Definition of Urinary Incontinence: Types, Causes, Diagnosis, Treatment and Perspectives

What is urinary incontinence in men and women?

Incontinence is an uncontrollable and involuntary loss of urine in the bladder.

Who does it affect?

It is more common in the elderly because of the deficiency of the sphincter muscles (which act as an outflow regulation valve) that surrounds the urethra (the tube through which urine is excreted from the bladder), which decreases with the age. Women are more affected than men.

Are there different types of urinary incontinence?

Stress incontinence is the involuntary escape of a small amount of urine when a person sneezes, coughs, laughs, or forces to pick up a heavy object. It is common in women, especially after delivery when the sphincter muscles are stretched.

Urge incontinence:  is the urgent need to urinate, which is accompanied by an inability to control the bladder while contracting. Once the urination begins, it continues until the bladder is empty. It is often triggered by a sudden change in your position.

Total or complete incontinence: is the lack of control of the bladder caused by the total absence of sphincter activity.

Overflow incontinence: occurs in chronic urinary retention (the individual is unable to empty the bladder normally, often due to an obstruction, such as an enlarged prostate). The bladder is always full, so there is constant dripping due to the abundance of urine.

What causes urinary incontinence?

  • Urinary tract disorders, such as infections or bladder stones.
  • In women, the prolapse (displacement of their normal position) of the uterus or vagina.
  • Damage to the brain or spinal cord.
  • Feelings of anxiety, stress or anger
  • A pelvic fracture or weak pelvic muscles.
  • Irritable bladder: the intermittent bladder muscle contracts and increases the pressure in the bladder to push the urine out of the urethra, causing an intense desire to urinate.
  • Disorders of the central nervous system: for example, cerebrovascular accident or Parkinson’s disease.

How is it diagnosed?

  • Urinalysis ( urine test). This is done in order to eliminate the possibility of infection, inflammation, diabetes mellitus or protein loss.
  • Ultrasound and radiography: these are used to investigate the possibility of an obstruction.
  • Cytometry (measurement of pressure in the bladder). Check if the bladder is functioning normally or if there are abnormalities of the nerves that innervate it.
  • Cystoscopy (examination of the urethra and bladder through a visualization instrument). They are the controls to detect the presence of stones in the bladder, or cysts.

Treatment for urinary incontinence

If weak pelvic muscles are the cause, pelvic floor exercises can help restore the sphincter muscle. In some cases an operation can be performed to tighten or lengthen the urethra. Anticholinergic drugs can be used to relax the irritable bladder muscle if it is found to be the cause.

Special incontinence underwear (with an inner pad to absorb urine) can be used if normal control of the bladder can not be restored. Men can use a penis sheath that leads to a tube connected to a portable urine bag.

In the most severe cases, when all other treatments have failed, your doctor may suggest urinary catheterization (a tube inserted into the bladder to drain urine) or a urinary diversion operation (to bypass the bladder).

What can I do about incontinence?

  • Do not hold urine. Go when you feel the need.
  • Practice good genital hygiene.
  • Plan a schedule to empty the bladder.
  • Keep a diary of fluid intake and urination.
  • Lose weight if you are overweight.
  • Do not drink too much liquid in situations where access to a bathroom is limited.

What are the perspectives?

Most people with incontinence can be helped and even in chronic cases it can often be cured.