What is Urinary incontinence ?
Urinary incontinence is not a normal part of aging. The aging process merely predisposes a woman to urine loss. Weak muscles, childbirth, poor nutrition and fluid intake, gynaecological surgery, urinary tract infections, spinal cord injuries and emotions all play a role in the aetiology of incontinence.
Impaired mobility, chronic constipation and prescription drugs, which can cause bladder dysfunction, should be addressed in the incontinent elderly.
Causes of Urinary Incontinence
The two most common causes of incontinence involve bladder instability (Urge Incontinence) and anatomic lack of urethral support (stress incontinence). Overflow urine loss and lack of tone in the urethra (bladder tube) can happen as age advances.
Stress incontinence is the leakage of urine with activities that increase pressure inside the abdomen like coughing, sneezing and laughing. Women can also lose urine while engaging in sports, bending, getting up from a seated position and lifting weights.
Urge incontinence is leakage of urine accompanied by a sense of urgency. Women typically complain of losing urine before they can make it to the bathroom. The sound of running water and activities like washing dishes can also precipitate sudden bladder spasms resulting in urine loss.
Diagnosis of urinary incontinence
Ways to diagnose urinary incontinence include:
- A bladder diary – the doctor may ask the patient to record how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
- Physical exam – the doctor may examine the vagina and check the strength of her pelvic floor muscles. If the patient is male, the doctor may examine his rectum to determine whether the prostate gland is enlarged.
- Urinalysis – tests for signs of infection and abnormalities.
- Blood test – to assess kidney function.
- PVR (postvoid residual) measurement – measures how much urine is left in the bladder after urinating.
- Pelvic ultrasound.
- Stress test – the patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
- Urodynamic testing – determines how much pressure the bladder and urinary sphincter muscle can withstand.
- Cystogram – X-ray procedure to visualize the bladder.
- Cystoscopy – a cystoscope (a thin tube with a lens at the end) is inserted into the urethra. The doctor can view abnormalities in the urinary tract.
Treatment for Female Urinary Incontinence in India
- Behavioral Modification
Behavioral modification involves timed voiding and bladder training. Timed voiding is done by emptying the bladder at specific intervals regularly. Intake of fluid is adjusted according to the times of bedtime and also before going out, so that the accidental urinary incontinence can be avoided during outing and on the bed.
- Vaginal Devices
Pessaries devices are used in the form of stiff ring for the urinary incontinence problem. It is inserted by either doctor or nurse. The device is inserted into the vagina to press against the vagina walls and also the surrounding of urethra. The pressure keeps the urethra to reposition so that the less stress leakage can be resulted.
Some medications are given to the candidate to relax the bladder and also its surrounding muscles so that the full emptying of bladder can be achieved
Neurostimulation is done for the nerves that come from the spinal cord and move towards the bladder. The nerve signals can be well modulated to the bladder so that the voiding can be controlled.
- Kegal Exercises
Kegal exercises are useful to strengthen the pelvic floor muscles, so that the sphincter muscles are kept tight so that the outlet of the bladder will be closed while strenuous activities are performed. Pelvic muscles are to be closed and count of 3 has to be done.
- Surgery or Stress Incontinence
After the childbirth, the bladder is moved from its position, for some of the women. Different surgical procedures can be performed to keep the bladder back to its position
- Retropubic Suspension
The surgery involves supporting the neck of the bladder using sutures or surgical threads. Burch procedure is one of the most commonly preferred retropubic suspension procedure.
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