladder (OAB) syndrome. This “gotta go” sensation makes you fear that if you don’t use the loo right away, you will leak. Urgency urinary incontinence (UUI) is the term for this urge-related urine leakage if you do not make it. You might feel the need to urinate frequently throughout the day if you have OAB. You might even get up several times during the night to go to the toilet. For many people, it is a very common health problem that may get worse as people age. People who have diabetes, multiple sclerosis, or stroke also frequently experience it.
Overflow incontinence
When the bladder remains full, this kind of incontinence occurs. It overflows and leaks because it is unable to empty. Numerous, tiny urinations per day or persistent dribbling are warning signs. Although it is rather uncommon in women, individuals with diabetes, neurological conditions, and/or an underactive, non-functioning bladder may experience this. Overflow incontinence is most frequently observed in men with prostate issues.
Mixed Urinary incontinence
A combination of these various forms of incontinence is known as mixed incontinence. Urinary incontinence can take many different forms for some people. Some people have a strong, uncontrollable sense of urgency (OAB) and leak urine when they are physically active (SUI). Mixed urinary incontinence is what this is. To learn how to handle issues in these situations, it is helpful to understand what is happening and what is causing leaks.
Treatment
Changes in Lifestyle
You should start by making lifestyle adjustments, like altering your diet. You alter your daily routine when you change your lifestyle. This could involve the foods and beverages you consume as well as the use of other symptom-controlling techniques. Changing a few habits may help your symptoms, but changing your lifestyle may not completely eliminate them. Losing weight has been associated with a reduction in urinary symptoms for some people.
Control of Fluids
It’s likely that you’ll be asked to keep track of what, when, and how much you drink. You might discover that you should cut back on things like alcohol and caffeine. These beverages may cause bladder irritation. Additionally, you might be asked to consume more water. It’s best to drink six to eight glasses of water each day. You might also be instructed to abstain from alcohol for a few hours prior to going to bed. This could lessen the need for you to wake up in the middle of the night to urinate.
Restrict Some Foods and Drinks
It has been discovered that certain foods and beverages can irritate some people’s bladders. For instance, some people find colas, tea, coffee, and spicy foods to be bothersome. Studies haven’t shown that these are “bladder irritants” for every patient, though. Trying to observe how various foods and beverages impact you and your symptoms on your own is a smart strategy.
Training of the Bladder
One way to begin bladder training is with a bladder diary. You record what you drink, how much you drink, and how frequently you use the loo for three days. Keeping track of your urine leaks could also be beneficial. You and your medical team may be able to identify factors that could exacerbate your symptoms with the help of this journal. It might also assist you in creating a plan for bladder training. This is the process of carefully emptying your bladder at predetermined intervals. You should experience fewer leaks if you regularly empty your bladder. Techniques that can assist with both OAB and SUI include timed urination, scheduled voiding, and double voiding.
Retraining your bladder may be helpful if you pass urine too frequently. Holding your urine in the bladder for increasing lengths of time is the aim. Little steps are taken in this process. Add five to ten minutes at first. Retraining your bladder to hold urine for three to four hours while reducing urgency and leakage is the aim.
Exercises for the Pelvic Floor
The urethral sphincter and pelvic floor muscles can be strengthened with Kegel exercises. This is applicable to both sexes. Developing the ability to contract and relax these muscles may aid in bladder control.
Kegel exercises may also aid in managing the urge to go that is brought on by bladder spasms. In order to get the bladder to calm down and possibly help suppress the urge, the pelvic floor muscles must be squeezed. Uncontrollable UUI leaks may be halted or at least paused by this. You can learn how to perform these exercises successfully from a healthcare professional.
Kegel exercises can help with OAB/UUI (by reducing the urge feeling) as well as SUI (by strengthening the muscles). To continue benefiting your body, you must perform the exercises frequently, just like in any fitness program.
Medicines for Incontinence Treatment
Your healthcare team may suggest that you try prescription drugs if lifestyle modifications are insufficiently beneficial.
Anticholinergic Substances – Anticholinergic medications work by relaxing the bladder muscle to treat OAB/UUI. Solifenacin, tolterodine, and oxybutynin are examples of common drugs. Although they are effective for the bladder, they are also associated with a number of unpleasant side effects, including dry mouth, constipation, blurred vision, and, more recently, some worries that prolonged use may result in dementia or confusion. Trospium chloride is not believed to pose a risk of dementia or confusion because it does not diffuse into the brain.
Beta 3 agonist – Mirabegron is another OAB medication. Since it is not an anticholinergic drug, none of the aforementioned adverse effects are associated with it. Although it acts slightly differently on the bladder because it is an alpha-agonist, it ultimately has the same effect of causing the bladder to relax. It should be used cautiously in patients with hypertension because it can raise blood pressure.
Treatments for Stress Urinary Incontinence (SUI)
Slings
Sling for Women
Midurethral sling surgery is the most popular surgical procedure and the accepted standard of care for treating female SUI. In order to support urethral closure during activities that involve physical pelvic stress, such as coughing, sneezing, bending, lifting, jumping, and running, a strip of soft permanent mesh is positioned beneath the urethra.
Sling for Men
Some men may be offered a sling procedure to treat SUI. The purpose of the male sling is to support the urethral sphincter muscle. This is accomplished by making a cut between the scrotum and the rectum and placing a soft mesh tape underneath the urethra.
Colposuspension and Bladder Neck Suspension – For female SUI, the Burch Colposuspension, also known as bladder neck suspension, is a surgical procedure that uses permanent stitches to raise the neck of the bladder up towards the pubic bone.
Bulking agents (injections) – By “bulking up” the inner urethral lining and narrowing the urethral opening, this option is used to treat female SUI. These days, bulking agents are permanent substances that are injected into the tissues surrounding the urethra and the sphincter muscle, which extends up to the neck of the bladder.
Artificial Urinary Sphincter (AUS): Both men and women may benefit from implanting an artificial urinary sphincter (AUS) around the urethra. For men with SUI, this is the most popular course of treatment.
Treatments for Overactive Bladder (OAB)
There are other options if medication and lifestyle modifications aren’t helping your OAB.
Botox® Treatment for the Bladder – To lessen urge incontinence and urine urgency, Botox® (onabotulinumtoxin) may help relax the muscles of the bladder wall. When OAB symptoms reappear, additional treatments will be required because Botox® effects last for approximately six to nine months.
Stimulation of Nerves – Nerve stimulation, also referred to as neuromodulation therapy, involves electrically stimulating the pelvic nerves, which share a common pathway with the bladder.
Surgery for Urinary Diversion and Bladder Reconstruction – Only extremely rare and complex cases call for these kinds of major abdominal surgeries. For OAB, the primary forms of major abdominal surgery are:
Urinary diversion, which can be used to redirect urine flow away from the bladder and frequently calls for a stoma and external appliance to catch the urine, and augmentation cystoplasty, which can be used to enlarge the bladder to increase the amount of urine it can hold at any given time.