Urinary incontinence means involuntary leakage of urine. In other words, it is inability to hold back urine.
This problem affects millions of women all over the world. Almost 20 to 30% of young women and 50% of the elderly suffer from this condition though it is grossly underreported due to embarrassment. It adversely affects the woman’s quality of her life as well as her confidence. In extreme cases, it can be so debilitating as to affect her family, social and sexual life too.
Women are much more prone to developing incontinence than their male counterparts because of the weakness of pelvic muscles resulting from excessive stretch and strain during pregnancy and delivery. Apart from this, the loss of the hormone estrogen after menopause can further weaken the pelvic floor and cause involuntary loss of urine.
Apart from this, nerve injury or weakness as well as aging can cause loss of continence in both sexes.
Incontinence is not inevitable with age and women need to know that this condition is treatable and surgery as well as medical treatment can help.
ANATOMY:
In order to understand incontinence, we have to understand the process of micturition (passage of urine).
The urinary bladder receives urine from the kidney and is the bag which stores urine. It is made up of muscle fibres, of which the most important is the detrusor. When urine in the bladder reaches a certain volume, the nerves sense this and pass on the message to the brain. When the person finds a suitable place to relieve herself, the brain releases its inhibition and the nerves from the brain to the urinary bladder signal for the detrusor muscle to contract and urinary flow occurs.
The other important muscle which plays a role in this process is the internal urinary sphincter, which is a part of the pelvic floor and surrounds the outflow passage from the bladder. When the sphincter contracts, the passage of urine is closed and urine cannot flow. When the detrusor contracts and the sphincter relaxes, urine can flow freely.
Incontinence would occur if the detrusor muscle of the bladder contracts inappropriately or the urinary sphincter weakens or relaxes suddenly. It usually results from damage to the nerve supply of the bladder or weakness of the muscles (pelvic floor and the urinary sphincter).
Incontinence can be of the following types:
- Stress incontinence
- Urge Incontinence
- Mixed Incontinence
- Overflow Incontinence
- Functional Incontinence
Stress incontinence implies loss of urine in the event of stress (here, increased pressure within the abdomen) such as sneezing, coughing, lifting weights or laughing aloud. This usually results after childbirth or after menopause and is the direct result of weakness of the pelvic floor. Urine thus leaks out in response to even small rise in the bladder pressure.
Urge incontinence means that the person suddenly gets the urge to pass urine and leaks small amounts of urine at such times over which she has no control. It may occur during sleep or during from hearing the sound of running water too.
It is usually the result of an overactive detrusor muscle caused by local infection, inflammation or irritation. Overactive nerves supplying this muscle can also cause this. e.g. conditions like multiple sclerosis, spinal cord injury or Alzheimer’s disease.
Mixed incontinence is the coexistence of stress and urge incontinence. It is caused by an overactive detrusor muscle as well as a weakened urethral sphincter. Mixed urinary incontinence is characterized by involuntary loss of urine associated with urgency as well as exertion, cough, sneeze, or any effort that increases intra-abdominal pressure. This is the most common type of incontinence in women.
Overflow incontinence occurs when the patient's bladder is always full so that it frequently leaks urine. These patients have a problem with emptying of the bladder due to weakness of the detrusor or the nerves supplying it or some obstruction to the passage of urine (say tumour or stone). Since the bladder cannot empty properly, it distends beyond its capacity and then leaks small amounts of urine leak intermittently throughout the day.
This condition is rare in women.
Functional Incontinence is often seen in the aged and accounts for some of the cases of incontinence among the elderly in nursing homes. People with functional incontinence may have problems thinking or moving that prevent them from reaching a toilet. For example, a person in a wheelchair may be blocked from getting to a toilet in time.
DIAGNOSIS:
The diagnosis of the type of incontinence is critical to the treatment. A good history taking, involving maintaining a urinary diary gives a fairly good idea of the condition and further work up usually includes routine blood and urine tests and a sonography of the urinary tract followed by cystoscopy (visualisation of the inner lining of the bladder through a telescope) in indicated cases.
Urodynamic study is a special type of evaluation of the pressures within the bladder and urethra at different stages of passage of urine. This test is critical to differentiate between different types of incontinence which in turn influences treatment.
TREATMENT:
The treatment of urinary incontinence depends upon:
- Age
- The type of incontinence
- Its severity
- The treatment goals of the patient
- The general medical condition of the patient
- Attitudes of the patient towards her condition and surgery
Pelvic floor exercises (Kegel’s) offer relief to many women with mixed and stress incontinence of the mild variety, but are largely ineffective in severe cases.
Surgical procedures for incontinence have made great strides over the past decade and women now have many minimally invasive options for surgery which have improved results dramatically, providing relief to women the world over. The latest techniques provide reliability, better success rates with fewer risks and minimal anaesthesia.
What we offer at GyneGuide:
Incontinence Clinic which would involve counselling on individual basis or in groups about
- The various aspects of incontinence
- Explanation about what the various tests mean
- Pelvic floor exercises.
- A detailed review of the latest and commonly performed surgical procedures with their pros and cons
Individual counselling for indicated cases where we would review your case history and papers and discuss with you the best possible options for you, surgical or otherwise.