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e-Medical
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Incontinence is the inability to control urination (passage of urine). Urinary incontinence can range from an occasional leakage of urine to a complete inability to hold any
urine (loss of bladder control; uncontrollable urination; urination, uncontrollable)
Incontinence is seen more frequently among the elderly. Women are more likely than men to be affected by urinary incontinence.
NORMAL URINATION
The ability to hold urine and maintain continence is dependent on normal anatomy and function of the lower urinary tract and the nervous system. Additionally, the person must possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.
The process of urination involves two phases: 1) the filling and storage phase, and 2) the emptying phase. Normally during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine. The first sensation of the urge to urinate occurs when approximately 200 ml of urine is stored. The healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate while also allowing the bladder to continue to fill. The average person can hold approximately 350 to 550 ml of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable bladder wall muscle (detrusor).
The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. Additionally, the body must also be able to simultaneously relax the sphincter to allow the urine to pass out of the body.
So if you experience a
sudden and compelling urge to pass urine at least eight times a day
and are frequently woken at night with the need to go to the toilet, then
you may have suffer from one of the various types of incontinence
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Types
of Urinary Incontinence: |
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Stress
Incontinence - Stress
Urinary Incontinence (SUI).
An
involuntary loss of urine that occurs at the same
time that internal abdominal pressure is
increased, such as with coughing, sneezing,
laughing, or physical activity.
Stress
incontinence is a storage problem in which the
strength of the urethra sphincter is diminished,
and the sphincter is not able to prevent urine
flow against increased pressure from the abdomen.
Storage
problems may occur as a result of weakened pelvic
muscles that support the bladder, or because of
malfunction of the urethra sphincter. Prior trauma
to the urethra area, neurological injury, and some
medications may weaken the urethra closure.
Sphincter
weakness may occur in women after pelvic surgery.
Stress
incontinence may be seen in women who have had
multiple pregnancies, or who have pelvic prolapse
(protrusion of the bladder, urethra, or rectal
wall into the vaginal space), with cystocele,
cystourethrocele, or rectocele. Additionally,
women with low estrogen levels may have stress
incontinence due to decreased vaginal muscle tone.
Studies
have documented that about 50% of all women have
occasional incontinence, and as many as 10% have
regular incontinence. Nearly 20% of women over age
75 experience daily incontinence. The risk
increases with advancing age, obesity, chronic
bronchitis, asthma and childbearing. |
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Urge
Incontinence - Overactive
Bladder (OAB)
A
condition characterized by a strong desire to
urinate immediately before an involuntary bladder
contraction with a loss of a large amount of
urine.
Urge
incontinence is basically a storage problem in
which the bladder muscle contracts
inappropriately. Often these contractions occur
regardless of the amount of urine that is in the
bladder. Urge incontinence may result from
neurological injuries (such as spinal cord injury
or stroke), neurological diseases (such as
multiple sclerosis), infection, bladder cancer,
bladder stones, bladder inflammation, or bladder
outlet obstruction (enlarged prostate). However,
the majority of cases are classified as
idiopathic--a specific cause cannot be identified.
Irritable
bladder may occur in either males or females at
any age, however it is more common in women and
the elderly. It is second only to stress
incontinence as the most common cause of urinary
incontinence (involuntary loss of urine).
Approximately 1 to 2% of the adult females are
affected by the problem. |
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Mixed
Incontinence
Mixed
incontinence is usually a 60%-40% combination of
stress incontinence and urge incontinence. It is
most common in older women and may occur at
different times or under different circumstances.
Since
the causes of mixed stress and urge incontinence
may or may not be the same, each aspect of this
disorder should be evaluated separately. |
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Overflow
Incontinence
People
with overflow incontinence do not feel the urge to
urinate. The bladder never empties normally and
remains at least partially full; small amounts of
urine are leaked on a nearly continuous basis.
Weak bladder muscles -- caused by nerve damage
from diabetes or other diseases -- or a blocked
urethra can be responsible for overflow
incontinence.
Overflow
incontinence most frequently appears in older men
in whom an enlarged prostate hinders the flow of
urine; urinary stones or tumors also may block the
urethra. Overflow incontinence is rare in women,
although sometimes it is caused by fibroid or
ovarian tumors. Spinal cord injuries or nervous
system disorders are additional causes of overflow
incontinence. Some of the symptoms of overflow
incontinence are:
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Feeling
as though the bladder is never completely
empty |
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Feeling
the urge to urinate, but not being able to |
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Passing
a dribbling stream of urine, even after
spending a long time at the toilet |
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Frequently
getting up at night to urinate |
Although
some people with overflow incontinence never have
the feeling of a full bladder, they may leak urine
day and night |
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10
Warning Signs of Urinary Incontinence |
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Leakage
of urine that impacts your activity |
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Leakage
of urine causing embarrassment |
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Leakage
of urine after an operation |
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Urgent
need to rush to the toilet &/or loss
of urine if you do not arrive in time |
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Frequent
bladder infections |
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Urinating
more frequently than usual without a
bladder infection |
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Pain
related to filling of the bladder &/or
during urination in the absence of a
bladder infection |
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Inability
to urinate (Urinary retention) |
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Progressive
weakness of the urinary stream with or
without a feeling of incomplete bladder
emptying |
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Changes
in urination related to a neurological
condition such as stroke, spinal cord
injury or multiple sclerosis |
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The first step is to
consult your doctor who has a range of options to offer - These
options might include some or all of the following:
A
"Bladder Diary" - Keeping a record for a few weeks helps
your doctor to work out how often you are able to finish what
you are doing before going to the toilet and whether you are able to
hold urine in if necessary.
Urine
test - A urine test checks for any possible bladder
infections, a high glucose level that could be a sign of diabetes and
signs of bleeding in the urinary tract.
Bladder
tests - Also called Urodynamic
tests, these may include
measuring how much liquid the bladder can hold and how fast the urine
comes out.
Physical
examination - The medic may check the area around the
genitalia and back passage for signs of constipation or cancer, which
can cause incontinence.
The
treatment options are:
Once OAB has been
diagnosed, you may be referred to a nurse-led continence clinic or to
a continence advisor for individually tailored treatment so that you
get back to living as normal a life as possible.
Kegel
Exercises (developed by the German Dr. Arnold Kegel in 1948)
and
Bladder
retraining - You may have got used to mapping every toilet
in town, but emptying your bladder at every available opportunity may
be counterproductive as your bladder learns to hold less and less
urine. The bladder can be retrained with a combination of pelvic floor
exercises [Kegel Exercise] and gradually increasing the time between visits to the
toilet
by learning to tolerate the feeling of the bladder being stretched as
it fills. Learn more
about Kegel Exercises!
Bladder
pacemakers - A small electrode is inserted into the
patient's back, close to the nerve that controls bladder function, and
an electric current is passed through the electrode to control it.
Bladder
surgery - There are two surgical approaches to the problem:
A piece of bowel is
inserted into the bladder wall to enlarge the bladder. Botulinum toxin
(popularly known as Botox) is injected into the bladder wall to block
the nerves that stimulate the detrusor muscle.
Drug
Therapy:
1.
Anticholinergic drugs (also known as antimuscarinics): they
relax the smooth bladder muscle and reduce the contractions of the
detrusor muscle. Two of the anticholinergics that medical
professionals may give you include:
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Tolterodine
or;
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A relative
newcomer: Vesicare (solifenacin), launched in autumn 2004. Your
doctor can prescribe solifenacin in doses of 5mg or 10mg which may
be useful if the smaller dose needs to be increased in order to
cope with your symptoms more effectively. Alternatively, you may
be advised to temporarily step up the dose to give you extra peace
of mind to help you cope with a journey or a special occasion.
2.
Combination: Anticholinergic drugs with physiotherapy and
bladder retraining - suppressing the detrusor's urge to empty the
bladder while the patient slowly learns to hold more liquid in the
bladder for longer periods of time can help the bladder to return to a
normal size.
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