What Causes Urinary Incontinence? Top 9 Research Based Treatment Methods.

What do you do when you feel a sneeze coming on? Do you cross your legs? Do you freak out when you feel an urgent need to use the restroom? Do leaks occur unexpectedly and unnoticed? This is called incontinence and this article is all about how you can prevent and manage it.

Incontinence refers to the involuntary loss of urine. Up to one-third of Americans struggle to resist the impulse to go, especially as they age.

Humans should urinate at least 4-6 times a day. But occasionally the pressures of modern life urge us to hold it in. The fix resides in an oval pouch located within the pelvis. There are a number of additional organs in the vicinity of this structure that work together to form the urinary system consisting of two kidneys, two ureters, two ureteral sphincters, and a urethra. Consisting of the body’s water and waste products, urine is a yellowish liquid that continuously drips from the kidneys. It is then funneled down into two muscular tubes, the ureters.

These carry it downwards into the hollow organ known as bladder.

This organ’s muscular wall is composed of detrusor muscle tissue, which relaxes and causes it to fill with urine. As the bladder fills, the detrusor contracts and internal urethral sphincter automatically and involuntarily opens and urine is released. Whooshing downwards, the urine reaches the urethra and stops at external urethral sphincter. This works like a tap, when you want to delay your urinating, you keep the sphincter closed. and voluntarily hoping it when you can urinate.

Inside the detrusor muscle are millions of stretch receptors that get triggered as the bladder fills. They send a signal on your nerves to the spinal cord and in response, the reflex signal is sent back to your bladder making the detrusor muscle contract and thereby alerting you that your bladder is filling. at the same time, the internal ureteral sphincter opens causing a micturition reflex.  The brain can counter it if it’s not a good time or situation to urinate by signaling the contraction(closing) of urethral sphincter.

Incontinence occurs when the muscles that hold in urine or support the bladder become sufficiently weakened to allow urine to flow out.

Types of Incontinence.

It is important to keep in mind that many people will experience a combination of these types (usually, stress and urge are observed combined), making it difficult to determine which type is giving the most discomfort and how to handle it.

1. Stress Incontinence.

Incontinence that occurs during physical activity, such as coughing, sneezing, exercising, lifting, or laughing, is known as stress urinary incontinence. Leakage of urine happens when the pelvic floor muscles are too weak to withstand the increased pressure that occurs during activities such as coughing, sneezing, exercising, or lifting heavy objects. The muscles that support the urethra might become weak with age, childbirth, excess body fat, and menopause allowing urine to leak out. It is prevalent among women, and it often worsens with age.

2. Urge Incontinence.

Urge incontinence refers to the involuntary release of urine in response to an urgent need to urinate that cannot be controlled. Running water, hand washing, and chilly temperatures might cause urine urgency. Frequent urination and awakenings during the night to do so are additional symptoms. Overactive bladder is another name for this problem. Bladder spasms can be caused by a number of different things, including what you eat and drink (bladder stimulants like caffeine or alcohol), how much fluid you drink, any medications you’re taking, a urinary tract infection or malignancy, or nerve malfunction (associated with nerve trauma, diabetes, multiple sclerosis, or spinal cord injury).

3. Overflow Incontinence.

Overflow incontinence is caused by the patient’s inability to recognize a full bladder.  Bladder trauma, major pelvic surgery, spinal cord or neurologic injury, and the use of specific medicines all increase the risk. In addition to leakage, overflow incontinence can cause urinary tract infections, difficulty starting to urinate, a weak urine stream, and nighttime urination.

4. Mixed Incontinence.

Patients with mixed incontinence show signs of both stress and urge incontinence. It can happen both during times of extreme urgency and during times of intense physical exertion. Typically, it is necessary to decide which component, urge or stress, is the more problematic and then treat that element first.

Mixed incontinence and urge type both rises with age, but the prevalence of stress incontinence peaks in the fifth decade and subsequently decreases. 

5. Functional Incontinence.

Functional incontinence occurs when a person is unable to make it to the restroom in a timely manner due to any reason, such as mental or physical impairment.

Incontinence With Exercise?  Stress urinary incontinence, or leaking while exercising, is the medical term for this condition. It usually occurs when the pelvic floor or sphincter muscles are weak and the bladder is unable to withstand the strain. Even while urinary incontinence is quite frequent during exercise, it is nevertheless annoying and sometimes embarrassing. There is good news, though: incontinence can be treated and cured.

Risk Factors. 

You can have urine urgency with or without any of these risk factors. The likelihood of developing it rises in proportion to the number of risk factors a person exposes themselves to. Have a discussion with your doctor about reducing your risk.

• Gender: Urinary incontinence affects more women with a ratio of 2:1. Pregnancy, delivery, menopause, and female anatomy cause this discrepancy. However, prostate gland issues raise the likelihood of urge and overflow incontinence.
• Certain Conditions: An increased likelihood of urination might be a symptom of specific medical conditions. This includes:

• Pregnancies increase the chances of urine urgency by 52% according to a study and hysterectomies by almost 70-85% according to another study. 
• Age: You’re more likely to develop it as you become older. People over the age of 60 have a significantly increased risk of developing incontinence. It is to be kept in mind, that incontinence doesn’t relate to aging but changes that occur as a result of the natural aging process may lead to urgency. It can be induced by age-related prostate gland growth in men and estrogen decrease and delivery in women.
• Smoking: Urinary incontinence is a possible side effect of smoking cigarettes.
• Family History: Your risk of getting urine incontinence, and notably urge incontinence, increases if a close relative also suffers from the illness.
• Menopause: During and after menopause, a woman’s body produces much less estrogen, a hormone that helps maintain a healthy bladder and urethra lining. When these tissues deteriorate, incontinence might be made worse. What other effects can menopause have? We have a detailed article Read it out Here.
• Cancer: Incontinence can be a symptom of prostate or bladder cancer. Unfortunately, bladder control issues are another side effect of several cancer treatments. Tumors, even benign ones, can obstruct the urinary tract and lead to incontinence.

Symptoms.

The inability to regulate urination is the most obvious sign of incontinence. On the other hand, you can experience any of these signs,

• Need to urinate often (more than eight times a day).
• Normal activities such as lifting, bending, coughing, or exercising are accompanied by urine leakage.
• Leaking urine without any feeling or alertness.
• Strong, sudden desires to urinate; the feeling that you may not make it to the restroom in time.
• Avoiding certain activities because you’re afraid of leaking.
• Urge to urinate soon after passing urine.

Diagnosis.

This condition is not a disease. It is a symptom of something else occurring in the body and should be discussed with a healthcare professional with expertise in the area.

Standard diagnostic procedures include a patient’s medical history, a physical exam, and a urinalysis. They may also question as to the specifics of your daily routine, such as the foods you typically eat and the supplements you use. Your doctor may recommend one of the following tests after evaluating your symptoms to focus on the root cause of your urinary leakage

• Urine tests: These tests can check the urine for the presence of microorganisms. Evidence of bacteria in the urine could indicate an infection.
• Blood test: Blood tests can detect chemicals and drugs that may be associated with incontinence-causing illnesses.
• Urinalysis: Infections, traces of blood, and other abnormalities, such as the presence of cancer cells, can be detected in a urine sample. A urine culture can determine the presence of infection, whereas urine cytology checks for cancer cells.
• Pelvic Ultrasound: In this imaging test, an ultrasound instrument is used to make an image of the bladder or other areas of the urinary tract in order to identify any potential issues.
• Postvoid residual (PVR) measurement: This test is performed in a filled bladder. Your bladder’s capacity and rate of emptying are then evaluated. As part of the investigation, a post-void residual volume test is carried out. This displays the amount of urine still present in the bladder following urination. Your bladder’s nerves and muscles, as well as any obstructions in your urinary tract, can be diagnosed with this test.
• Cytogram: It’s an X-ray of the bladder. After filling your bladder with a contrast chemical, your doctor will take X-rays of it. A related treatment is a voiding cystogram, in which the doctor keeps taking X-rays even as you urinate. These two exams are useful in determining the reason for incontinence, which may be an issue with the bladder.
• Cystoscopy: For this procedure, your doctor will insert a small camera into your urethra, the tube that conducts urine from your bladder. This will allow the doctor to check for structural issues.

Prevention. 

There are several ways to cope with incontinence, so it’s not something you have to accept as a natural part of becoming older.

Regulate Water/Fluid Intake: Do not consume excessive amounts of fluids, including water and fruit juice, all at once. Instead, sip slowly and frequently throughout the day. If you have trouble sleeping because you have to get up to go urinate in the middle of the night, avoid drinking anything with liquid in it right before bed. Caffeinated drinks, alcohol, and coffee are all diuretics that can increase the frequency of urination and should be avoided.

Healthy Bladder Habits: Maintain healthy bladder habits by voiding only when the bladder is full. Do not visit the toilet “just in case.”

Avoid Hovering Over: Take a seat on the toilet properly. Hovering, or lingering, over the toilet seat is a common habit among women who use public restrooms and should be avoided.

Reduce Bathroom barriers: Maintaining a clean, well-lit route to the restroom can be helpful if you’re having problems finding your way there, especially at night.

Keep up Exercises: While regular physical activity is essential for good health, many people stop exercising due to urinary incontinence. When you don’t exercise, you increase your chances of developing health issues like diabetes and obesity. Keeping your core tight when you’re on your feet will help you keep your pelvic floor supported.

Shed Weight: If your body mass index (BMI) is 25 or more, decreasing weight can help relieve some of the strain on your pelvic floor and bladder. Stress incontinence may greatly benefit from even a modest weight decrease. If you need help losing weight, it’s best to consult a doctor.

Incontinence can generally be managed without surgery. If left untreated, UI can cause insomnia, sadness, anxiety, and a loss of sexual interest.

Treatment.

Urinary incontinence is a prevalent problem that requires medical attention in the same way that any other health issue would. It’s important that females know they don’t have to put up with this problem on their own and feel safe seeking help. Its treatment usually depends upon the underlying condition.

1. Bladder training.

If you want to increase your bladder capacity and learn to urinate more under control, you can train your bladder by trying to urinate at regular intervals and it is one of the first treatments for urge incontinence.  It entails learning strategies to increase the duration between the sensation of having to urinate and the actual urination. Typically, the course will run for at least six weeks. A bladder journal is the first step in this approach. You’ll record the times and amounts that you consume fluids, urinate, and leak urine. Such apps are also available online on Appstore.

2. Pelvic floor Exercises:

The pelvic floor muscles, like any other muscle in the body, can become stronger with regular use and exercise and are the most natural way to treat this condition. Performing Kegel exercises is a simple method of building strength in the pelvic floor. It requires repeatedly contracting and relaxing those muscles throughout the day. The urinary muscles, the anus muscles, and the urethral and vaginal muscles are all worked on in these exercises. In addition, the deep abdominal muscles are strengthened during the activities. Strong, well-activated pelvic floor muscles support the bladder, uterus, and colon, ensuring system health.

Incontinence in women can be effectively treated with a combination of pelvic floor exercises and bladder retraining treatments, according to studies with reported success rates as high as 73%.  You can watch tutorials for these exercises but it is best to consult a physical therapist to learn how to correctly perform these exercises.

3. Behavioral Training. 

Depending on the cause, bladder leakage may be controlled by limiting fluid consumption, altering the diet, or making regular trips to the bathroom.  Your doctor may suggest making certain modifications to your routine in order to alleviate or avoid urine incontinence. Changes in food, physical activity, and time management between bathroom visits are all possible options.

4. Medication.

Medicines like mirabegron (Myrbetriq), oxybutynin (Ditropan), and tamsulosin (Flomax) can help relax an overactive bladder. Used frequently to help with urge incontinence. After 2–4 weeks, you’ll be evaluated to determine whether or not the medication is helping and whether or not it’s having any adverse effects.

5. Absorbent Garments. 

You can safeguard yourself in high-risk scenarios, including when you’re participating in strenuous physical activity or when you don’t have easy access to a bathroom, by using precautionary products. Using pads or absorbent undergarments, such as disposable panties or washable and reusable ones, can help stop minor leaks from spreading and save from embarrassments.

6. Estrogen Creams.

Topical estrogen cream has been shown to improve the health of impaired urethral and vaginal tissues. Many women after menopause use this medication. However, creams can be a hassle to apply and often need to be repeated any time a week.

7. Electrical Stimulation. 

If you have trouble contracting your pelvic floor muscles, electrical stimulation may help. A tiny probe will be introduced into the vagina or anus. The probe conducts an electrical current, which strengthens your pelvic floor muscles as you exercise them. If you are unable to perform pelvic floor muscle contractions without electrical stimulation, you may find it difficult or unpleasant, but it may be beneficial.

8. Pessaries

They are inserted vaginally to treat bladder problems by propping up the bladder.  Pessaries are made up of silicone and come in a wide variety of forms. Some are temporary, lasting only a few weeks, while others can be left in for up to three months. We’ll make sure you know what to do at every step.

9. Surgical Interventions.

If you have attempted these methods to manage your leakage with little success, your doctor may propose the following surgical procedures:

• Injectables; Around the urethra, a material like a collagen is injected. This aids in keeping the urethra closed, preventing urine from leaking out or collecting in the urethra’s lining. This procedure is typically performed on women; however, it can also be used to treat male stress incontinence. Another type of injectable used is Botox, this enhances the bladder’s ability to store urine and reduce urine leakage occurrences.
• Nerve Stimulators: The majority of doctors will only prescribe this product to patients who have acute urge leakage. After being surgically implanted under the skin, it controls bladder function by means of electrical pulses sent to the underlying muscular tissue.
• Sling: A sling is made up of soft mesh material and can be used If the pelvic floor muscles that support the bladder have deteriorated. It can be surgically inserted under the urethra to support it in both men and women.
• Tension-free vaginal tape (TVT): The more recent method of tension-free vaginal tape (TVT) has a higher success rate and fewer side effects than sling surgery. It is performed vaginally with the help of a local anesthetic and doesn’t require the patient to stay overnight in the hospital.
• Burch procedure (for women): Retropubic colposuspension and bladder neck suspension are two more names for this procedure. Stitches are performed to sew the urethra and bladder neck to the person’s abdominal wall assisting in supporting the urethra and sphincter muscles.
• Artificial urinary sphincter (more common in men). An artificial sphincter is surgically inserted. It consists of a cuff that is placed around the urethra, an abdominal reservoir, and a pump. In men, the pump is normally situated in the scrotum, whereas in women, it is situated in the labia. The fluid-filled cuff maintains the urethra’s closure. Urination activates the pump. The fluid then goes from the cuff to the reservoir in order to release urine. After urinating, the fluid returns to the cuff to close the urethra.

Incontinence can diminish one’s quality of life regardless of the underlying cause. If you are having problems with your urination, it is recommended that you consult a doctor. A doctor can also tell whether there’s something more dangerous going on medically. The root reason may potentially be treatable.

Is taking that initial step still disturbing? Constantly remind yourself that incontinence is no reason to give up living life to the fullest. The appropriate diagnosis and therapy can make all the difference in the world.