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Questionnaire and Guide for Urinary Incontinence
By Dr Veena G.D.
What is urinary incontinence?
Urinary incontinence is the inability to control the release of urine. Urinary incontinence is not a disease, but it may indicate a problem with the urinary tract and the nervous system which controls the urinary bladder (Detrusor) muscle.
What causes urinary incontinence?
There are many causes of urinary incontinence like Urinary Tract Infection (UTI), medications, Detrusor muscle weakness, enlarged prostate constricting neck of the bladder and urethra, complications from surgery, or chronic diseases like diabetes, multiple sclerosis, and Parkinson’s disease. Any disease that affects the bladder nerves or spinal cord could also cause urinary incontinence.
What are the symptoms?
The main symptom of urinary incontinence is the accidental release of urine. In case of stress incontinence, person may experience leak of a small to medium amount of urine when you cough, sneeze, laugh, exercise, or do similar things. If it is urge incontinence, one may feel a sudden urge to urinate and the need to urinate often. With this type of bladder control problem, one may leak a larger amount of urine that can soak your clothes or run down your legs. Persons with mixed incontinence, will have symptoms of both.
Who gets urinary incontinence?
Commonly women suffer from incontinence twice as often as men do. Both women and men can have trouble with bladder control from neurological (nervous) injury, strokes, multiple sclerosis (MS). Older women have more bladder control issues than younger women do. Loss of bladder control in women most often happens because of problems with the muscles that help to hold or release urine along with pelvic floor muscle weakness.
What are the different types of urinary incontinence?
- Stress incontinence - Leaking small amounts of urine during physical movement (like coughing, sneezing, and exercising). Stress incontinence is the most common form of incontinence in women and it is treatable.
- Urge incontinence/Overactive Bladder (OAB) - An uncontrollable urge to urinate or leaking large amounts of urine at unexpected times, including during sleep, after drinking a small amount of water, or when you touch water or hear it running.
- Functional incontinence – Unable to reach a toilet in time because of new terrain and lack of information of the same. For example, a person with Alzheimer's disease may not think well enough to plan a trip to the bathroom in time to urinate or a person in a wheelchair may be unable to get to a toilet in time due to immobility.
- Overflow incontinence - Leaking small quantity of urine because the bladder is always partially voided. In this condition, the bladder never empties completely.
- Mixed incontinence - A combination of incontinence, most often when both stress and urge incontinence occur together.
- Transient incontinence – Temporary phase of urine leakage. It can be triggered by medications, urinary tract infections and stool impaction (severe constipation). Once the condition or infection is treated, the incontinence disappears.
How is urinary incontinence diagnosed?
To diagnose urinary incontinence, the doctor will query about the symptoms, medical history, and do a physical examination. The person would be asked to provide the details about bladder habits, how often you empty your bladder, how and when you leak urine.
Investigations for Incontinence:
- Provoked Full Bladder Stress Test –
This is done by the urologist to figure out how much your bladder can hold and how well your bladder muscles function. You are required to drink plenty of water and then amount of urine passed in specified time period is measured. Leak or wetting is also recorded.
- Cough Reflex - Take a deep breath and cough hard when the doctor indicates. Any urine leakage is recorded. This test is done in an upright position.
- Urinalysis - Urine sample is routinely tested for signs of infection or other causes of incontinence.
- Blood tests - Routine blood test is done for systemic evaluation of any causative factors of incontinence.
- Ultrasound - Sound waves are used to take a picture of the kidneys, bladder, and urethra, so any problems in these regions that could cause incontinence can be identified .And also residual urine in a poorly emptying bladder can be measured.
- Cystoscopy - A thin tube with a tiny camera is placed inside the urethra to view the inside of the urethra and bladder to look for abnormalities.
- Urodynamics - Pressure in the bladder and the flow of urine are measured using a special instrument.
What “lifestyle changes and exercises” will benefit?
If you are overweight and sedentary, a small lifestyle change like brisk walk and some stretching exercises will help you to become active and agile. This inturn helps in reducing weight which gives you a good bladder muscle tone, if this is combined with pelvic floor muscle strengthening exercise also.
Certain food and drinks can cause incontinence, such as caffeine (in coffee, soda, chocolate), tea, and alcohol. Restricting these in your diet may reduce the risk of incontinence.
Professionals also advice de-stressing is a definite beneficial factor so that a person may not feel the day to day stress precipitate the incontinence. Also personnel counseling is advised to face the situation and learn to handle the incontinence in a good stride.
What medications are available to treat urinary incontinence?
Oxybutynin (Ditropan), Tolterodine (Detrol, Detrol LA), Estrogen and Imipramine hydrochloride (Tofranil) are some of the drugs which are in practice for treating OAB / Incontinence but to be used under urologist or doctors prescription and direction.
Further Read:
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