OVERVIEW OF URINARY INCONTINENCE IN FEMALES AND MALES:

TYPES OF URINARY INCONTINENCE

Stress incontinence
Urge incontinence
Overflow incontinence
Functional incontinence
Mixed incontinence.

Stress incontinence:

Stress incontinence is the leakage of urine during exercise, coughing, sneezing, laughing, walking, lifting heavy objects such as a bag of groceries, rising from a sitting to a standing position, or other body movements that put pressure on the bladder.

The word ‘stress’ in this case does not mean emotional stress. The stress referred to here is physical in nature. It refers to an increased pressure on the bladder when ordinary physical activities are performed. The time period during which leakage occurs may be very short.

Causes of Stress incontinence:

It is the most common type of incontinence and can almost always be cured. Most women with stress urinary incontinence have weak pelvic muscles. These are the muscles that support the bladder, bladder neck, and urethra (the urinary passage). Pregnancy, childbirth, and prior pelvic surgery are among the reasons for weakened pelvic muscles. Another possible cause of stress incontinence in women is a weakened or damaged urethral sphincter muscle itself or poor bladder support. Both of these weak pelvic muscles and a weakened urethral sphincter muscle may co-exist in the patient.

Urge Incontinence:

Urge incontinence is the inability to hold urine long enough to reach a toilet. In such a case, an overactive bladder contracts without you wanting it to do so. You may feel as if you can’t wait to reach the toilet. There is a sudden, strong urge to urinate, with an uncontrollable rush of urine.

It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson’s disease, and multiple sclerosis. On occasion, it can also be a warning sign of early bladder cancer. Urge incontinence in men is often a sign of an enlarged prostate. It can, however, occur in otherwise healthy older people.

Overflow Incontinence:

Overflow incontinence is the leakage of small amounts of urine from a bladder that is always full. It results when the bladder is allowed to become so full that it overflows. In this form of incontinence, the bladder never entirely empties and the urine stream is weak, with a frequent or constant dribble. Overflow incontinence can occur when the flow of urine from the bladder is blocked, when there is a loss of normal bladder function in some people with diabetes, or due to bladder muscle weakness secondary to neurological issues.

Functional Incontinence:

Functional incontinence occurs in many older people who have normal urine control but who have difficulty reaching a toilet in time because of arthritis or other crippling disorders.

Total Incontinence:

Total incontinence occurs when there is a complete loss of bladder control, usually occurring after some form of surgery on the lower urinary tract..
Mixed Incontinence: is a combination of urge and stress incontinence.

TREATMENT FOR URINARY INCONTINENCE IN MALES AND FEMALES

1. Treatment for stress incontinence: Head over to our blog on stress incontinence
2. Treatment of Urge incontinence:
   

   The first step should be behaviour modification, like drinking less fluid, not drinking at bedtime, and timed voiding around the clock. Exercising the pelvic muscles (Kegel exercises) also helps.

   The mainstay of treatment is a medication called bladder-specific anticholinergics. This consists of the use of bladder relaxants that prevent the bladder from contracting without the patient's permission.

   The most common side effects of the medication are dryness of the mouth, constipation, or changes in vision. Sometimes, a reduction in medication takes care of the side effects.

In more difficult cases, the bladder can be made bigger using a segment of the small intestine. This operation, called augmentation cystoplasty, is very successful in curing incontinence, but its main drawback is the need for 10 to 30 percent of the patients to perform intermittent self-catheterization to empty their bladder. For patients who don’t respond to anticholinergics or who cannot tolerate the side effects of these drugs, the option of a Botox injection into the bladder muscle is available. The advantage is no need for medications and a more sustained effect, and the disadvantage is that the dose may need to be repeated after 6–9 months.

TESTS TO EVALUATE URINARY LEAK:

Urinalysis:

A sample of your urine will be tested for the presence of infection, blood or other abnormalities.

Uroflowmetry:

Uroflowmetry (urine flow test) is the simplest of the urodynamic tests. This test measures the rate of urine flow as well as the amount of urine passed. You will have to come to the clinic with a reasonably full bladder (as per what feels comfortable to you), sit on a modified toilet seat (called a micturition chair), and, in private, pass urine in the usual way into a flow metre.

Residual Urine Measurement:

This test is performed to find out whether any urine remains after you have attempted to empty your bladder. Residual urine is measured by placing a bladder scanner over your bladder, a painless procedure lasting only a few seconds.

In our hospital, we do not combine uroflowmetry with residual urine measurement. This is because when you finish uroflow and come to the scan room, there may be another patient undergoing a scan, and it may take 15 minutes to complete the scan. By then, your bladder will start refilling, giving you falsely high residual urine.

So what we do in our hospital is advise you to do these tests separately, i.e., fill the bladder once for uroflowmetry and again for pre- and post-void. We agree this takes more time, but I assure you, this will help us accurately assess the residual urine.

If your uroflowmetry and/or residual urine are abnormal, you will then require a voiding cystometry (urodynamics) to determine the cause of your difficulty passing urine.

Urodynamics are special outpatient tests used to assess the normal and abnormal function of the urinary tract, especially the bladder and the urethra (the 'water pipe' leading from the bladder to the outside of the body). These range from the simple to the more sophisticated, depending on the complexity of your problem.

Urethral Pressure Profile (UPP): UPP will only be performed in some of those patients who have had previous failed surgery for incontinence. As this test is not commonly undergone, your doctor will explain how it is performed in the event that you are required to take it.

Video-Cystourethrography (VCU): VCU will only be performed in some of those patients who have had previous failed surgery for incontinence. As this test is not commonly undergone, your doctor will explain how it is performed in the event that you are required to take it.

Stress Test: While your bladder is full, you may be asked to cough, stand, and perform other activities to find out whether these stresses on the bladder cause leakage.

Ultrasound: This technique is used to determine the size and shape of the kidneys, the bladder, and the prostate.

Cystoscopy: A thin, telescope-like instrument called a cystoscope is inserted into the bladder through the urethra.