Description

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong not getting to the bathroom in time.

Although it occurs more frequently in the elderly, urinary incontinence is not an inevitable consequence of aging. If urinary incontinence affects your daily activities, do not hesitate to consult your doctor. To most people, simple lifestyle and diet changes, or medical care can treat the symptoms of urinary incontinence.

Symptoms

Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.

Types of urinary incontinence are:

  • The stress urinary incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
  • Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as an infection or a more serious disease such as a neurologic disorder or diabetes.
  • Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
  • Functional incontinence. A physical or mental impairment that prevents you from doing the bathroom in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
  • Mixed incontinence. Experience more than one type of urinary incontinence is most often this refers to a combination of stress incontinence and urge incontinence.

When to see a doctor

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is common or is affecting your quality of life, it is important to go to the doctor because of urinary incontinence may be:

  • Cause that restrict their activities and limit their social interactions
  • Negatively affect your quality of life
  • Increase the risk of falls in older adults that are released into the bathroom
  • Indicate a more serious underlying condition

Causes

Urinary incontinence can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by your doctor can help determine what's behind your incontinence.

Temporary urinary incontinence

Some drinks, food, and medications can act as diuretics and stimulants of the bladder and the increase of its volume of urine. They include:

  • Alcohol
  • Caffeine
  • The carbonated soft drinks and sparkling water
  • Artificial sweeteners
  • Chocolate
  • Chili peppers
  • Foods that are high in spice, sugar or acid, especially citrus fruits
  • Heart and blood pressure medications, sedatives, and muscle relaxants
  • Large doses of vitamin C

Urinary incontinence can also be caused by an easily treatable medical condition, such as:

  • Urinary tract infection. Infections can irritate the bladder, causing you to have the urge to urinate, and sometimes incontinence.
  • The constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency.

Persistent urinary incontinence

Urinary incontinence may also be a persistent condition caused by underlying physical problems or changes, including:

  • Pregnancy. The hormonal changes and the increased weight of the fetus can lead to stress urinary incontinence.
  • Delivery. Vaginal delivery can weaken muscles needed for bladder control and damage bladder nerves and supportive tissue, leading to a decrease in the (prolapse) of the pelvic floor. With the prolapse of the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. These bumps may be associated with incontinence.
  • Changes with age. The aging of the bladder muscle can decrease the bladder's capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
  • Menopause. After menopause women produce less estrogen, a hormone that helps to maintain the lining of the bladder and urethra healthy. The deterioration of these tissues can worsen incontinence.
  • Enlargement of the prostate. Especially in older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
  • The prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. But more often, incontinence is a side effect of treatments for prostate cancer.
  • The obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones — hard, stonelike masses that form in the bladder — sometimes the cause of leaks of urine.
  • Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Risk factors

Factors that increase the risk of developing urinary incontinence include:

  • Gender. Women are more likely to have stress incontinence. Pregnancy, childbirth, menopause and the normal female anatomy of the account of this difference. However, men who have problems with the prostate gland are at increased risk of urge and overflow incontinence.
  • Age. As you get older, the muscles of the bladder and urethra lose part of their strength. Changes with age decrease the amount that you can store the bladder and increase the chances of involuntary urine release.
  • The overweight. Excess weight increases the pressure on the bladder and surrounds the muscles, which weakens them and allows urine to leak out when you cough or sneeze.
  • The habit of smoking. The consumption of tobacco can increase the risk of urinary incontinence.
  • The history of the family. If a family member has problems of urinary incontinence, especially urge incontinence, your risk of developing the disease is higher.
  • Some diseases. Neurological disease or diabetes may increase the risk of incontinence.

Complications

Chronic complications of urinary incontinence include:

  • Problems of the skin. Skin rashes, skin infections and ulcers can develop from constantly wet skin.
  • Infections of the urinary tract. Incontinence increases the risk of repeated urinary tract infections.
  • The impacts on his personal life. Urinary incontinence can affect your social life, work, and personal relationships.

Prevention

Urinary incontinence is not always avoidable. However, in order to help decrease your risk of:

  • Maintain a healthy weight
  • The practice of pelvic floor exercises
  • Avoid bladder irritants such as caffeine, alcohol and food acids
  • Eat more fiber, which can prevent constipation, one of the causes of urinary incontinence
  • Do not smoke, or to seek help to stop smoking if you are a smoker

Diagnosis

It is important to determine the type of urinary incontinence that you have, and your symptoms often tell your doctor which type you have. That information will guide treatment decisions.

Your doctor is likely to start with a complete history and physical examination. Then, you can be asked to do a simple maneuver that can demonstrate incontinence, such as coughing.

After that, your doctor will likely recommend:

  • Analysis of urine. A sample of your urine is checked for signs of infection, traces of blood or other abnormalities.
  • The bladder diary. For several days, record the amount that you drink, when you urinate, the amount of urine you produce, if you had the urge to urinate and the number of episodes of incontinence.
  • Postvoid residual measurement. You will be asked to urinate (void) in a container that measures the production of urine. Then, your doctor checks for the amount of the remains of the urine in his bladder with a catheter or an ultrasound test. A large number of traces of urine in your bladder may mean that you have an obstruction in the urinary tract or a problem with the bladder nerves or muscles.

If more information is needed, the doctor may recommend more-participate in the tests, such as the urodynamic test and pelvic ultrasound. These tests are usually done if you are considering the surgery.

Treatment

The treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be necessary. If an underlying condition that is causing your symptoms, your doctor in the first place, the treatment of this condition.

Your doctor may recommend less invasive treatments to get started and move on to other options if these techniques do not help.

Behavioral techniques

Your doctor may recommend:

  • The training of the bladder, to delay urination after you get the urge to go. You can start by trying to hold off for 10 minutes every time you feel the urge to urinate. The goal is to lengthen the time between trips to the bathroom to urinate every 2.5 to 3.5 hours.
  • Double voiding, to help you learn to empty your bladder completely, to avoid overflow incontinence. Double urination means to urinate, then wait for a few minutes and try again.
  • Scheduled toilet trips, to urinate every two to four hours, instead of waiting for the need to go.
  • Fluid and diet management, to regain control of his bladder. You may need to reduce or avoid the consumption of alcohol, caffeine or acidic foods. Reduce fluid intake, weight loss or increased physical activity can also help the problem.

Pelvic floor muscle exercises

Your doctor may recommend that you do these exercises frequently to strengthen the muscles that help control urination. Also known as Kegel exercises, these techniques are especially effective for stress incontinence, but it can also help urge incontinence.

Exercises for the pelvic floor muscles, imagine that you're trying to stop the flow of urine. Then:

  • Tighten (contract) the muscles used to stop urinating and hold for five seconds, and then relax for five seconds. (If this is too difficult, start with the celebration of two seconds and relax for three seconds.)
  • Work up to holding the contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

To help you identify and contract the right muscles, your doctor may suggest that you work with a pelvic floor physical therapist or try to techniques of biofeedback.

Drugs

The medications commonly used to treat incontinence include:

  • Anticholinergics. These medications can calm the hyperactivity of the bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare), and chloride trospium.
  • Mirabegron (Myrbetriq). It is used to treat urge incontinence, this medication relaxes the muscles of the bladder and can increase the amount of urine your bladder can hold. You can also increase the amount that you will be able to urinate at a time, helping to empty the bladder completely.
  • Alpha blockers. In men who have urge incontinence or overflow incontinence, these medications relax the bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura).
  • Topical estrogen. The application of low-dose topical estrogen in the form of a vaginal cream, ring, or the patch can help to tone and rejuvenate the tissues of the urethra and the vagina of the areas.

Electrical stimulation

The electrodes are temporarily inserted in the rectum or in the vagina to stimulate and strengthen the muscles of the pelvic floor. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need several treatments over several months.

Medical devices

Devices designed to treat women with incontinence include:

  • Urethral insert a small buffer as a disposable device that is inserted into the urethra prior to a specific activity, such as tennis, which can cause incontinence. The insert acts as a stopper to prevent leaking and is removed before urination.
  • Pessary, a flexible silicone ring that is inserted in the vagina and the all day wear. The device can also be used in women with vaginal prolapse. The pessary help support the urethra to prevent urine leakage.

Interventional therapies

Interventional therapies that can help with incontinence include:

  • Material to increase the volume of the injections. A synthetic material that is injected into the tissue that surrounds the urethra. The bed help keep the urethra closed and reduce urine leakage. This procedure is for the treatment of stress urinary incontinence and is less effective than the more-invasive treatments such as surgery. It may be necessary to repeat it more than once.
  • OnabotulinumtoxinA (Botox). Injections of Botox into the bladder muscle may benefit people who have an overactive bladder and urge incontinence. Botox is generally prescribed to people only if other treatments have not been successful.
  • Nerve stimulators. There are two types of devices that use painless electrical impulses to stimulate the nerves involved in the control of the bladder (sacral nerves). A type is implanted under the skin of the buttock and connected to the cables at the bottom of the back. The other type is a stopper is removable, which is inserted in the vagina. Stimulation of the sacral nerves can control the overactive bladder and urge incontinence if other treatments have not worked.

Surgery

If other treatments do not work, several surgical procedures that can treat the issues that cause urinary incontinence:

  • Sling procedures. Synthetic Material (mesh) or strips of the tissues of the body are used to create a pelvic support under the urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The harness helps to keep the urethra closed, especially when you cough or sneeze. This procedure is used to treat stress urinary incontinence.
  • The bladder neck suspension. This procedure is designed to provide support to the urethra and the neck of the bladder — an area of thickened muscle where the bladder connects to the urethra. It is an abdominal incision, so it is made for general or spinal anesthesia.
  • Prolapse surgery. In women who have pelvic organ prolapse and mixed incontinence, surgery may include a combination of a sling procedure and prolapse surgery. The repair of pelvic organ prolapse is not only routinely to improve symptoms of urinary incontinence.
  • Artificial urinary sphincter. A small, fluid-filled, and the ring is implanted around the bladder neck to keep the urinary sphincter closed until there is a need to urinate. To urinate, press a valve that is implanted under the skin that causes the ring to deflate and allows the urine from the bladder to the flow.

Absorbent pads and catheters

If medical treatments cannot delete incontinence, you can try products that help to relieve the discomfort and inconvenience of the output of the urine:

  • Pads and protective garments. Most of the products are not more bulky than regular underwear and can be easily worn under everyday clothing. Men who have problems with leakage of urine can use a manifold of drip — a small pocket of absorbent padding that is placed over the penis and held in place by a close-fitting underwear.
  • Catheter. If you are incontinent because his bladder does not empty properly, your doctor may recommend that you learn to insert a flexible tube (catheter) through your urethra several times a day to drain the bladder. You will be instructed on how to clean these catheters for the safe reuse.

Lifestyle and home remedies

Problems with urine leakage can require you to take extra care to avoid skin irritation:

  • Use a towel to clean himself up.
  • Let your skin air dry.
  • Avoid frequent washing and douching, as these can overwhelm the body's natural defenses against infections of the bladder.
  • Consider the use of a barrier cream, such as vaseline or cocoa butter to protect their skin from the urine.
  • Ask your doctor about the special cleansers made to eliminate the urine, which may be less drying than other products.

If you have urge incontinence or incontinence during the night, make the bath more convenient:

  • Move all the rugs or furniture you could trip over or bump into on the way to the bathroom.
  • Use a night light to light your way and reduce the risk of falls.

If you have functional incontinence, you can:

  • Keep a toilet of night in his bedroom
  • Install a raised toilet seat
  • Expand an existing bathroom door

Alternative medicine

There is No alternative medicine therapies that have been shown to cure urinary incontinence. Early studies have shown that acupuncture may provide some benefit. Yoga may also provide some benefit for the urinary incontinence, but further studies are needed.

Coping and support

If you're embarrassed by your bladder control problem, you can try to cope on your own using absorbent pads, carry extra clothes or even avoid going out.

But effective treatments are available for urinary incontinence. It is important to ask your doctor about your treatment. Once you do, you'll be on your way to recover an asset and life insurance.

Preparing for your appointment

If you have urinary incontinence, which is likely to start by seeing your primary care physician. You may be referred to a doctor who specializes in disorders of the urinary tract (urologist) or a gynecologist with special training in women with bladder problems and urinary function (urogynecologist).

What you can do

To prepare for your appointment, it helps to:

  • Be aware of any pre-appointment restrictions, such as the restriction of the diet
  • Write down your symptoms, including the frequency of urination at night the activity of the bladder and incontinence episodes
  • Make a list of all your medications, vitamins and supplements, including dosage and how often you take the medication
  • Make a note of the key medical information, including other conditions that you may have
  • Ask a relative or friend to accompany you, to help you remember what the doctor says
  • Take a notebook or electronic device with you, and use important note the information during your visit
  • Write questions to ask your doctor

For urinary incontinence, some basic questions to ask your doctor include:

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • It is my urinary incontinence in time?
  • What treatments are available?
  • Should I anticipate the side effects of treatment?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • I have other health conditions. How can I best manage these conditions?

Do not hesitate to ask questions during your appointment, as it will happen.

What to expect from your doctor

Your doctor may ask you some questions, such as:

  • When did you first begin to experience the symptoms, and how severe are they?
  • The symptoms been continuous or occasional?
  • What, if anything, seems to improve or worsen your symptoms?
  • How often you need to urinate?
  • When do you leak urine?
  • Do you have trouble emptying your bladder?
  • Have you noticed blood in your urine?
  • Do you smoke?
  • How often do you drink alcohol and drinks with caffeine?
  • How often do you eat spicy, sugary or acidic foods?
Symptoms and treatment of Urinary incontinence