Types of urinary incontinence

There are varying degrees of urinary incontinence, mild losses when the person laughs at the urge to urinate to the point where they can not wait until they get to the bathroom.

In women, this problem can also be juvenile (for example at age 30) due to a childbirth or it can happen in  menopause , while in men one of the causes is  prostate surgery .

In some cases, incontinence is stabilized, for example in menopause , while in others it may be a transient disorder (postpartum or after prostatectomy surgery in man).

 

Stress urinary incontinence

Stress urinary incontinence is observed when a person sneezes, coughs, laughs, or lifts heavy objects.
This type of problem is occasional and especially diurnal  because it is caused by some actions of the individual.
It occurs when the sphincter muscle in the bladder :

  • Is weak,
  • Can not control the flow of urine; if weakness is mild the person loses only a few drops.

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

  • Part,
  • Obesity ,
  • Prostate surgery.

The sphincter muscle is a circular muscle that:

  • Normally it keeps closed a hole or a natural passage of the body,
  • Relaxed to allow normal physiological functions.

 

Urinary incontinence of urgency

In case of sudden need to urinate that occurs in the middle of daily activities and the person loses urine before reaching the bathroom, the person suffers from urge incontinence.
The bladder muscle (detrusor) contracts and signals the need to urinate even if the bladder is not full.
This disease is very serious because the bladder gives the person only a few seconds notice before they lose control.
It may be due to:

It is also called an overactive bladder.

Overflow incontinence

When the bladder can not completely empty, a continuous drip of urine may occur.
This type of incontinence is common among women who have a bladder damaged or in men with prostatic hyperplasia .
Among the causes are:

  • Diabetic neuropathy,
  • A spinal cord injury .

Mixed incontinence

As the name says, if a person has more than one type of incontinence (such as effort and urgency together) it is said that the individual suffers from mixed incontinence.
One cause of mixed incontinence may be:

  • An illness, for example thyroid problems and diabetes (which is not under medical observation),
  • Medications, for example diuretics .

 

Functional incontinence

This type has more to do with the loss of bodily functions and mainly affects the elderly (senile incontinence).

For example:

  • A person who is not aware of the need to go to the bathroom.
  • Although it is primarily associated with age, this type of incontinence can also affect people suffering from paralysis or a physical disability that causes difficulty in going to the bathroom.

Bedwetting

Night enuresis is a typically childhood illness.
Commonly known as “bed wetting”, it refers to involuntary urination at night.
Although it is seen more often in children, there may be rare cases in which it can also affect adults.
Sometimes children up to 12 years old may suffer from this disease, which usually goes by itself.
2 to 3% of adults suffer from nocturnal enuresis problems.

 

Total incontinence

In this type of incontinence, the bladder does not work.
This is due to different reasons such as, for example:

  • Spinal cord injury – this affects the nerves that control the bladder,
  • Vesico-vaginal fistula – an abnormal canal between the bladder and the vagina.

 


Loss of urine during pregnancy

As already mentioned, the loss of urine during the initial pregnancy is very rare.
However, this stage is characterized by increasing vaginal secretions .
Therefore, it is likely that many women find that thin, viscous vaginal discharge is urine.
This misconception can be very dangerous because loss can be the sign of an infection .

However, it  should  be possible to distinguish whether the loss is due to vaginal discharge or urine by the smell.
Any kind of bacterial or fungal infection usually gives off a bad smell .
When there is suspicion of an infection, first of all the woman should be treated by a doctor.

Sometimes the loss can be totally harmless and can be the consequence of increased hormonal activity.

Loss of urine during the advanced stages of pregnancy
With the advancement of pregnancy, the size and weight of the fetus increase.
The uterus continues to expand to accommodate the growth of the baby.
This exerts heavy pressure on the bladder, causing an accidental loss of urine.
Sometimes the child can kick the bladder by dripping some urine.
These situations are perfectly normal.
However, in the latter stages of pregnancy there is also the possibility of loss of amniotic fluid.

 


Incontinence after prostate surgery

The prostate gland is responsible for the secretion of a slightly alkaline liquid which constitutes 25-30% of the seminal fluid volume.
The prostate cancer is one of the most frequent types of cancer observed in men.
When this tumor is identified, it is cured:

  • With the help of radiotherapy ,
  • Through a surgical removal of the prostate.

When the prostate is removed surgically, many side effects can occur.
One is incontinence, visible in almost three men out of ten who have undergone prostatectomy.

 


Diagnosis and exams for urinary incontinence

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

1. Electromyography : this is the study of nerve conduction.
2. Fluxometry : it is used to evaluate the relationship between the volume of urine expelled per unit of time.
3. Cystomanometry: is used to analyze the pressure inside the bladder during filling.
4. Urethral pressure profile: is the measurement of pressure on the urethra at rest and during an exertion.

 


Treatment for Male Urinary Incontinence

The options for treatment for the inability to control the release of urine after surgical removal of the prostate are different .
Most doctors prefer to start with techniques that help train men to control the flow of urine.
There are some exercises (known as Kegel exercises ) that help strengthen the muscles used to stop the flow of urine.

There are many other preventative measures that can be taken, including avoiding diuretic substances such as caffeine, alcohol, beverages etc.
It also helps to avoid drinking liquids before going to bed.

If supportive measures are not enough, it is possible to prescribe medications that act:

  • By increasing bladder capacity,
  • Decreasing urination frequency.

Surgery should be chosen only if the other treatment options for urinary incontinence after prostate surgery fail.

During surgery for incontinence, it is possible to insert an artificial sphincter that is very efficient in controlling the flow of urine.
In some cases, it is possible to use a band under the urethra (Sling Screen).


Female urinary incontinence by effort

In women, stress incontinence occurs mainly due to weakening of the pelvic floor muscles, usually due to labor.
The pelvic floor muscles are present below the rectum and bladder.
In addition, it most commonly occurs with advancing age (especially after menopause ) because the muscles continue to become weaker and weaker.
Overweight women are very prone to suffer from this disease.
Another cause of female stress incontinence is hysterectomy .

 


Exercising to strengthen the pelvic floor

First of all it is necessary to exercise the right muscles. The doctor may advise the person to seek a physiotherapist for guidance on how to do the exercises for incontinence.

The following tips explain the steps of the exercises in detail:

  • Begin sitting on a chair with your knees slightly apart.
  • Try not to move your legs or hips.
  • Then try to imagine urinating and try to stop the flow.
  • Here you strengthen the front muscles.

It is necessary to do these exercises every day.
After a few weeks you may notice that the pelvic floor muscles become stronger.
It takes 8 to 20 weeks.
It is advisable to continue doing these exercises for the rest of your life.

Vaginal Cones
It is also possible to use the vaginal cones to help strengthen the pelvic floor muscles.
The vaginal cones are light weights inserted into the vagina, cone-shaped.
The woman’s position is standing with her legs slightly apart.
The patient maintains these weights in position using the pelvic floor muscles.
When possible, the woman uses another heavier vaginal cone.

 

Medical / pharmacological therapy for urinary incontinence

Among the medications prescribed for urinary incontinence are:

  • Alfabloqueadores – In men with incontinence due to overflow or urgency, these drugs relax the muscles of the bladder and the muscle fibers of the prostate, favoring also the emptying of the bladder.
  • Anticholinergics – These medications serve for urge incontinence because they can reduce bladder muscle activity.

If incontinence is neurological (for example in case of multiple sclerosis), it may be caused by detrusor muscle hyperactivity.
In these cases, the physician may recommend intravesical infiltration with botulinum toxin that reduces muscle contractility.

 


Objects that help against urinary incontinence

  • Adult diapers: They can be male or female and are useful when the person is in a place without a toilet for long periods. For example, it can be used during a trip.
  • Pessaries: are only available for women. They are made of latex or silicone and are placed in the vagina to provide support for the bladder. Only a medical professional can insert this instrument into the vagina; a woman can not do it alone.

 


Natural Remedies and Solutions for Male or Female Incontinence

Electrical stimulation
If a patient is unable to contract the pelvic floor muscles, the use of an instrument that measures and stimulates the electrical impulses in the muscles: the electro-stimulator may be recommended .
This treatment is called electrical stimulation.
In women, a small catheter is inserted into the vagina, while in men it is inserted into the anus.
The instrument emits a small electric shock through the catheter that strengthens the pelvic floor muscles.

The biofeedback is a therapy that involves measuring the muscle contraction.
It is made with a device that shows the intensity of the muscles effort by  lighting some  colored lights .

Bladder Rehabilitation Bladder
training includes learning techniques to increase the time between:

  • The need to urinate,
  • The exit from the urine.

The course usually lasts at least 6 weeks.
If the patient has memory problems (eg dementia), they may receive specific training to avoid urine leakage.
This may involve the need for a particular nurse to remind the patient to go to the toilet at fixed times.

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