Urinary Incontinence

How Does Urinary Incontinence Impact Your Anatomy and Health?

Urinary incontinence can have a significant impact on both the anatomy and overall health of an individual. The following are some ways in which incontinence can affect the body:

• Bladder and urethra: Incontinence can be caused by damage to the muscles and nerves of the bladder and urethra, leading to decreased muscle tone and weakened muscles that are unable to hold or release urine properly.
• Kidneys: If urine is not expelled correctly or if incontinence leads to urinary tract infections, it can cause damage to the kidneys.
• Skin: Prolonged exposure to urine causes irritation, rashes, and skin infections, particularly in the genital and anal areas.
• Psychological: Incontinence can lead to embarrassment, depression, and social isolation, negatively impacting an individual's overall well-being.
• Physical: Incontinence can lead to skin breakdown and pressure sores, particularly in older adults or people with mobility issues. It can also lead to an increased risk of falls due to the urgency to reach the toilet.

Who Does Urinary Incontinence Affect?

Urinary incontinence in some individuals may be a regular part of growth and disappears naturally over time. However, if it does not disappear, it requires treatment and the condition improves when the underlying cause is treated.

Urinary incontinence is more common in women than in men. Older women experience urinary incontinence more often than younger women. 

The probable cause for the higher incidence in women can be attributed to pregnancy and childbirth, menopause and the structure of the female urinary tract.

Individuals with urinary incontinence may experience a strong, sudden, urgent and uncontrollable need to urinate, frequent urination, and involuntary loss of urine.

Causes of Urinary Incontinence

Urinary incontinence can be caused by a variety of factors, including

• Muscles weakness: The muscles that control the release of urine and faeces (pelvic floor muscles, external urethral sphincter, and the muscles of the rectum) can become weak due to pregnancy, childbirth, ageing, surgery, or certain medical conditions such as multiple sclerosis.
• Nerve damage: Nerve damage can occur due to injury, surgery, or certain medical conditions such as diabetes, Parkinson's disease, or spinal cord injury, which can affect the muscles that control the release of urine and faeces.
• Bladder or prostate problems: Enlarged prostate, bladder infections, bladder stones, bladder cancer, or other bladder-related problems can cause incontinence.
• Constipation: Hard stools can pressure the bladder and rectum, leading to incontinence.
• Medications: Certain medications, such as diuretics, antidepressants, and sedatives, can increase the risk of incontinence.
• Lifestyle factors: Drinking alcohol, caffeine, and smoking can irritate the bladder and increase the risk of incontinence.

Symptoms of Urinary Incontinence

The symptoms of incontinence can vary depending on the type and cause of the condition. However, some common symptoms include

• Leakage of urine, 
• Strong and sudden urge to urinate,
• Leakage of urine during physical activity,
• Inability to empty the bladder.
• Incontinence caused by an underlying medical condition

Types of Urinary Incontinence

Urinary incontinence can be categorised into five basic types depending on the causes and symptoms:

Stress Incontinence 

This type of incontinence occurs when physical activity or pressure on the bladder causes leakage of urine. Common causes include pregnancy, childbirth, obesity, and certain medical conditions such as prostate cancer.

Urge Incontinence

This type of incontinence is characterised by a sudden and intense need to urinate, often accompanied by leakage before reaching the toilet. Nerve damage, bladder infections, and medical conditions such as multiple sclerosis can cause this.

Overflow Incontinence

This type of incontinence occurs when the bladder cannot empty, resulting in urine leakage. A blocked urethra, nerve damage, or an enlarged prostate can cause this.

Functional Incontinence

This type of incontinence occurs when an individual has difficulty getting to the toilet in time due to a physical or cognitive impairment.

Mixed Incontinence

This type of incontinence is a combination of more than one type of incontinence, such as stress and urge incontinence.

Diagnosis for Urinary Incontinence

Incontinence is typically diagnosed by a healthcare professional, such as a primary care physician, urologist, or gynaecologist. The diagnosis process typically includes the following steps:

• Medical history: Your healthcare professional will ask you about your symptoms, including when they occur, how often they occur, and how much urine or faeces is lost. They will also ask about any underlying medical conditions, medications you are taking, and recent changes in your life.
• Physical examination: Your healthcare professional will perform a physical examination, including a pelvic exam for women and a rectal exam for men. They will check for any signs of muscle weakness, nerve damage, or other physical problems causing incontinence.
• Urine test: Your healthcare professional may test your urine for signs of infection or other problems contributing to incontinence.
• Bladder diary: Your healthcare professional may ask you to keep a diary of your fluid intake, urination, and incontinence episodes over some time.
• Urodynamic tests: If your symptoms are unclear, your healthcare professional may refer you to a specialist (urologist or urogynecologist) who may conduct urodynamic tests to evaluate your bladder function and urethra. These tests include measuring the pressure in the bladder, the flow of urine, and the amount of urine left in the bladder after urination.
• Imaging tests: Imaging tests such as ultrasound, CT scan, or MRI may be ordered if there is a concern of a structural issue in the urinary tract.

The diagnosis process may vary depending on the specific case, but the goal is to identify the underlying cause of incontinence and determine the appropriate treatment.

Treatment For Incontinence

The treatment for incontinence depends on the underlying cause and type. Some common treatments include

• Lifestyle changes: Simple changes in lifestyle such as weight loss, reducing or eliminating alcohol and caffeine, and quitting smoking can help improve incontinence.
• Pelvic floor muscle exercises: These exercises, also known as Kegel exercises, can help to strengthen the muscles that control the release of urine and faeces.
• Bladder retraining: This involves gradually increasing the time between urination and retraining the bladder to hold more urine.
• Medications: Medications such as anticholinergics, beta-3 agonists, and mirabegron can help to relax the bladder muscles and reduce the urge to urinate.
• Behavioural therapies: Behavioural therapies such as biofeedback, pelvic floor electrical stimulation, and cognitive behavioural therapy can be helpful in some instances.
• Assistive devices: Devices such as adult diapers, pads, and catheters can help manage incontinence.
• Surgery: Surgery may be recommended in some instances, such as when a structural problem with the urinary tract or other treatments has not been successful.

Suppose these conservative treatment measures fail to treat your condition. In that case, your physician may recommend surgical procedures such as 

• Colposuspension,
• Minimally Invasive Surgeries - including mid-urethral slings,
• Outpatient Botox Bladder Injection, and
• Neuromodulation

Treatments of Urinary Incontinence

You may require surgical procedures if conservative treatment measures fail to treat your condition. These procedures will treat stress incontinence.

Midurethral Sling

This is a minimally invasive surgical procedure. 

A tiny sling is placed under the urethra. The procedure takes about 30 minutes, and most women will stay in the hospital overnight. 

Normal bladder function returns within a short period before discharge. Most women will note an instant improvement in their symptoms of stress incontinence.

Urethral Bulking Agent

This is a minimally invasive procedure performed via cystoscopy in theatre. The bulking agent is injected into the bladder neck. Patients can go home the same day.

Voiding Dysfunction

What is Void Dysfunction?

The lower urinary tract, which includes the bladder and urethra, allows for the storage and timely expulsion of urine. 

Voiding dysfunction is a broad term to describe conditions with poor coordination between the bladder muscle and the urethra. This results in incomplete relaxation or overactivity of the pelvic floor muscles during voiding. 

Voiding dysfunction can manifest as a wide range of symptoms, including difficulty emptying the bladder, urinary hesitancy, slow or weak urine stream, urinary urgency, urinary frequency or dribbling of urine.

Causes of Void Dysfunction

Voiding dysfunction can be nerve dysfunction, non-relaxing pelvic floor muscles or both.

Voiding dysfunction is also classified as being caused by either under activity of the bladder (detrusor) or outflow (urethra). 

Evaluation by a clinician may include tests, such as uroflowmetry, post-void residual and pressure flow studies. Treatment is individualised, depending on specific aetiology. 

Treatments for Void Dysfunction

Possible treatments include 

• pelvic floor therapy, 
• intermittent self-catheterization, 
• muscle relaxants or 
• placement of a neuromodulation device.

What if Urinary Incontinence is Untreated?

If left untreated, incontinence can lead to various adverse health consequences. Some of the potential risks of untreated incontinence include

• Skin irritation and infections
• Urinary tract infections
• Dehydration
• Emotional and psychological effects
• Physical effects,
• Quality of life.

Incontinence is a treatable condition, and early intervention can prevent it from becoming a chronic issue. If you're experiencing incontinence, you must see a urologist to determine the cause and appropriate treatment.