| Urinary Incontinence |
Article Index for Urinary |
Website Links For Urinary |
Information AboutUrinary Incontinence |
| CATEGORIES ABOUT URINARY INCONTINENCE | |
| urology | |
Urinary incontinence: unintentional loss of urine. Inability to hold urine in the Bladder due to loss of voluntary control over the urinary sphincters resulting in the involuntary passage of urine. It is often temporary, and it almost always results from an underlying medical condition. In this article, the term "incontinence" will be used to mean urinary incontinence. See also Fecal Incontinence . PHYSIOLOGY OF CONTINENCE Continence and Micturition involve a balance between Urethral closure and Detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intraabdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence. Normal voiding is the result of changes in both of these pressure factors:urethral pressure falls and bladder pressure rises. TYPES Stress incontinence Stress urinary incontinence (SUI) is essentially due to pelvic floor muscle weakness. It is loss of small amounts of urine with coughing, laughing, sneezing, exercising or other movements that increase intraabdominal pressure and thus increase pressure on the bladder. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence, and in men it is a common problem following a Prostatectomy . It is the most common form of incontinence in men and is treatable. The urethra is supported by Fascia of the pelvic floor. If the fascial support is weakened, as it can be in pregnancy and childbirth, the urethra can move downward at times of increased abdominal pressure, resulting in stress incontinence. Stress incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause, similarly because of lowered estrogen levels. LABS Urine analysis, cystometry and postvoid residual volume are normal. Urge incontinence or Hypertonic Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence is involuntary and inappropriate detrusor muscle contractions. ''Idiopathic Detrusor Overactivity'' - Local or surrounding infection, inflammation or irritation of the bladder. ''Neurogenic Detrusor Overactivity'' - Defective CNS inhibitory response. Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Urge incontinence may also be called "reflex incontinence" if it results from overactive nerves controlling the bladder. Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running (as when washing dishes or hearing someone else taking a shower). Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's Disease, stroke, and injury--including injury that occurs during surgery--can all harm bladder nerves or muscles. Functional incontinence Functional incontinence occurs when a person does not recognize the need to go to the toilet, recognize where the toilet is, or get to the toilet in time. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity, unwillingness to toilet because of depression, anxiety or anger, or being in a situation in which you are unable to reach a toilet. 1 People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer's Disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly women and men in nursing homes. Overflow incontinence or Hypotonic Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have passed urine. It is as if their bladders were like a constantly overflowing pan - hence the general name overflow incontinence. Overflow incontinence occurs when the patient's bladder is always full so that it frequently leaks urine. Weak bladder muscles, resulting in incomplete emptying of the bladder, or a blocked urethra can cause this type of incontinence. Autonomic Neuropathy from diabetes or other diseases (e.g Multiple Sclerosis ) can decrease neural signals from the bladder (allowing for overfilling) and may also decrease the expulsion of urine by the Detrusor muscle (allowing for urinary retention). Additionally, tumors and Kidney Stone s can block the urethra. In men, Benign Prostatic Hypertrophy (BPH) may also restrict the flow of urine. Overflow incontinence is rare in women, although sometimes it is caused by fibroid or ovarian tumors. Spinal cord injuries or nervous system disorders are additional causes of overflow incontinence. Also overflow incontinence in women can be from increased outlet resistance from advanced vaginal prolapse causing a "kink" in the urethra or after an anti-incontinence procedure which has overcorrected the problem.2 Early symptoms include a hesitant or slow stream of urine during voluntary urination. Anticholinergic medications may worsen overflow incontinence. Other types of incontinence Stress and urge incontinence often occur together in women. Combinations of incontinence - and this combination in particular - are sometimes referred to as "mixed incontinence." "Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow. Incontinence can often occur while trying to concentrate on a task and avoiding using the toilet. DIAGNOSIS Patients with incontinence should be referred to a medical practitioner specializing in this field. Urologist s specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth and some also treat urinary incontinece in women. Family practitioners and internists see patients for all kinds of complaints and can refer patients on to the relevant specialists. A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness. The Physical Examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause. A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles. Other tests include:
Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced. Urinary incontinence in men Men experience incontinence twice as often as women, and the structure of the male Urinary Tract accounts for this difference. But both women and men can become incontinent from neurologic injury, Congenital Defect s, Stroke s, Multiple Sclerosis , and physical problems associated with Aging . While urinary incontinence affects older men more often than younger men, the onset of incontinence is not inevitable with age. Incontinence is treatable and often curable at all ages. Incontinence in men usually occurs because of problems with muscles that help to hold or release urine. The body stores urine - water and wastes removed by the kidneys - in the Urinary Bladder , a balloon-like organ. The bladder connects to the Urethra , the tube through which urine leaves the body. |
|
|