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Urinary incontinence Causes, Symptoms and Treatment

The urinary incontinence results in uncontrollable and involuntary loss of urine that occurs the day or night. It is not a disease, but a symptom most often related to a physical disorder.

Urinary incontinence is more common with age. However, it is not only older people who suffer from it. In North America, it is estimated that it affects globally 1 in 4 women (and from 60 years, at least 1 in 3). Men are twice as likely to be affected, for reasons of anatomy.

Too few people dare to talk to their doctor. However, in most cases, there are solutions to solve the problem or to control it successfully, even if the incontinence lasts for months or even years.

Causes of Urinary incontinence

Here are the main causes of urinary incontinence . They vary according to the type of incontinence (see below).

  • weakening of the pelvic floor muscles (perineum). These muscles are located at the bottom of the pelvis. They are used to keep the bladder in place and to control the evacuation of stool and urine.
    Pregnancy and vaginal deliveries can weaken them. The musculature can also relax with aging and loss of physical fitness.
  • The ”  bladder descent  “. It affects only women and occurs when tissues between the bladder and vagina are so weak or stretched that they can no longer support the weight of the bladder. It becomes more difficult to control (see diagram). Muscle strengthening is often enough to put the bladder back in place, but sometimes surgery is necessary.
  • prostate disorder or surgery to the prostate (see illustration in Prostate Hypertrophy).
  • A chronic health problem that affects the control of the muscles of the bladder through the nerves. For this reason, even if one wants to refrain from urinating, it is difficult or impossible to get there. Diabetic neuropathy, Parkinson’s disease, multiple sclerosis or spinal cord injury can have this effect.
  • Taking certain medications (for example, antidepressants, nasal decongestants, and muscle relaxants).
  • difficulty walking , preventing travel to the bathroom in time.
  • Constipation with faecal (compressed and hardened stools in the rectum).

Types of urinary incontinence

Urinary incontinence on exercise This is the most common form of urinary incontinence in women . This is the leakage of a small amount of urine due to increased pressure in the abdomen, hence on the bladder, caused by physical exertion, coughing, sneezing, laughter, etc. . The pelvic floor muscles must be weakened for these situations to cause leakage of urine. The flight is not necessarily preceded by a desire to urinate.

In men, this type of incontinence can appear following a partial or total removal of the prostate (prostatectomy) if the surgery accidentally reaches the sphincter located at the bottom of the bladder and makes it less effective.

Urinary incontinence. This incontinence represents a quarter of female incontinence, but it can affect the child and the elderly man. It is also called ”  overactive bladder  ” or “uninhibited bladder”. Just walking, thinking about urinating (unlocking the house door, for example), or hearing running water can trigger sometimes severe urine loss. People with urination therefore frequently.

This type of incontinence often results from a chronic health problem that affects the nervous control of the bladder. Normally, the urination control center , located in the frontal lobe of the brain, helps to restrain urination even if the urge is present. It sends signals to the muscles of the bladder to prevent contractions. People who have this area of ​​the brain affected (for example, as a result of a stroke , Alzheimer’s disease or Parkinson’s disease) no longer control their desires.

Urine loss can also be triggered by the following situations: drinking alcohol , coffee, urinary tract infection, etc.

Mixed urinary incontinence. This form of urinary incontinence associates with at least 2 forms of this disorder. The most common combination is stress incontinence and emergency incontinence. It accounts for about a quarter of female urinary incontinence.

Urinary incontinence by overflow (or overflow). It results from an overflow of urine in the bladder. This can then let out urine in an uncontrolled way. This overflow can be explained by an obstacle to the emptying of the bladder, for example, as a result of a disorder of the prostate, the main cause of this type of incontinence in humans. It may also be due to an inability of the bladder to empty due to weakness of the bladder muscle, which then has difficulty in contracting (for example, due to diabetes or neurological disease).

Functional incontinence. Some physical or mental conditions may prevent a person from going to the bathroom in time. This incontinence is common in the elderly because of multiple mobility problems, such as osteoarthritis of the hip or knee, hip fracture, sequelae of a stroke , and so on.

Total incontinence. It is an incontinence characterized by a continuous flow of urine, day and night. Affected individuals have no voluntary control of their bladder, which is no longer able to play its role as a reservoir of urine. Total urinary incontinence is most often the consequence of physical lesions occurring, in particular, because of an accident or disease that reaches the spinal cord, or by total or partial destruction of the sphincter that controls the exit of the urine, as a result of prostate surgery, for example.

Consequences and possible complications

Because of the taboo surrounding urinary incontinence , many people are reluctant to consult. They deprive themselves of the help and treatments offered. However, when left untreated, incontinence can significantly limit physical activity and disrupt social, sexual and work life.

Chronic urinary incontinence increases the risk of recurrent urinary tract infections . It can also cause redness of the skin that surrounds the genitals (up to infections and ulcers), as it creates moisture.

The symptoms of urinary incontinence

  • On exertion  : leakage of urine during an effort, usually weak or sudden. We are not always aware of the losses.
  • Emergency  : Conscious and usually large losses of urine, sudden urges to urinate that always precede urine leakage, but do not give time to go to the bathroom. The urgent need to urinate can occur at night.
  • Mixed  : combination of symptoms of stress urinary incontinence and emergency urinary incontinence to varying degrees.
  • Overflow ( overflow )  : Small amounts of urine escape several times throughout the day. Urination (the action of urinating) begins with difficulty. The flow is weak and often leaves the impression that the bladder is not empty. The need to urinate is also apparent during the night.
  • Functional  : losses related to difficulty moving quickly.
  • Total  : constant losses, day and night.

Note. When urine loss is accompanied by pain or burning sensation during urination, urine changes color and odor, and urges to urinate frequently, it is possible that urinary tract infection is involved. See a doctor.

People at risk for  Urinary incontinence

  • The women run 2 times more likely to suffer from incontinence than men because of their anatomical characteristics, pregnancy, childbirth and menopause.
  • The elderly may gradually become incontinent because the muscles pelvic floor lose their tone. In addition, they are increasingly exposed to neurological disorders.
  • The people with diabetes.

Risk factors

  • Physical inactivity.
  • Obesity. Excess weight causes constant pressure on the bladder and pelvic floor muscles, which weakens them.
  • Smoking. A chronic cough can cause or aggravate urinary incontinence.
  • Anxiety.

Prevention of urinary incontinence

Basic preventive measures

Keep or regain a healthy weight

This avoids the constant pressure that the excess weight exerts on the bladder and the muscles around it. To know your body mass index, do our test: Body Mass Index (BMI) and waist measurement .

Strengthen the pelvic floor muscles

Pregnant women have an interest in practicing Kegel exercises (refer to the Treatments section) to prevent weakening of the pelvic floor muscles. As a result of delivery, those with urinary problems should also do these exercises and, if necessary, undertake pelvic floor rehabilitation (also known as perineum) at a physiotherapist or specialized physiotherapist.

Prevent and treat prostate disorders

Prostatitis (inflammation of the prostate), benign prostatic hypertrophy or prostate cancer can cause incontinence.

  • Prostatitis can be prevented by using the condom (or condom) and quickly treating any urinary or genital infections.
  • As soon as there are difficulties in urinating (for example, difficulty urinating or reducing the urinary flow) or, on the contrary, urgent and frequent urination (for example, getting up at night to urinate) ), you need to be examined to see if you have benign prostatic hypertrophy . Various treatments (drugs and plants) can be used.
  • In the case of prostate cancer, incontinence can result directly from the disease. However, most often, it is an undesirable effect of the treatments, such as surgery or radiotherapy.

No smoking

A chronic cough may cause occasional incontinence or aggravate existing incontinence related to other causes.

Prevent constipation

In both men and women, constipation can cause incontinence. With the rectum behind the bladder , blocked stools can exert pressure on the bladder, causing urine loss.

Monitor your medication

Medications in the following categories may cause or aggravate incontinence: antihypertensive medications, antidepressants, heart and cold medications, muscle relaxants, sleeping pills. Discuss with your doctor.

Measures to prevent aggravation

Drink properly

Reducing the amount of fluids that are consumed does not eliminate incontinence. It is important to drink enough , otherwise the urine becomes very concentrated. This can irritate the bladderand trigger urge incontinence (emergency incontinence). Here are a few tips.

  • Avoid drinking a lot in a short time .
  • In case of nocturnal incontinence, reduce liquid consumption in the evening .
  • Do not drink too much in risky circumstances (away from home, away from toilets, etc.).

Beware of irritating foods

This measure is for people with emergency urinary incontinence.

  • Reduce the consumption of citrus fruits and citrus juices (eg orange, grapefruit, tangerine), chocolate, drinks containing sugar substitutes ( diet drinks ), tomatoes and spicy foods, which are among irritating products for the bladder. They stimulate his contraction.
  • Reduce or avoid the consumption of alcohol .
  • Reduce or avoid the consumption of coffee and other caffeinated beverages (tea, cola) as they irritate the bladder.

Prevent urinary tract infections

A urinary tract infection in someone with or immediately approaching urinary incontinence can cause urine loss. Better to prevent urinary tract infections or treat them quickly.

Medical treatments for urinary incontinence

It is important to consult a doctor in case of symptoms that are similar to urinary incontinence. Once diagnosed, other health professionals can offer helpful help. It may be an incontinence nurse consultant or a physiotherapist specialized in bladder rehabilitation. A list of incontinence professionals in Canada is available on the website of the Continence Care Foundation .

The treatment varies depending on the cause and the severity of the urinary incontinence . If necessary, it is necessary, of course, to cure the disease that causes incontinence, in addition to treating the symptoms.

Food

See the Prevention section for more information on foods to reduce or avoid.

Behavioral techniques

These techniques generally require the accompaniment of a physiotherapist or a physiotherapist or a nurse . Some specialize in incontinence problems.

Kegel exercises

This recognized practice improves the tone of the pelvic floor muscles (perineum). Both women and men can use it in case of stress incontinence or urgency.

The exercises should be done regularly for several weeks to give a beneficial result. 40% to 75% of women who go to court noted an improvement in their control urinary. In the case of men, this practice is mainly used after removal of the prostate (prostatectomy).

Note. By strengthening the pelvic floor muscles, Kegel exercises can also enhance sexual pleasure .

How to practice Kegel exercises 
In the beginning, practice these exercises while lying on the back, knees bent and slightly apart (at the width of the pelvis). Once mastered, start sitting them up and then stand up.

– Contract the pelvic floor muscles by holding the contraction for 5 to 10 seconds . (Make sure you get the right muscles!) You need to feel the contraction of the muscles around the vagina or penis, as if to hold back urine or stool. (Caution: do not contract the muscles of the belly and buttocks.)
– Breathe calmly during the contraction.
– Release the contraction for 5 to 10 seconds .
– Repeat the contraction and relaxation cycle 12 to 20 times.
To practice 3 times a day, ideally in the morning, the afternoon and the evening.

For more information, see the information sheet produced by the Continence Foundation (Sites of Interest section).

biofeedback

Biofeedback can help women feel the contractions of their pelvic floor muscles better and control them better. This technique allows visualizing on a computer screen contraction and relaxation of muscles during the practice of Kegel exercises. This visualization, which is done with a sensor placed in the vagina, leads to become aware, in a very precise way, the intensity of a contraction and its duration.

Bladder rehabilitation

This can be done in different ways, depending on the type of urinary incontinence .

  • We can delay urination . At first, when the urge to urinate is felt, we try to wait 10 minutes before relieve themselves. This time is then increased to 20 minutes, the goal being to space urination by at least 2 hours (maximum 4 hours).
  • In the case of incontinence by overflow, one can practice the exercise of the double emptying . It consists of urinating and then trying again a few minutes later. It allows you to learn how to empty your bladder better to avoid overflow of urine.
  • We can adopt a fixed schedule. It’s about going to the bathroom at a set time, rather than waiting to feel like urinating. The goal is to space urination by at least 2 hours and up to 4 hours. This practice is very important and often effective in older people with mobility issues.
  • To control the urgent need to urinate, it can be relaxing by taking a few deep breaths. One can also distract one’s attention by taking care of oneself: by reading, by doing crossword puzzles or dishes, for example.

electrostimulation

Electrostimulation, or electrical stimulation, involves inserting an electrode into the vagina or anus to stimulate and tone the pelvic floor muscles. By associating this method with biofeedback, one can visualize muscular contractions on a computer screen. This allows them to feel better, so that they can control them. This approach is usually reserved for people for whom behavioral techniques are ineffective.

Medication

Some medications can reduce contractions of the bladder . They are therefore useful in cases of emergency urinary incontinence  : oxybutynin (Oxybutynin and Ditropan, for example), flavoxate (Urispas) and tolterodine (Detrol). One of their side effects is dry mouth, which can cause patients to drink more. There are various ways to mitigate them. Discuss with your doctor.

Local estrogen therapy may help reduce symptoms for some women during menopause . The application of estrogen is done in the vagina as eggs (for example, Vagifem), rings (Estring) or cream. The doses of hormones used are very small in the case of eggs and rings. They are a little higher for cream, which sometimes requires the use of a progestin (eg Provera) to reduce the risks associated with long-term hormone therapy. For more information, see our Menopause fact sheet.

Other drugs may be used to treat the disease that causes urinary incontinence, for example, antibiotics in case of urinary tract infection.

Various devices and accessories

External devices

– Absorbent pads

– Adult diapers

– Devices for collecting urine (men)

– Protective underwear

Internal features

They are often used as a last resort.

– Catheter. It is a flexible and very thin tube connected to an external bag. The tube is inserted into the urethra, allowing the urine to drain into the bag. In some cases, patients can learn how to insert and remove the catheter (3 or 4 times a day), which avoids wearing a bag permanently.

Pessary. The doctor introduces a rigid ring into the vagina to hold the bladder in place and prevent it from descending. It is useful for women who have a bladder descent.

Surgery

In many cases, surgery may be required. In women, it is most often used to hold the bladder in place or up when bladder descent, by an intervention called cystopexy .

One can also:
– operate a bladder tumor, a uterine fibroid, a urogenital fistula or a tumor of the prostate;
– put in place a device for suspension of the bladder neck and bladder in women;
– install an artificial urinary sphincter (especially in men);
– install a device that stimulates the sacral nerve (nerve located behind the sacrum).

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