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Urinary incontinence is the inability to control urination. The term may be used interchangeably with OverActive Bladder (OAB) which also includes the same frequency in urination and urinary urge. People who suffer from overactive bladder, or urinary incontinence, can't hold their urine -- they wet themselves. (Leaking urine is normal only in infants; it is not a normal result of aging. If you have this problem, you may be too embarrassed or upset to ask for help.)
Hattat Hospital is a urology hospital where all the appropriate tests including video-urodinamy are performed to determine not only the type /cause of the incontinence, but also the treatment option for it (medical or surgery).
Incontinence is classified by the symptoms of or circumstances occurring at the time of urine leakage.
- Stress incontinence may be due to poor bladder support by the pelvic muscles or to a weak or damaged sphincter. This condition allows urine to leak when you do anything that strains or stresses the abdomen, such as coughing, sneezing, laughing, or even walking.
- Urge incontinence results when an overactive bladder contracts without your wanting it to do so. You may feel as if you can't wait to reach a toilet. At times, you may leak urine without any warning at all. A bladder can become overactive because of infection that irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. In other cases, the cause may be unclear.
- Mixed incontinence is often a combination of both conditions above -- stress and urge incontinence.
- Overflow incontinence occurs when the bladder is allowed to become so full that it simply overflows. This happens when bladder weakness or a blocked urethra prevents normal emptying. An enlarged prostate can result in such blockage. For this reason, overflow incontinence is more common in men that in women. Bladder weakness can develop in both men and women, but it happens most often in people with diabetes, heavy alcohol users, and others with decreased nerve function.
- Environmental incontinence (sometimes called functional incontinence) occurs when people cannot get to the toilet or get a bedpan when they need it. The urinary system may work well, but physical or mental disabilities or other circumstances prevent normal toilet usage.
- Nocturnal enuresis is incontinence that occurs during sleep.
Urodynamic testing
When individuals have two or more types of incontinence, the causes of each must be found and considered in planning appropriate treatment.Depending upon the type and suspected causes of your particular incontinence, some of the following tests may be performed at Hattat Hospital to help your health care provider choose a treatment that is right for you.
Urodynamic testing provides a more advanced way to check bladder function. It may be done if the above tests do not give an answer to why you have leakage of urine or your health professional suspects that you have mixed incontinence with more than one cause. The actual tests done in urodynamic testing often vary. They may include postvoid residual (PVR) measurements and X-rays or ultrasound to examine changes in the position of the bladder and urethra during urination, coughing, or straining. Urodynamic testing may also include cystometry (cystometrography, uroflowmetry), a series of tests to measure bladder pressure at different levels of fullness. Cystometry is helpful in diagnosing urge incontinence.3 Cystometry tests include: Leak point pressure (LPP), which measures weakness in the muscle that holds back urine (sphincter) and Maximum urethral closure pressure (MUCP), which measures the pressure keeping the urethra closed naturally. If the underlying cause of incontinence is not identified by the above tests, more tests such as cystoscopy may be needed.
Treatment
The best treatment depends on the cause of your incontinence and your own preferences.
Surgery
There are several different kinds of surgeries to correct stress urinary incontinence, which results when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra and/or bladder into their normal position. When they are returned to their proper position, sneezing, coughing, and laughing are less likely to result in the release of urine from the bladder. Surgery is usually not done for urge incontinence. The decision to have surgery must always be based on an accurate diagnosis, consideration of other treatment possibilities, and realistic expectations for the surgery.
Surgery Choices
Tension-free vaginal tape (TVT) surgery. TVT surgery is becoming more popular among women with stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has recurred after having another type of incontinence surgery.
Retropubic suspension. The Marshall-Marchetti-Krantz (MMK) and Burch colposuspension procedures are the most common types of retropubic suspension. Retropubic surgeries provide lift to the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone or tough ligaments. These surgeries require hospitalization.
Urethral sling. The surgeon fashions a piece of muscle, ligament, or tendon tissue or synthetic material into a sling that lifts the urethra back into a normal position. Since this involves abdominal surgery, hospitalization is required.
Other Treatment
Changes in habits (behavioral methods) and exercise are often used first to treat urinary incontinence because they do not involve surgery, have no serious side effects, can be done at home, and do not limit future treatment options. These methods are often successful in treating mild to moderate incontinence.
Behavioral methods. These methods, which include bladder training and timed voiding, are used to treat urge incontinence.
Exercise. Pelvic floor, or Kegel, exercises strengthen the pelvic muscles involved in urination and are used to treat stress or urge incontinence.
Electrical stimulation. Electrical stimulation treatment uses a mild electrical current to stimulate the pelvic muscles that are involved in urination.
Mechanical devices. These devices include a pessary (a rubber device that is inserted into the upper vagina to lift the bladder to help control stress incontinence) and a catheter (a thin, flexible tube that a woman inserts into her bladder to drain urine and help control overflow incontinence).
Absorbent products. These include adult diapers, plastic-coated underwear, pads, or panty liners that attach to underwear.
Urethral bulking. Urethral bulking involves injecting collagen or other bulking materials around the urethra to build up the urethra where it leaves the bladder. This procedure usually relieves symptoms for about 1 year, although 2 to 3 injections are likely to be needed.
What causes urinary incontinence in men?
Urinary incontinence occurs when the muscle (sphincter) that holds the bladder's outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull. In men, urinary incontinence often is related to a problem or a treatment involving the prostate gland, such as enlargement of the prostate (benign prostatic hyperplasia, or BPH).
- Stress incontinence may develop when a man's prostate gland is removed and there has been dysfunction of or damage to the nerves or the sphincter, resulting in inadequate support for the lower bladder (bladder neck). The sphincter must then do all the work of maintaining continence, and the extra pressure (stress) of sneezing, coughing, or straining forces urine past the sphincter and through the urethra.
- Urge incontinence is caused by bladder contractions that are too strong to be stopped by the sphincter, causing an irresistible need to urinate. This is usually called an "overactive bladder." In many cases, the cause of an overactive bladder cannot be determined, but sometimes it can be traced to urinary tract infections, early BPH, interstitial cystitis, or early bladder cancer.
- Overflow incontinence is usually caused by a blockage of the urethra that forces urine to build up in the bladder. Often the blockage stems from an enlarged prostate gland (benign prostatic hyperplasia) or a narrowing of the urethra. Eventually the pressure from the full bladder forces excess urine past the obstruction. Overflow incontinence may also occur because of muscle weakness of the bladder.
Urinary incontinence can sometimes be aggravated by drinking alcohol or by taking diuretics, antidepressants, sedatives, narcotics, or nonprescription cold or diet medications.
What are the symptoms?
The main symptom of urinary incontinence is the accidental release of urine. Additional symptoms will vary depending on the type of urinary incontinence.
- Stress incontinence: Unintentional release of a small amount of urine occurs with coughing, straining, lifting, or changing posture.
- Urge incontinence: The need to urinate is so strong that the patient cannot reach the toilet in time.
- Overflow incontinence: The patient have uncontrolled dribbling of urine, or you have the urge to urinate but can only release a small volume of urine.
How is urinary incontinence in men diagnosed?
The medical history and a physical examination, along with some simple diagnostic tests such as a urinalysis, often provide enough information for your health professional to determine the cause of your incontinence. Additional tests called urodynamics may be needed if the incontinence is caused by more than one problem or if the cause is unclear.
How is it treated?
Incontinence is usually treatable with medications, specific exercises, or surgery, once a health professional has determined what is causing the problem. Treatment varies based on the type of incontinence and how much it is affecting the patient’s life.
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