Urinary Incontinence is a condition in which the control over voluntary urination is lost or weakened. It is also known as Involuntary Urination. Urinary incontinence is a very common problem which is a major cause of health related stress. This problem is more prevalent in women than men. It is also a major issue among older people as due to old age, they lose control over the urinary muscles. Other group of people who are more prone to Urinary Incontinence are pregnant women, women who have recently gone through childbirth and older women who are going through menopause. Bed wetting, which is pretty common in children, has been termed as Enuresis. Bed wetting normally occurs during sleep at night. This is known as Nocturnal Enuresis. Moreover, urinary incontinence, when not the sole condition affecting a person’s urine discharge, it is usually a symptom of an under-lying medical condition. When people consult a doctor for such a condition, they omit to inform the doctor about this condition due to fear of embarrassment. Urinary Incontinence is one of the lesser reported symptoms.
Causes of Urinary Incontinence
Excessive Urine Production
When the body makes larger than normal amounts of urine, people feel an urgency to urinate and their frequency to urinate also increases. This production of excessive urine is called as Polyuria. Some medical conditions can also cause polyuria such as diabetes (type 1 and type 2), primary polydipsia, which is the tendency to drink excessive amount of water. Medications which are diuretic in nature can also increase the frequency of urination. Polyuria may only increase amount of urine formation and increased frequency, but doesn’t usually lead to incontinence.
Prostate is a gland located just below the urinary bladder. This gland produces some of the fluid that protects the reproductive sperm cells hence making prostate an essential reproductive gland. When the prostate gland swells for any reason, it puts pressure on the urinary bladder. This causes an urge to urinate which is more frequent than usual.
Underlying medical conditions such as Multiple Sclerosis, Spina Bifida, Parkinson’s disease and strokes can disrupt the nerve functions that control the contraction of the urinary bladder.
One of the effects of a prostectomy is urinary incontinence, among others.
Women who have natural deliveries without a C-section, are twice more susceptible to urinary incontinence as compared to women with surgical deliveries. Statistically, 33 percent women who experience urinary incontinence are those who gave birth naturally.
The process of Urination
Our body produces urine by filtering the blood in our kidneys. In this process, the kidneys remove all the waste material that was absorbed by the blood from the body cells. The main constituent of the urine is water, followed by urea, chloride and sodium. This urine is then passed down to the urinary bladder and stored there. The urinary bladder is a balloon like muscle. When the bladder contracts, due to pressure, the urine stored inside it is pushed down towards the urethra and subsequently out of the body. The urethra is a canal through which the urine passes out of the body.
Normally, people have control over when to urinate according to the time and place. This is controlled by the nerves, muscles, spinal cord and the brain. The urinary bladder consists of two kinds of muscles namely, the detrusor and the sphincter.
Detrusor – This is the muscle group that constitutes the muscles of the bladder where the urine is stored. Upon receiving signal from the brain which is carried by the nerves, these muscles contract and hence urine is passed out of the body.
Sphincter – A sphincter is circular in shape. It is a group of round muscles located right beneath the detrusor. Sphincter is always closed. It acts like a cork which keeps all the liquid stored in the urinary bladder sealed inside. It only relaxes and opens when it’s time to let the urine flow down. When the bladder contracts, the sphincter automatically relaxes, in turn opening the passageway to the urinary canal. A third group of muscles are the pelvic floor muscles that contract to keep the urine from flowing out.
Failure to control this process is called urinary incontinence.
Types of Urinary Incontinence
Stress related incontinence: during sneezing and coughing, the strength of the pelvic floor muscles is weakened leading to leakage of urine.
Urge incontinence: this incontinence has no apparent reason. It is simply an immediate urge to urinate.
Overflow incontinence: when the urine continues to leak even after the person has stopped urinating, it’s known as overflow incontinence.
Mixed incontinence: it is mostly common in older women.
Structural incontinence: on rare occasions, structural abnormalities, either from birth or an injury, can also cause urinary incontinence.
Functional incontinence: this kind of incontinence refer to a situation where a person feels the urge to urinate, but before reaching the proper place, the urine flows down involuntarily. This might be caused by several medical conditions such as depression, alcohol abuse, confusion mobility disorder and some mental disorders like dementia.
Nocturnal enuresis: As mentioned above, this kind of urinary incontinence occurs at night time among children.
Transient incontinence: This is a temporary situation. Women who are pregnant suffer from this. It might happen due to numerous reasons a common cause might be identified as the baby pushing against the urinary bladder. This kind of urinary incontinence is resolved automatically once the child is born.
Giggle incontinence: it is the involuntary release of urine while laughing uncontrollably. It is most common in children.
Double incontinence: The processes of urination and excretion (defecation) are controlled by the same group of muscles. When a person suffers from urinary incontinence, it is very likely that fecal incontinence might occur. Such an incontinences is called double incontinence.
The treatment for urinary incontinence varies according to the underlying cause. Some of the common treatments are mentioned below for educational purposes only:
• Behaviour management
• Bladder detainment
• Therapy of the pelvic floor muscles
The treatments mentioned above vary from person to person and their success depends upon the correct diagnosis of the cause of urinary incontinence. If a person show symptoms of incontinence, a doctor must be immediately consulted, explaining all symptoms without withholding any information.