Urinary Incontinence or UI

Urinary incontinence is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age.  Urinary incontinence almost always results from an underlying treatable medical condition.

Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is urge incontinence or overactive bladder. There are other causes of incontinence, such as prostate problems and nerve damage.

Treatment depends on the type of problem you have and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures prescribed by your doctor, or surgery.

Causes

Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:
•  Bedrest -- for example, when recovering from surgery
•  Certain medications (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies, and antihistamines for allergies)
•  Increased urine amounts, like with poorly controlled diabetes
•  Mental confusion
•  Pregnancy
•  Prostate infection or inflammation
•  Stool impaction from severe constipation, causing pressure on the bladder
•  Urinary tract infection or inflammation
•  Weight gain

Causes that may be more long-term:
•  Alzheimer's disease
•  Bladder cancer
•  Bladder spasms
•  Depression
•  Large prostate in men
•  Neurological conditions such as multiple sclerosis or stroke
•  Nerve or muscle damage after pelvic radiation
•  Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vaginal space, often related to having had multiple pregnancies and deliveries
•  Problems with the structure of the urinary tract
•  Spinal injuries
•  Weakness of the sphincter, the circular muscles of the bladder responsible for opening and closing it; this can happen following prostate surgery in men, or vaginal surgery in women

Treatment

Treatment options vary, depending on the cause and type of incontinence you have. Some of them are:

Exercises: One of the most common treatment recommendations includes exercising the muscles of the pelvis. Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage. Vaginal cones enhance the performance of Kegel exercises for women.

Electrical stimulation: Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This can stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

Biofeedback: Biofeedback uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Timed voiding or bladder training: This involves urinating on a schedule, whether you feel a need to go or not. In between those times, you try to wait to the next scheduled time. At first, you may need to schedule 1 hour intervals. Gradually, you can increase by 1/2 hour intervals until you are only urinating every 3-4 hours without leakage.

Other measures include:
•  Regulate your bowels to avoid constipation. Try increasing fiber in your diet.
•  Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk of bladder cancer. Avoid alcohol and caffeinated beverages, particularly coffee, which can overstimulate your bladder.
•  Lose weight if you need to.
•  Avoid foods and drinks that may irritate your bladder like spicy foods, carbonated beverages, and citrus fruits and juices.
•  Keep blood sugars under good control if you have diabetes.
•  Your doctor may recommend medication or surgery, especially if home care measures are not helping or if your symptoms are getting worse.
•  Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.
•  Surgery may be required to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women. Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters. These are synthetic cuffs that are surgically placed around the urethra to help retain urine.

Cost of treatment

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