Diagnosis and Treatment for Urinary Incontinence

Diagnosis and Treatment of Urinary Incontinence

The urinary system comprises the kidneys which generate urine, long, thin tubes called ureters that carry the urine from the kidneys to a temporary reservoir called the bladder, and urethra, a thin tube that clears the urine from the bladder to outside of the body. Various muscles regulate the process of urination. Whenever a person has an urge to urinate, the bladder muscles contract, and the sphincter, a ring of muscles that encircles the urethra relaxes and allows the urine to drain. The pelvic floor is a mesh of muscles that supports or holds these pelvic organs in place.

In some people, this seemingly simple activity of urination is disrupted in different ways. The condition is called urinary incontinence (UI) and causes social awkwardness for the person, along with some health complications.

Types of Urinary Incontinence (UI)

There are various types of UI:

• Stress incontinence: The bladder is stressed by actions such as laughing, coughing, sneezing, or lifting heavy weights, causing some urine to leak
• Urge incontinence: The person has a strong urge to urinate, but even before he/she urinates, there is some urine that leaks
• Overflow incontinence: There is a significant amount of urine left in the bladder (a few drops remaining is normal) even after urination, some of which leaks or ‘dribbles’
• Functional incontinence: The bladder function is normal but the person has ailments such as arthritis or Alzheimer’s disease which prevents him from urinating on time.
• Mixed incontinence: When the person has two or more of the above types

Causes and Risk Factors

The UI may be a temporary or persistent problem. Either way, there are various causes and risk factors:

• Foods such as chocolate, artificial sweeteners, spicy foods, and citrus foods
• Consumption of caffeine, alcohol, sodas, energy drinks and sports drinks
• Constipation
• Urinary tract infection
• Medications used to treat hypertension, liver and kidney diseases, diuretics and anti-depressants
• Urinary obstruction due to an enlarged prostate in men, tumour or kidney stones
• Reduced control over bladder muscles due to ageing
• Pelvic floor muscles getting weakened with age
• Pregnancy, child birth and menopause in women
• Pelvic surgeries
• Neurological disorders such as Parkinson’s, Alzheimer’s and multiple sclerosis
• Being overweight
• Physical damage to pelvic floor muscles from a fall, fracture or accident
• Prostatitis or inflammation of the prostate in men
• Stroke
• Diabetes
• Surgery for prostate cancer
• Overactive bladder muscles
• Smoking: Smoker’s cough can aggravate the symptoms of UI

Complications Arising Out of UI

In addition to social withdrawal and restrictions in activities, both of which affect the quality of life, there are health conditions that can develop if UI is untreated for long.

• Urinary tract infections: UTI which is one of the risk factors for UI can also be one of the complications from UI
• Skin conditions: Irregular or disrupted urination can lead to accumulation of toxins in the blood, leading to different kinds of infections, rashes, and skin sores
• For the same reason (toxin accumulation), healing of wounds in patients gets delayed

Diagnosis

• Physical examination: Women are examined for the strength of pelvic floor muscles, while men are examined for enlarged prostate.
• Blood tests: The person’s blood is examined for any chemicals or substances that can trigger UI.
• Urine analysis: A urine sample is checked for traces of blood, indications of any disease and any signs of infection
• An ultrasound of the bladder: This is done to assess if the bladder is being emptied fully or if some urine is still left (called (PVR) post-void residual urine).
• Bladder diary: For about 3 days to a week, the patient must maintain a record of how much fluids were consumed, when and how many times a day the person urinated, the amount of urine passed every time, if there was an urge to urinate soon after, and the number of incontinence episodes.
• Stress test: There is sudden pressure applied on the patient, and the doctor will check if there is any leakage of urine.
• Urodynamic testing: This is a test to evaluate how much stress the bladder muscles and sphincter muscles can withstand. This comprises inserting a tube into the bladder and filling it with a special liquid.
• Cystogram: A dye is injected into the bladder, and when the patient urinates, a series of X-ray images of the bladder are taken which will reveal any abnormalities in the urinary tract.
• Cystoscopy: A thin and flexible tube with a camera fitted on one end (called the Cystoscope) is inserted through the urethra and also into the bladder to get a close look at the inside of your urinary tract.
• Pad test: The patient will be asked to wear a pad and urinate afterwards. Subsequent leakage of urine is caught by the pad, and this is measured.

Treatment

Various options will be applied depending on the person’s gender, age, underlying conditions, and severity of UI.

• Behavioural techniques such as bladder training, double voiding, scheduled toilet trips, and fluid and diet management
• Kegel exercises to strengthen pelvic floor muscles
• Absorbent pads, protective garments and catheters
• Medications such as anticholinergics, mirabegron, alpha blockers and topical estrogen
• Electrical simulation to treat stress and urge incontinence
• Medical devices such as urethral insert and pessary
• Interventional therapies such as bulking material injections, botox injections and nerve simulators
• Surgical procedures such as sling technique, bladder-neck suspension, prolapse surgery and artificial urinary sphincter

Outlook

UI is often treated as an inevitable sign of ageing and is ignored. But this can be dangerous. UI is not necessarily normal with ageing and can be cured if treated on time. If you or your dear ones are showing signs of UI, go to a reputed hospital. Such hospitals have highly qualified urologists and nephrologists on their rolls. These specialists will diagnose your condition precisely and design a course of treatment for quick recovery and rehabilitation

Dr Muruganandham K

HOD & Senior Consultant -Department of urology