Urinary Incontinence

Urinary incontinence is any involuntary or unwanted  loss of urine. It is considered a medical condition if it happens regularly. The risk of developing incontinence increases with age, but younger people may also develop it. If incontinence is frequent or affects your quality of life, it is important to seek medical advice. In most cases, incontinence can be treated or cured with various treatment options. Together with your doctor you can discuss which treatment is best for you.

Treatment for urinary incontinence depends on the  type of incontinence, how severe it is, and what may cause it. There is no single solution to incontinence that works for everyone. The various treatment options for urinary incontinence can be grouped under self-management or lifestyle changes, drug treatment, and surgery.

What causes Urinary Incontinence?

Some of the most common causes of incontinence  are: 

  • Hormone deficiencies
  • Weak pelvic floor muscles
  • Neurological lower urinary tract dysfunction
  • Urinary tract infections
  • Benign prostatic enlargement (BPE) 

Common risk factors include:

  • Pelvic surgery
  • Prostate surgery
  • Childbirth
  • Menopause

There are different types of urinary incontinence,  depending on how and when you lose urine. This is related to which part of the lower urinary tract is affected: 

  • Stress Urinary Incontinence (SUI) means  that you lose urine during certain activities, like coughing, sneezing, laughing, running, jumping, or lifting heavy things. 
  • Urgency Urinary Incontinence (UUI) happens when you get a sudden need to urinate which you cannot postpone. The bladder muscle contracts and you urinate when you do not want to.
  • Your doctor may diagnose you with Mixed Urinary Incontinence if you suffer from both SUI and UUI symptoms. 

Your doctor needs to find out which type of incontinence  you have and what causes it. This will help to find the best treatment. Some of the tests that the doctor can perform to better understand your situation are: 

  • A full medical history.
  • A physical examination.
  • Patient questionnaires.
  • A bladder diary.
  • A urine test.
  • An assessment of residual urine.
  • A pad test 

Your doctor may also recommend a urodynamic  evaluation, a uroflowmetry test, more invasive urodynamic testing, a cystoscopy, or imaging in case your diagnosis is unclear for some reason. 

Your doctor may ask you to keep a bladder diary for  a few days. Here you will note down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better. You can download a bladder diary from the website. 

Urinary incontinence can be an embarrassing and  isolating condition that affects your physical and psychological health. Although it is not life-threatening, it usually has a negative impact on your quality of life. Incontinence can affect your social life, your work, and your sex life. It causes physical and emotional discomfort, and can lead to low self-esteem. 

If you suffer from stress urinary incontinence (SUI),  your doctor may recommend surgical treatment. Common treatment options for SUI are: 

  • Sling implantation: Slings provide support to the pelvic floor muscles and help the urethra to better resist pressure from a full bladder. Slings are placed under the urethra to support it.
  • Injections with bulking agents: If you suffer from SUI, your doctor may recommend treatment with bulking agents. These are injected into your urethra wall so that the urethra is compressed and can better resist the pressure of a full bladder.
  • Artificial compression devices (balloon insertion): Artificial compression devices, also known as balloons, are a second-line treatment for moderate to severe SUI. They compress the urethra just below the bladder neck so that it can better resist the pressure of a full bladder. The goal of the balloons is to reduce urine leakage during activities such as sneezing, coughing, laughing, or running.
  • Artificial Urinary Sphincter implantation (AUS): Artificial urinary sphincter implantation, or AUS, is a second-line treatment for moderate to severe SUI. With the help of a hand-controlled pump, the AUS allows you to control your bladder by compressing and releasing a cuff around the urethra. The goal of the AUS is to reduce urine leakage during activities such as sneezing, coughing, laughing, or running.
  • Burch colposuspension: This surgery is a treatment for SUI in women. The aim is to reposition the bladder neck so that it can better resist the pressure from a full bladder. 

Sometimes self-management or the drugs your doctor prescribed do not improve your urgency urinary incontinence (UUI). In these cases, other treatment options are available. Together with your doctor you can decide which approach is best for you. Common treatment options for UUI are: 

  • Botulinum toxin bladder injection: Botulinum toxin is widely known by one of its trade names, Botox┬« and is often used in cosmetic surgery. For UUI, the toxin is injected into the bladder wall to reduce the activity of the nerves which cause the symptoms. 
  • Nerve stimulation: Nerve stimulation, also known as neuromodulation, is a treatment which uses electrical pulses to stimulate the sacral nerves, which control the bladder. The electrical pulses can be directed to the tibial or the sacral nerves. 
  • Surgery to increase bladder volume: In case your symptoms have not improved with drug or other treatments, you may need surgery on your bladder. The goal of the procedure is to increase the capacity of the bladder. This will reduce the pressure in the bladder as it fills so that it can hold more urine. 

Bladder control depends on muscles working together when the bladder is filling with urine. The bladder muscle should be relaxed and the muscles around the urethra (the tube that urine passes through), called the pelvic floor muscles, should be tight. Exercises that strengthen the pelvic floor muscles can help hold urine inside the bladder, preventing leakage. These pelvic floor muscle exercises are commonly called "Kegel" exercises, named after the doctor who developed them.

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