Urinary Incontinence

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Presently, I am having a sore throat and a cough. This has been going on for almost two weeks. Probably, all those Raya goodies has a lot to do with this. Luckily, the tight feeling is only in the throat area. My doctor says my upper and lower respiratory are alright. However, all this cough make me leak. This is called urinary incontinence.

Urinary incontinence is no longer a problem that belonged solely in the realm of the aged or infirm. More common among women than men in most age groups, it is also a problem that may affect as many as one in five young adults.

What is urinary incontinence?

Our kidneys constantly produces urine which flows to our bladder where it is then stored. The lowest part of the bladder is encircled by a muscle (also known as the sphincter muscle) that remains contracted or in other words, closed-off so that urine is retained in the bladder until it is full. When the bladder is full, signals are sent to the brain and that is at that moment when one becomes aware of the urge to urinate. A person who can consciously and voluntarily control urination can then decide to release the urine from the bladder or to hold it in for a while. When one decide to urinate, the sphincter muscles relaxes, allowing urine to flow and the bladder wall muscles contract to push the urine out.

Urinary incontinence is essentially a condition where one is not able to control the release of urine from the bladder. It ranges from the occasional leak of of urine when one sneezes or coughs to th sudden and strong urge to urinate as the person makes a dash for the toilet.

There are five basic types of incontinence based oin the pattern symptoms:

STRESS INCONTINENCE

It is the uncontrollable loss of small amounts of urine when one exerts pressure during actions like coughing or, sneezing, or also while straining or lifting heavy objects. Stress incontinence can be caused by the weakening of the sphincter muscle of the bladder.

URGE CONTINENCE

When one experiences a sudden intense urge to urinate followed by an uncontrollable loss of urine. People with urge incontinence are given a warning of only a few seconds or up to a minute to reach a toilet as the bladder muscle contracts. Urge incontinence may be caused by an underlying condition such as urinary tract infections, bowel problems, stroke, Parkinsons’s disease, or Alzheimer’s disease.

OVERFLOW INCONTINENCE

This is the uncontrollable leakage of small amounts of urine, i.e. when one frequently or constantly dribbles urine, Now and again, you may feel as if you never completely empty your bladder and only a weak stream of urine is produced when one attempts to urinate. It is usually caused by bladder damage, a blocked urethra or nerve damage.

FUNCTIONAL INCONTINENCE

Due to physical or mental impairment, one is not able to get to a toilet in time. A classic example would a person with severe arthritis who may not be able to unfasten his or her pants fast enough. This type of incontinence is very common among the elderly at nursing homes.      

MIXED INCONTINENCE

This involve more than one type of intontinence and the most common type would be the mixture of urge and stress incontinence in older women.

Causes of Urinary Incontinence

Urinary incontinence can be caused by everyday habits, underlying mecical coniions or physical problems.

Certain foods, drinks or medications can cause temporary urinary incontinence and a simple change can bring relief:

• DEHYDRATION results in very concentrated urine that may irritate the bladder and worsen incontinence.
• BLADDER STIMULANT (e.g. carbonated drinks, food or beverage high in spice, sugar and acid) can aggravate your bladder.
• OVER HYDRATION. Drinking to  much in a short time increases the amount of urine for the bladder to deal with.
• EXCESS INTAKE OF ALCOHOL / OR CAFFEINE. This acts as s diuretic, which can cause an urgent need to urinate.
• MEDICATIONS such as blood pressure drugs, sedatives and muscle relaxants mnay contribute to bladder control problems.

Here are some medical conditions which mayu be responsible urinary incontinence.

• URINARY TRACT INFECTIONS. Infections c an irritate your bladder causing a strong urge to urinate and this may result in episodes of incontinence.
• BOWEL PROBLEMS such as constipation. As your erection is located near the bladder, hard, compacted stools may put pressure on the bladder neck or urethra.

Urinary incontinence can also be a persistent problem due to the following common underlying physical changes or problems:

• PREGNANCY AND CHILDBIRTH. Pregnant women may experience stress incontinence due to hormonal changes as well as the extra weight from an enlarging uterus. Also, the stress of a vaginal delivery can weaken the urinary sphincter muscle.
• AGEING. Physiological changes with age such as decline in th bladder’s capacity to store urine, and the slowing rate of urine flow out of the bladder and through the urethra. In addition, the amount or urine remaining in the bladder after urination also increases with age. 
• NEUROLOGICAL DISORDERS such as multiple sclerosis, Parkinson’s disease, stroke or a spinal injury can disrupt the nervous systems’s ability to control the bladder.

Coping with urinary incontinence

Urinary incontinence can often results in much anxiety as one’s lifestyle is very much compromised at work or at home. Urinary leaks can affect all areas of life from sleep disturbance, sexual difficulties, social isolation to loss of self-esteem.

Treatment varies according to the type of incontinence, its’ severity and the underlying cause. Adopting the following behavioural techniques, lifestyle changes and physical therapy can go a long way and in fact, may oftentimes be the only treatment needed.

BLADDER TRAINING

A term rarely heard of, such training may involve:

• Learning to delay urination. One may start to hold off for 10 minutes every time you feel an urge to urinate and the goal is to lengthen the time between trips to the toilet, i.e. ideally every two to four hours.
• Double voiding. An exercise where one tries to urinate again after a few minutes. This exercise helps to empty the bladder more completely and this avoids overflow incontinence.
• Learning to control urges to urinate by relaxing.

TIMED URINATION

Deliberately urinating at regular intervals, usually every two to three hours as this keeps the bladder relatively empty.

A FLUID AND DIET MANAGEMENT

Simply cutting back on or avoiding alcohol, caffeine or acidic foods may help. You should drink adequate amounts of fluids to prevent dehydration.

PELVIC FLOOR MUSCLE EXERCISES

Also known as Kegel exercises. These exercises involve repeatedly  contracting the muscles used to stop urinating and this is done many times a day. This is to build up strength and to learn to use the muscles properly in situations that cause incontinence such as coughing or sneezing. However, it is difficult to know whether the right muscles are contracting, hence a nurse or physical therapists can help to shed some light on the right techniques.

In addition, there medications that can be prescribed to treat incontinence.

• Drugs that relax the bladder with the most commonly prescribed two being oxybutinin and tolterodine.
• Topical estrogen (e.g vaginal cream, ring or patch) may help tone and rejuvenate tissues in the urethra and vaginal areas, hence reducing some of the symptoms.

If all fails, there are several surgical procedures to explore.

• Surgically replacing a urinary sphincter that does not close adequately with an artificial one.
• A sling procedure where a pelvic sling or hammock is created around the bladder neck ant urethra. This helps keep the urethra closed especially when one coughs or sneezes.
• Bladder neck suspension. A surgical procedure designed to provide support to the urethra and bladder neck.

Prior to seeking treatment oir in the event that medical treatment cannot completely eliminate the problem, there are products which can help ease discomfort and the incontinence associated with incontinence.

• Absorbent pads and protective garments. Such products help in managing urine loss or leaks.
• Catheter. Especially for people with overflow incontinence, a catherer may be inserted to help drain the bladder.

People with urinary incontinence often try to cope on their own as they feel embarrassed. Remember, the condition is manageable and new treatments are continuously being discovered. So, take control of your bladder!

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