What is incontinence and what you can do about it?

It hap­pens at the most inop­por­tune of times. It is a severe­ly under-diag­nosed and under-report­ed prob­lem that increas­es with age. It is twice as like­ly among females as males.

Pelvic floor exer­cis­es are one of the main treat­ments for female stress incon­ti­nence and are very effec­tive in pro­vid­ing symp­tom relief. Suc­cess with pelvic floor exer­cis­es is very high in cas­es with mild to mod­er­ate stress incon­ti­nence.”

Uri­nary incon­ti­nence is the loss of blad­der con­trol (leak­ing urine). Can be annoy­ing and embar­rass­ing in equal mea­sure. Often occurs in post­par­tum women and seniors. Stroke, demen­tia, mul­ti­ple scle­ro­sis, Parkinson’s or injuries are com­mon caus­es. Incon­ti­nence may come in a vari­ety of types, includ­ing:

  • Stress incon­ti­nence occurs when abdom­i­nal pres­sure is placed on the blad­der often caused by cough­ing, sneez­ing, laugh­ing cough­ing, exer­cis­ing, lift­ing or doing oth­er sim­i­lar activ­i­ties.
  • Urge incon­ti­nence. The sud­den urge to uri­nate fol­lowed by an uncon­trolled loss of urine. Urge incon­ti­nence may cause fre­quent uri­na­tion neck and con­tin­ued through­out the night. This type of incon­ti­nence may be caused by many con­di­tions.
  • Over­flow incon­ti­nence. When a blad­der does not ful­ly emp­ty, patients may have fre­quent uri­na­tion or con­stant drib­bling of urine.
  • Lack of mobil­i­ty. This is uri­nary incon­ti­nence that occurs because the patient’s mobil­i­ty is lim­it­ed and they can­not get to the bath­room in time.
  • Mixed incon­ti­nence is a com­bi­na­tion of more than one type of the above.
  • Any activ­i­ty that increas­es pres­sure on the blad­der can cause vul­ner­a­bil­i­ty to urine loss, espe­cial­ly when the blad­der is full. Stress incon­ti­nence is more com­mon in women than men and occurs when the pelvic floor mus­cles weak­en with age and child­birth.

Child­birth. Dur­ing child­birth, tis­sue and nerve dam­age may occur dur­ing the deliv­ery of an infant. Dam­age to these tis­sues and nerves may cre­ate weak pelvic floor mus­cles and can begin incon­ti­nence soon after deliv­ery or years lat­er.

What are treat­ments are avail­able for uri­nary incon­ti­nence ?

  • 1: Behav­ioral changes
  • 2: Biofeed­back to learn con­trol of pelvic mus­cles and pelvic floor exer­cise
  • 3: Nerve stim­u­la­tions
  • 4: Botox injec­tions in the blad­der wall
  • 5: Med­ica­tions ‑In peo­ple with over­ac­tive blad­der, mus­cles in the blad­der wall con­tract at the wrong time. Anti­cholin­er­gics drugs are being used to treat OAB & UI by block­ing the nerve sig­nals relat­ed to blad­der mus­cle con­trac­tions.

What sur­gi­cal treat­ments are avail­able for uri­nary incon­ti­nence?

Most com­mon surgery for stress incon­ti­nence is the place­ment of a “sling” under the ure­thra where a mesh under the ure­thra is placed through a small inci­sion in the vagi­na which helps the ure­thra remains closed pre­vent­ing invol­un­tary urine leak­age. Blad­der neck sus­pen­sion is anoth­er oper­a­tion, which also helps pro­vide sup­port for the ure­thra and the part of the blad­der that con­nects to the ure­thra. But all oper­a­tions have some com­pli­ca­tions, require anes­the­sia and admis­sion in hos­pi­tal

Pre­ven­tion

Uri­nary incon­ti­nence isn’t always pre­ventable. How­ev­er, to help decrease your risk:

  • Main­tain a healthy weight
  • Prac­tice pelvic floor exer­cis­es
  • Avoid blad­der irri­tants, such as caf­feine, alco­hol and acidic foods
  • Eat more fiber, which can pre­vent con­sti­pa­tion, a cause of uri­nary incon­ti­nence
  • Don’t smoke, or seek help to quit smok­ing

In 1998, a team of Nor­we­gian researchers con­duct­ed a six-month tri­al of the var­i­ous treat­ment options for SUI. These includ­ed pelvic floor exer­cis­es, elec­tri­cal stim­u­la­tion, vagi­nal cones and no treat­ment. Of these, women who did pelvic floor exer­cis­es showed the most sig­nif­i­cant improve­ment.

More stud­ies have backed up this find­ing since, includ­ing a recent pub­li­ca­tion by Dumoulin (et al 2011), which describes pelvic floor mus­cle train­ing as hav­ing a “level‑A evi­dence” rat­ing.

Prof Fion­nu­ala McAu­li­ffe of the Roy­al Col­lege of Physi­cians of Ire­land says: “Pelvic floor exer­cis­es are one of the main treat­ments for female stress incon­ti­nence and are very effec­tive in pro­vid­ing symp­tom relief. Suc­cess with pelvic floor exer­cis­es is very high in cas­es with mild to mod­er­ate stress incon­ti­nence.”

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