Urinary Incontinence – Types, Investigation and Treatment

• Types of Urinary Incontinence
• Investigation
• Treatment

Urinary incontinence is a symptom resulting in loss of control of the bladder contents. It is a common problem that increases in prevalence with age, and is more common in women than men. It is important to report this condition to your doctor or health care provider, as a thorough evaluation can usually determine the cause of your incontinence.
To better understand incontinence, it helps to understand the structure of the urinary tract. Urine is waste products and water removed from the blood by the kidneys. Urine flows from the kidneys downwards through a pair of tubes (the ureters) to the bladder. The bladder is a balloon-like structure that stores urine. Urine leaves the body through another tube (the urethra) at the bottom of the bladder. Urination is controlled by special muscles, called sphincters, located at the base of the bladder and the wall of the urethra. These normally control the flow of urine by contracting and therefore closing off the neck of the bladder and the urethra, like a tie around the bottom of a balloon, so that no urine is leaked. When the sphincters relax, they open the passage for urine to pass. At the same time, the muscle of the bladder wall contracts (squeezes) and forces the urine out of the bladder. When the urination process is finished, the sphincters contract and the bladder itself stops squeezing and relaxes.

Types of Urinary Incontinence

Incontinence is classified by the symptoms or circumstances occurring at the time of urine leakage. There are many different types of incontinence.
Stress incontinence may be due to poor bladder support by the pelvic muscles or to a weak or damaged sphincter. This condition allows urine to leak when you do anything that strains or stresses the abdomen, such as coughing, sneezing, laughing, or even walking.
Urge incontinence results when an overactive bladder contracts without your wanting it to do so. You may feel as if you can’t wait to reach a toilet. At times, you may leak urine without any warning at all. A bladder can become overactive because of infection that irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. In other cases, the cause may be unclear. Mixed incontinence is often a combination of both conditions above – stress and urge incontinence.
Overflow incontinence occurs when the bladder is allowed to become so full that it simply overflows. This happens when bladder weakness or a blocked urethra prevents normal emptying. An enlarged prostate can result in such blockage. For this reason, overflow incontinence is more common in men that in women.
Bladder weakness can develop in both men and women, but it happens most often in people with diabetes, heavy alcohol users, and others with decreased nerve function.
Environmental incontinence (sometimes called functional incontinence) occurs when people cannot get to the toilet or get a bedpan when they need it. The urinary system may work well, but physical or mental disabilities or other circumstances prevent normal toilet usage.
Nocturnal enuresisis incontinence that occurs during sleep.

Investigation of Urinary Incontinence

Your health care provider will ask questions about your symptoms and the situations in which you experience urine leakage. He or she will also ask you about your medical and surgical history, medications, and habits. A thorough physical exam will include your abdomen, pelvis (women), rectum (men), and nervous system. You may be referred to a specialist. Physicians who specialize in diagnosing and treating disorders of the urinary tract include urogynecologists (for women) and urologists. Depending upon the type and suspected causes of your particular incontinence, some of the following tests will be performed to help your health care provider choose a treatment that is right for you.  
Urinalysis: You will be asked to collect a sample of your urine, which will be examined for the presence of infection, blood, or other abnormalities.
Post-void residual measurement: This test is performed to see whether any urine remains after you have attempted to empty your bladder completely. Measurements may be made by inserting a small, soft tube, called a catheter, into the bladder to drain the remaining urine or by using sound waves, called ultrasound. When these special sound waves are directed at an organ, such as the bladder, shadow-like images are produced. These images can determine the amount of urine present in the bladder. Ultrasound: This technique also can be used to determine the size and shape of the kidneys, bladder, and prostate.
Cystoscopy: A thin telescope-like instrument, called a cystoscope, is inserted into the bladder through the urethra. This test allows a physician to see the inside of the bladder and to visually check for problems.
Stress Test: Urodynamic tests examine bladder and sphincter muscle function. Using several such tests, your health care provider can find out whether you have normal bladder sensations and capacity and whether your bladder fills and empties in a normal manner. An x-ray test may be used to establish the degree of change in the position of the bladder and urethra during normal voiding, coughing, or straining.

Treatment of Incontinence

Many types of treatment are available for incontinence. A qualified specialist can recommend the treatment that is best for your condition.
Behavioural therapy: Special exercises and training programs are effective in improving bladder control. Exercises to strengthen the sphincter muscles must be done correctly and faithfully to regain and maintain continence. Bladder retraining (gradually prolonging the time between visits to the toilet), along with reasonable fluid intake, has helped many people with incontinence. Several types of health care providers are able to offer assistance with this treatment.  
Medicine: Medicines can be prescribed to relax the bladder or tighten the sphincter muscles. Certain medications you may be taking for other conditions can affect your bladder control. Review your medication with your health care professional.
Surgery: Several operations for incontinence exist. In men, an operation may be required to relieve the blockage caused by an enlarged prostate. In women, an operation may be required to restore the support of the pelvic floor muscles or to reconstruct or compress the sphincter An artificial urinary sphincter is another surgical treatment for people whose sphincter muscle is absent or has been severely damaged and whose problem has not responded to simpler treatments.
Other options: Certain materials can be injected around the urethra to add bulk to that area. These serve to compress the urethra and thereby increase resistance to urine flow.
Absorbent products and devices: For people who are currently participating in a treatment program or whose incontinence cannot be cured, many absorbent products and devices are available to wear. There are also devices, called pessaries, worn internally by women to support the bladder and improve control. The use of Spinal Cord Stimulation is currently being investigated for treatment of urinary incontinence. You may wish to ask your health care professional for more information on these treatment options.