Causes and risk factors:
Urinary incontinence occurs due to weak pelvic floor structures or due to weak urethral sphincter. It is commonly seen in women after delivery due to damage to the pelvic floor structures. In men high incidence is seen after prostate surgery. Urinary incontinence called as athlete incontinence occurs in athletes who are engaged in heavy exercises. Diseases of the prostate gland like enlarged prostate or cancer of prostate also lead to incontinence. Over activity of detursor muscle at old age or detursor muscle abnormalities also lead to incontinence. Diseases like spina bifida, multiple sclerosis, spinal cord injury affects the function of the nerve which supply the bladder leading to incontinence. Urinary infection, severe constipation and use of certain medications particularly diuretics are other contributing factors.
Clinical presentations:
The patient complaints of passage of small quantities of urine during activity or during rest. The complaint is aggravated due to activities which cause increase abdominal pressure like coughing, sneezing, or lifting of heavy objects. The patient lacks control to hold the urine there is need to void the urine immediately. Patient passes urine involuntarily this involuntary passage of urine can lead to an embarrassing feeling for people. It can lead to depression in some people.People with associated diseases like severe arthritis feel the problem of incontinence they fail to rush to the toilet due to underlying pathology. Severe constipation and loaded rectum can lead to incontinence.
Diagnosis and investigations:
Symptoms narrated by the patient and the physical examination carried out by the doctor will help to confirm the diagnosis. Stress test is one of the tests conducted in patient for urinary incontinence. Post voidal urine measurement is done. Urodynamic studies are advised .Certain investigations which are done are routine blood test, urine analysis, ultrasonography of the pelvis and abdomen. Cystogram and Cystoscopy are other valuable investigations which are to be done.
Treatment:
Bladder training is the main line of treatment. It consists of training the bladder to hold the urine at least 10 min after the urge. Toilet timing can be scheduled or waiting patiently for complete emptying of bladder are taught. Certain pelvic floor exercises i.e. kegels exercises to strengthen the pelvic muscles are advised. These are exercises which causes repeated contraction and relaxation of the muscles of the pelvic floor. It is done with the help of a pelvic tonic device. In cases which do not respond well to behavioral training and exercises medications are prescribed in such cases. Catheterization and use of absorbent pads or certain devices like pessary, or fixer occlude devices is advised. In cases where incontinence is caused due to diseases like prolapse of pelvic organs or weak sphincter needs to be corrected by surgery. Other surgical procedures like mid urethral slings, bulking around urethra are adopted. In some cases electro nerve stimulation is done.
Other Modes of treatment
The other modes of treatment can also be effective in treating sciatic pain. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating pain. Certain yoga exercises can be helpful in strengthening the muscles of the pelvic floor.
Recent updates:
Medical University of Vienna has published an article stating that proteins in the urine could play an important role in stress incontinence.
Injecting human adipose stem cells in urethra (ASCS) helps in managing of urine incontinence.
