Urinary incontinence

Urinary incontinence is the inability to control urine leakage.


Types of urinary incontinence

There are different degrees of urinary incontinence, from mild loss of urine when laughing to the urge to urinate, which cannot be restrained until reaching the toilet.

In women, this problem can occur at a young age (for example, at the age of 30) due to childbirth or as a result of menopause, while in men, surgery of the prostate is often the cause.

In some cases, the problem persists, for example during menopause, while in other cases it is a temporary disorder (after childbirth or after a prostatectomy in men).

Stress incontinence

Stress incontinence is observed when sneezing, coughing, laughing or carrying heavy loads.

This type is an occasional disturbance, especially during the day and caused by certain actions of the person concerned.

It happens when the sphincter of the bladder:

  • is weakened,
  • Can not control the urine. If this weakness is low, you only lose a few drops.

The cause of stress incontinence is physical, not psychological, for example:

  • Birth
  • Overweight
  • Surgical intervention on the prostate.

The sphincter is a ring-shaped muscle that:

  • Normally keeps an opening or natural passage in the body closed,
  • Relaxes according to normal physiological functions.

Urge incontinence

If you feel an urgent need to urinate that cannot be kept under control until a toilet is reached, you suffer from urge incontinence.

The muscle of the bladder (detrusor) contracts indicates a need for micturition, even if the bladder is not filled.

This disorder is to be taken seriously, because the bladder leaves the person concerned only a few seconds of warning before losing control.

This can be due to the following reasons:

  • Urinary tract infection
  • Neurological diseases such as multiple sclerosis, spina bifida, Parkinson’s, Alzheimer’s
  • Stroke
  • lesions of the central nervous system.

This disorder is also called overactive bladder.

Overflow incontinence

If the bladder cannot empty completely, this leads to constant dripping of urine.

This type of incontinence is common in women who have a damaged bladder or in men with prostate enlargement.

Causes include:

  • diabetogenic neuropathy,
  • An injury to the spinal cord.

Mixed incontinence

As the name suggests, if a person does not suffer from just one type of incontinence (such as stress incontinence and urge incontinence together), then it means that they suffer from mixed incontinence.

One cause of mixed incontinence can be:

  • A disease, for example, problems with the thyroid gland and diabetes (which is not under medical observation),
  • Medications, for example, diuretics.

Functional urinary incontinence

This species has more to do with the loss of bodily functions. Older people in particular suffer from this (senile incontinence).

For example:

  • A person who is not aware of having to go to the toilet.
  • Even though this is mainly related to age, this type of incontinence could also affect people who suffer from paralysis or are physically disabled, making it difficult to go to the toilet.

Enuresis nocturna

Enuresis nocturna is a typical infantile disorder.

Commonly known as bedwetting, this refers to involuntary urination during the night.

Although it is mainly observed in children, isolated cases can also occur in which adults are affected.

Sometimes children suffer from this disorder up to the age of 12, usually it subsides on its own.

Between 2 and 3% of adults suffer from bedwetting problems.

Complete incontinence

With this type of incontinence, the bladder does not work.

There are several reasons for this, such as:

  • Spinal cord injuries – These affect the nerves that control the bladder,
  • Bladder-vaginal fistula – An abnormal canal between the bladder and vagina.

Urine loss during pregnancy

As already indicated, urine loss in early pregnancy is very rare.

Nevertheless, this phase is characterized by increasing vaginal secretion.

So this is a problem that many women think that a fine and slimy discharge could also be drops of urine.

This misinterpretation can be dangerous, because the discharge could also be a sign of infection.

One should be able to determine from the smell whether the leaking secretion is discharge or urine.

Any kind of bacterial or yeast infections leaves a very bad smell.

If an infection is suspected, it is especially important to be treated by a doctor.

Sometimes vaginal discharge can be completely harmless and a consequence of increasing hormonal changes.

Urine leakage during advanced pregnancy

As pregnancy progresses, the size and weight of the fetus increase.

The uterus expands and adapts to the size of the child.

This exerts strong pressure on the bladder and causes accidental leakage.

Sometimes the child kicks the bladder during his movements, so a little urine shoots out.

These situations are perfectly normal.

Nevertheless, it is also possible that amniotic fluid leaks in the last phase of pregnancy.

Urinary incontinence after prostate surgery

The prostate gland is responsible for the secretion of a slightly alkaline fluid. This accounts for about 25-30% of the seed volume.

One of the most common cancers seen in men is a tumor of the prostate.

If such a tumor is diagnosed, treatment is carried out:

  • With the help of radiotherapy,
  • By surgical removal of the prostate.

If the prostate is removed, many side effects can occur.

One effect is urinary incontinence in about three out of ten men who have undergone a prostatectomy.

Diagnosis and examination of urinary incontinence

The urologist may order diagnostic tests to determine the cause of urinary incontinence and its severity, for example:

  1. Electromyography: This is an examination of nerve conductivity.
  2. Uroflowmetry: Used to determine the amount of urine expelled per unit of time.
  3. Cystomanometry: Used to analyze the pressure inside the bladder during filling.
  4. Sphincterometry: Pressure determination in the urethra at rest and under stress.

Treatment of male urinary incontinence

The therapeutic options for controlling urinary leakage after prostate surgery are diverse.

Most doctors initially prefer training behavioral techniques that help control urine leakage.

There are exercises (known as Kegel exercises) that are used to strengthen the muscles to stop the flow of urine.

There are many other preventive measures that can be considered, including restricting diuretic substances such as caffeine, alcohol, beverages, etc.

It also helps not to drink anything before bedtime.

If supportive measures are inadequate, medications may be prescribed to:

  • increase bladder capacity,
  • Reduce the frequency of micturition.

An operative procedure is only chosen if all possibilities to cure urinary incontinence after prostate surgery fail.

During the operation for urinary incontinence, an artificial sphincter can be applied, which very reliably takes over the control of the flow of urine.

In some cases, a suburethral loop (a ligament that supports the urethra) may be inserted.

Stress incontinence in women

In women, stress incontinence occurs mainly due to sagging pelvic floor muscles, usually as a result of the birth of a child.

The pelvic floor muscles are located below the rectum and bladder.

This disorder is more common with age (especially after menopause) because the muscles become progressively weaker.

Overweight women are also much more susceptible to suffering from this condition.

Another cause of female stress incontinence is surgical removal of the uterus.

Pelvic floor strengthening exercises

Above all, it is important to train the muscles correctly. The doctor can send the patient to a physiotherapist or incontinence consultation so that she can learn how to perform the appropriate exercises.

The following steps are explained in detail:

  • Start sitting on the chair and keeping the knees slightly apart from each other.
  • Try not to move the legs and hips.
  • In the next step, imagine urinating and at the same time trying to stop the flow of urine.
  • Here the anterior muscles are strengthened.

It is important to do these exercises daily.

After a few weeks, you can observe that the pelvic floor muscles have become much stronger.

It takes about 8 to 20 weeks until a significant improvement.

It is recommended to perform this exercise throughout one’s life.

Vaginal cones

You can strengthen your pelvic floor muscles with the help of vaginal cones.

Vaginal cones are light weights inserted into the vagina that have the shape of a cone.

The woman stands upright with her legs slightly apart.

The patient holds this weight in its position by using the pelvic floor muscles.

As soon as possible, the woman switches to a vaginal cone with greater weight.

Medical/pharmacological therapy for urinary incontinence

Medications prescribed for urinary incontinence include:

  • Alpha-blockers – In men with overflow bladder or sudden urge to urinate, this medication has a relaxing effect on the bladder muscles and muscle fibers of the prostate, as well as supporting bladder emptying.
  • Anticholinergics – These drugs help with urinary urgency incontinence because they decrease bladder muscle activity.

If urinary incontinence is of neurological origin (for example, in the case of multiple sclerosis), overactivity of the detrusor muscle may be the cause.

In these cases, the doctor may recommend infiltration of the bladder with botulinum toxin, thereby reducing muscular contractility.

Products to help with urinary incontinence

  • Diapers for adults: They can be used by men and women if you stay for a long time in a place without a nearby toilet. They can be used, for example, during a trip.
  • Pessaries: These are only to be used by women. They are made of latex or silicone and are positioned in the vagina to support the bladder. Only a doctor can insert this into the vagina, the woman cannot do it herself.

Natural remedies and solutions for urinary incontinence in men and women

Electrical stimulation

If a patient is unable to contract the muscles of the pelvic floor, it may be recommended to use an instrument that measures and stimulates the electrical impulses in the muscles: the electrostimulator.

This treatment is called electrical stimulation.

In women, a small tube is placed in the vagina, while in men it is inserted in the anus.

There is a small electric shock via the probe, which strengthens the pelvic floor muscles.

Biofeedback is a therapy that consists of measuring muscle contraction.

It is done by a device that indicates the intensity of muscle strength through colored light.

Bladder rehabilitation

Bladder training involves learning techniques to extend the time between:

  • urge to urinate and urinate,

A course usually lasts at least 6 weeks.

If the patient has memory problems (for example, in dementia), he receives special training to prevent involuntary urination.

This can involve a caregiver who reminds the patient to go to the toilet at certain times.

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