Urinary Incontinence is the loss of bladder control — It 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 you don't get to a toilet in time.  Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.

 

Types of urinary incontinence include:

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- Stress 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 infection, or a more severe condition, such as a neurological 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 keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

- Mixed Incontinence. You experience more than one type of urinary incontinence — most often, this refers to a combination of stress incontinence and urge incontinence.

- Temporary Urinary Incontinence. Certain drinks, foods and medications may act as diuretics — stimulating your bladder and increasing your volume of urine. They include:

 

- Alcohol
- Caffeine
- Carbonated drinks and sparkling water
- Artificial sweeteners
- Chocolate
- Chilli 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 may also be caused by an easily treatable medical condition, such as:

 

- Urinary Tract Infection (UTI). Infections can irritate your bladder, causing strong urges to urinate and, sometimes, incontinence.

- 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 can also be a persistent condition caused by underlying physical problems or changes, including:

 

- Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
 

- Childbirth. Vaginal delivery can weaken muscles needed for bladder control and damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions may be associated with incontinence.
 

   - Changes with Age. 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 keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.

   - Enlarged Prostate. Especially in older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
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.

   - Neurological Disorders. Multiple sclerosis, Parkinson's disease, a 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 your risk of developing Urinary Incontinence include:

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Gender. Women are more likely to have stress incontinence. Pregnancy, childbirth, menopause and normal female anatomy account for this difference. However, men who have prostate gland problems are at increased risk of urge and overflow incontinence.
Age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release.
 

Being Overweight. Extra weight increases pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
Smoking. Tobacco use may increase your risk of urinary incontinence.
Family history. If a close family member has urinary incontinence, especially urge incontinence, your risk of developing the condition is higher.
Some diseases. Neurological disease or diabetes may increase your risk of incontinence.
Prevention

Urinary Incontinence isn't always preventable. However, to help decrease your risk:

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- Maintain a healthy weight
- Practice pelvic floor exercises
- Avoid bladder irritants, such as caffeine, alcohol, and acidic foods
- Eat more fiber, which can prevent constipation, a cause of urinary incontinence
- Don't smoke, or seek help to quit if you're a smoker

When to See a Doctor?

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it's important to seek medical advice because urinary incontinence may:

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- Cause you to restrict your activities and limit your social interactions
- Negatively impact your quality of life
- Increase the risk of falls in older adults as they rush to the toilet
- Indicate a more serious underlying condition
 
Diagnosis:

    It's important to determine the type of Urinary Incontinence that you have and your symptoms. 
    We start with a thorough history and physical exam. You may then be asked to do a simple maneuver that can demonstrate incontinence, such as coughing.

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After that, we likely recommend:

- Urinalysis .to see if you have a urinary infection
 

- Bladder Diary. For several days you record how much you drink when you urinate, the amount of urine you produce, whether you had an urge to urinate, and the number of incontinence episodes.
 

- Postvoid Residual Measurement. You're asked to urinate (void) into a container that measures urine output. Then your doctor checks the amount of leftover urine in your bladder using a catheter or ultrasound test. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.
 

    If further information is needed, your doctor may recommend more-involved tests, such as urodynamic testing and pelvic ultrasound. These tests are usually done if you're considering surgery.

Treatment Options:

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. We may recommend:

- Bladder Training, to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every 2.5 to 3.5 hours.
Double voiding helps you learn to empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.
Timed schedule voiding, Scheduled toilet trips to urinate every two to four hours rather than waiting for the need to go.

- Fluid & Diet Management to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight, or increasing physical activity also can ease the problem.

- Pelvic Floor Muscle Exercises or "Kegel" Exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence. To do these pelvic floor muscle exercises, imagine that you're trying to stop your urine flow. Then:

Tighten (contract) the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing 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, we may suggest that you work with a pelvic floor physical therapist or try biofeedback techniques.

 

Problems with urine leakage may require you to take extra care to prevent skin irritation:

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- Use a washcloth to clean yourself.
- Allow your skin to air dry.
- Avoid frequent washing and douching because these can overwhelm your body's natural defenses against bladder infections.
- Consider using barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine.
 

Ask your doctor about special cleansers made to remove urine that may be less drying than other products.
 

If you have urge incontinence or nighttime incontinence, make the toilet more convenient:

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- Move any rugs or furniture you might trip over or collide with on the way to the toilet.
- Use a night light to illuminate your path and reduce your risk of falling.
 

If you have functional incontinence, you might:

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- Keep a bedside commode in your bedroom
- Install an elevated toilet seat
- Widen an existing bathroom doorway

During the initial assessment, we usually ask you:

- When did you first begin experiencing symptoms, and how severe are they?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve or worsen your symptoms?
- How often do 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 caffeinated beverages?
- How often do you eat spicy, sugary, or acidic foods?

      I've had the privilege to perform hundreds of sling procedures for stress urinary incontinence in females. I also managed many of them conservatively. So, depending on which incontinence you have, we can find the best solution for you.

   We can use biofeedback, pelvic exercise education, recommendation of herbs, supplements, and acupuncture are other methods of treatment. After all, there are some situations where the best solution for you is still surgery. We can then refer you to the appropriate referral centers for definitive treatment.