Urinary Incontinence

What is urinary incontinence? What causes it? 

Urinary incontinence refers to loss of control over urination. The most common causes are activities which increase intra-abdominal pressure like exercise or can be associated with sudden feeling of urgency associated with loss of urine.

This is a topic which is often not talked about or addressed in women. Women are hesitant to start discussions about urine leakage symptoms due to embarrassment, lack of knowledge about treatment options, and/or fear of surgery.

Impact on Health — Incontinence can impact many other aspects of a woman’s life

Quality of life – Loss of control on urination (urinary incontinence) in women is associated with depression and anxiety, difficulty at work and in social settings. It may also cause increased infections in the vagina and vulva as the area remains moist for a long time.

Sexual relationships- Fear of leaking urine during sexual activity contributes to sexual dysfunction.

Increased caregiver burden – Leakage of urine in older women can cause a significant increase the amount of care required.

Why don’t we leak urine normally?

It is because of a intact reflex arc between the bladder, pelvic muscles and the brain, controlling urination. It also requires the functional ability to be able to use the restroom to void. Also the urethra has a good support beneath it and a good baseline tone to facilitate urethral closure.

Types of urinary incontinence:

Stress incontinence — Individuals with stress incontinence have loss of urinary control that occurs with increases in intra-abdominal pressure (e.g., with exertion, sneezing, coughing, laughing). Stress incontinence is the most common type in younger women, with the highest incidence in women ages 45 to 49 years.

Mechanisms of stress incontinence include loss of support to the urethra (urethral hyper mobility) and loss of tone of the urethra (intrinsic sphincteric deficiency).

  • Loss of urethral support (Urethral hypermobility)

This occurs due to insufficient support of the pelvic floor muscles and vaginal connective tissue to the urethra and bladder neck. So the urethra fails to close with increased intra-abdominal pressure ( eg coughing or sneezing) leading to leakage of urine. This can happen due to increase in abdominal  pressure for a long time(i.e. high-impact activity, chronic cough, or obesity).Treatment in this case is aimed at providing a backboard of support for the urethra in form of pessary, bulking agents or placement of sling.

  • Loss of tone of the urethra –Intrinsic sphincteric deficiency (ISD)is another form of stress urinary incontinence that results from a loss of urethral tone that normally keeps the urethra closed. This can occur in the presence or absence of urethral hypermobility and typically results in severe urinary leakage even with minimal increases in abdominal pressure.

Urgency incontinence — Women with urgency incontinence experience a strong urge to void immediately before the leakage of urine.  The amount of leakage ranges from a few drops to completely soaked undergarments. A normal bladder muscle stays relaxed as the bladder fills with urine. In these patients it contracts even when not completely filled causing a sudden desire to leak urine. This is also called a overactive bladder.

Mixed incontinence — Women with symptoms of leakage of urine with both increase in intra-abdominal pressure ( coughing/ sneezing) and associated with sudden desire to void are said to have urge incontinence.

Overflow incontinence — Overflow incontinence typically presents with continuous urinary leakage or dribbling as the bladder does not empty well.

Overflow incontinence is caused by weak muscle of the bladder which does not contract well to empty the bladder or obstruction preventing the bladder from emptying well.

Functional incontinence – Functional incontinence occurs when a patient has intact urinary storage and emptying functions but is physically unable to toilet herself in a timely fashion. This appears to be a common contributor to urinary incontinence for older women.

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