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Urinary Incontinence
W
hat is Urinary Incontinence?
Urinary incontinence is generally defined as a
complaint of any involuntary leakage of urine.
What are the types of urinary incontinence?
The most common types are:
•Stress urinary incontinence – the involuntary loss
of urine during physical exertion (exercise or lifting of
objects) or during coughing or sneezing
•Urge urinary incontinence – the involuntary loss of urine associated with
the feeling of a sudden desire to void
•Continuous urinary incontinence – complaint of a continuous involuntary
loss of urine
What are the causes and risk factors of urinary incontinence?
Factors associated with urinary incontinence include: pregnancy, mode
of delivery, aging, previous continence or prolapse surgery, body mass index
(BMI), prior hysterectomy, and physical work requiring heavy lifting.
Other potentially reversible causes of urinary incontinence are best
remembered by the word DIAPPERS which means Dementia/delirium,
Infection, Atrophic vaginitis, Psychological, Pharmacologic, Endocrine,
Restricted mobility, and Stool Impaction.
What happens when you have urinary incontinence?
Stress urinary incontinence – The female pelvic organs (urethra, bladder,
vagina, uterus, rectum) are supported by the pelvic floor muscles and
ligaments. Pregnancy, childbirth, menopause and obesity are just some of the
conditions that may affect these supporting structures. Stress incontinence
happens when these muscles and ligaments around the bladder and urethra
weaken, preventing them from closing the urethra as tightly as they should
during increases in abdominal pressure like coughing or laughing.
Urge urinary incontinence – The bladder basically has two main functions
- to store and empty urine. During filling, the bladder muscles have to
continually adjust and relax to accommodate urine (average capacity is 400-
600ml) while the urethral muscles remain contracted in order to prevent
leakage. During voiding, the bladder muscles contract and the urethral
muscles relax in a synchronized manner in order to effectively empty the
bladder. This relaxation and contraction movements are coordinated and
regulated for a normal voiding cycle. Urge incontinence happens when
there is inappropriate or untimely bladder contractions which affects the
coordination of the bladder and urethra, leading to an involuntary loss
of urine. These involuntary bladder spasms may be caused by infection,
damages to the bladder wall or to the nerves of the bladder, or disorders of
the nervous system. Certain medical conditions (diabetes) and medications
(diuretics) can cause or worsen urge incontinence.
Continuous urinary incontinence - A continuous involuntary loss of
urine is usually caused by some anatomical or structural problem in the
urinary tract. An abnormal opening connecting the bladder and the vagina
(vesicovaginal fistula) causes continuous loss of urine into the vaginal vault.
These fistulas may happen after surgery (hysterectomy or cesarean section),
prolonged labor during childbirth, or radiation treatment for pelvic cancers.
How is urinary incontinence diagnosed?
A detailed medical history is first obtained to identify potential risk factors.
Physical examination (pelvic exam) will be done to detect any structural
conditions that cause leakage. Other tests include:
1.Urinalysis – to assess for any infection of the urinary tract
2.Pad test – a pad is worn while several activities are performed, and
leakage is confirmed if the pad stains with urine
3.Ultrasound– can show any