WHAT
Urinary incontinence is defined as the involuntary leakage of urine.
It is:
- Very common.
- Underdiagnosed
- Undertreated
- Has intense social stigma attached to it.
There are four different categories of incontinence:
- Stress Incontinence
This means involuntary leakage of urine when a person coughs/ sneezes/ jumps/ dances/ lifts heavy weights or strains due to constipation or any other reason.
This usually happens when the person is awake and walking around.
2) Urge Incontinence
In this condition, the person experiences a sudden urge and intense sensation to urinate. When they go to the bathroom, they may urinate a lot or a little. The sensation may linger even after they have urinated.
Sometimes there can be chronic pain in the pelvic region associated with this.
If the person is unable to reach the bathroom in time, then they make experience leakage, hence the term “urge incontinence”.
This can happen during waking hours but can also happen while sleeping (bedwetting) or can wake the person multiple times at night (nocturia).
3) Mixed Incontinence
This term implies a combination of stress and urge incontinence in the same person.
4) Neurogenic bladder (overflow incontinence)
This means that the bladder cannot sense its fullness. As a result, it gets really full and then the urine is forced to trickle out of the urethra because the bladder gets ballooned and full. The bladder muscles have very weak or no muscle tone due to which the bladder muscle is unable to contract properly to allow adequate urination and bladder emptying.
WHO
Any woman can be afflicted with any one or a mix of the above conditions.
- Nearly 50% of adult women suffer from this.
- Only 25-35% actively seek care.
WHY
There are a variety of reasons that can lead to incontinence. We can break it down by the types here.
Stress Incontinence
- Child birth
- Overweight or obesity
- Straining – lifting heavy weights, specially seen in weight lifters, cleaners, stocking personnel.
- Cough – Chronic cough due to asthma, COPD or medications.
- Constipation – Chronic straining
- Menopause – Lack of estrogen after menopause leads to loss of muscle tone and elasticity of the urethral and the bladder muscles leading to stress incontinence
- Congenital weakness of the pelvic floor due to tissue disorder – Unknown genetic defects can sometimes cause the pelvic floor tissues to lose their tone and elasticity.
- Acquired weakness of pelvic floor – This can happen due to any of the above reasons.
- Unexplained
Urge Incontinence
This occurs due to Bladder muscle overactivity or dysfunction which can be attributed to any of the below causes.
- Age – menopause.
- Diet – spicy, irritant diet, lack of water.
- Lifestyle – holding the urine for long times can lead to the bladder getting “angry” and not responding to the regular signals of urination.
- Stress – Stressful life can lead to the bladder indirectly receiving conflicting signals since the bladder muscle are under the influence of a complex nervous networks that are controlled by our autonomic nervous system.
- Unexplained
Mixed Incontinence
This is combination of stress and mixed incontinence.
- Can occur due to a mix of the above factors.
Neurogenic bladder
This can occur to any condition interrupting or disrupting the nervous pathways to and from the bladder.
- Diabetes
- Trauma
- Cancer
- Drugs/ medications
- Unknown
WHEN
- Post menopausal
- Post partum
- Any age
Although it is more common in post-menopausal women, it is also common in the post-partum period but rarely talked about.
This can also happen in younger women without a history of child birth so do not ignore this important question when dealing with any person of any age.
HOW
How can it be fixed?
Stress Incontinence
1a) Pelvic floor physical therapy
- Self directed: Kegels or self-use devices.
- Biofeedback therapy administered by a clinician: This allows the patient to see and sense the specific muscles that require exercise through a feedback system and thus allows them to learn to use the correct muscles that need strengthening.
Properly administered and ongoing physical therapy has a success rate from 75-85% depending on the severity of the condition.
1b) Surgery
Surgery for stress incontinence mostly involves a vaginal approach.
Bladder Neck Sling Procedure: A small tape may be placed to help elevate the neck of the bladder back to the correct spot to allow the urine to be controlled better.
Anterior Colporrhaphy: Additional tightening of the pelvic floor muscles can be done as well.
Surgery has a 80-85% success rate depending on many patient factors.
1c) Laser treatment
Some studies have shown that focused laser treatment of the urethral tissues may help increase the tone of the urethral or pelvic floor muscles. The data and long-term efficacy is controversial.
1d) Injectable thickening devices
Urge Incontinence
- Diet changes*
- Lifestyle modification*
- Medications.
See the bladder diet and lifestyle handout.
Mixed Incontinence
- Physical therapy/ surgery + diet/ lifestyle/ medications
Neurogenic Incontinence
- Treatment of the cause
- TENS or bladder retraining devices
- Intermittent catheterization.
Additional considerations:
- Local vaginal/ vulval estrogen treatment may be needed in postpartum and postmenopausal women or anyone else experiencing vulvo-vaginal atrophy due to lack of estrogen.
- Weight loss.
- Relief of Constipation.
- Relief of chronic cough.
- Avoidance of heavy strenuous activities post-surgery or post treatment will increase the success rate of the treatment.
- Rule out Urinary tract infections
- Rule out interstitial cystitis.
If these factors are not attended to then surgery, therapy or medications will not work.
If you have any questions or concerns, or want to schedule an initial consultation, please reach out to your friendly team at contact@walkingyn.com or schedule an appointment online at https://walkingyn.com/ or just walk in :))
#walkingyncare #womenempowered
Be safe, be strong and be prepared.
Dr. Adeeti Gupta