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Urinary incontinence (UI)

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. 

It is a common and distressing problem, which may have a large impact on quality of life. 

Causes of UI may be:

  • Urinary Tract Infection
  • Constipation
  • Multiple Childbirth
  • Overactive Bladder
  • Weak bladder Muscles
  • Weak pelvic floor muscles-These muscles provide support for the bladder, intestine, and the uterus.
  • Surgery
  • Anxiety or Stress (Emotional factors)
  • Pelvic organ Prolapse-This happens when organs shift out of place and into the vagina. This shift can prevent the bladder and urethra from working properly. 
  • Diseases like diabetes, Parkinson’s and multiple sclerosis (MS)- Can damage the nerves that control your bladder. 

Risk Factors of UI

  • Old age.
  • Obesity and physical inactivity. 
  • Pregnancy and childbirth.
  • Menopause.
  • Diseases that affect the nerves or spinal cord (neurological diseases).
  • Chronic coughing-This can increase pressure on the bladder and pelvic floor muscles

Types of UI:

  • Urge Incontinence: A sudden urge to urinate and passing urine involuntarily before you can get to a bathroom 
  • Stress Incontinence: Sudden forceful activity that forces urine to pass involuntarily like coughing, laughing, exercise, sneezing or even sometimes turning in the bed
  • Overflow Incontinence: Needing to urinate often but urinating only a small amount or constantly dribbling urine.
  • Functional Incontinence: Urinating because you cannot get to the bathroom in time due to a physical disability or communication/thinking problems, such as Alzheimer disease

Diagnosis:

  • Proper Medical history and Physical examination
  • Urine Tests
  • Frequency-Volume charting: Urologist may ask to make a log of when you urinate, how much you urinate and kind of sensation with leakage of urine.
  • USG /CT scan KUB (Kidney, Ureter and Bladder) region
  • Cystoscopy: In this procedure, Urologists inserts a tube with a light and camera (cystoscope) through the urethra and into the bladder to check for problems.
  • Urodynamic testing. These tests assess how well the bladder, urethra, and sphincter can store and release urine.

Treatment:

Depends on the type of incontinence that you have and its cause. It includes:

  • Lifestyle changes
    • Quit smoking.
    • Reducing and maintain a healthy weight.
  • Physical Activity/Exercise: Moderate intensity exercise of at least 15-30mins/day
  • Eating a healthy diet.
    • Avoid fried foods/high fat diet.
    • Avoid refined carbohydrates like white bread and white rice. 
    • Limit alcohol and caffeine.
    • Increase your fiber intake like fresh fruits, vegetables, whole grains etc.
  • Strengthening Pelvic floor muscles by regular pelvic floor exercises.
  • Bladder training to increase the amount of time between bathroom breaks
  • Using techniques to suppress bladder urges like distraction techniques
  • Medicines to relax the bladder muscles and prevent bladder spasms. 
  • Botox injections- These can help relax the bladder muscles.
  • Electric Nerve Stimulation-Using pulses of electricity to help change bladder reflexes
  • Surgery like Tension Free Vaginal Tapes (TVT-O, TVT-Retropubic)