A Simple Guide to Urinary Incontinence

A Simple Guide to Urinary Incontinence
------------------------------------------------

What is Urinary Incontinence?
----------------------------------------

Urinary incontinence is a symptom and means the the uncontrollable leakage of urine.
It can cause a lot social discomfort to patients having this problem.
Men are more prone to it than women.

What are the Causes of Urinary Incontinence?
------------------------------------------------

Urinary Incontinence is a medical condition which may be temporary or permanent.

There are many causes of urinary incontinence:
Temporary urinary incontinence
------------------------------

1.Drinking too much tea, coffee or carbonated drinks can irritate the bladder and cause or contribute to incontinence.
Coffee and other drinks containing caffeine can be a particular problem as caffeine is a diuretic, i.e. it increases the urge to pass urine.

2.Excessive alcohol. Alcohol is also a diuretic. Because it has deppresant effect on the the brain, it may affect the person's judgement temporarily, hence resulting in accidental leakage of urine.

3.Some medications like diuretic pills, heart medications and antidepressants can cause or contribute to incontinence.

4.Urinary Tract Infection may cause sufficient irritation to the bladder to stimulate incontinence.

5.Constipation result in impaction of the stools in the rectum. This irritates the nerves to the bladder resulting in incontinence.

Permanent urinary incontinence
-------------------------------
In both sexes there are many conditions which can cause or contribute to chronic or persistent urinary incontinence:

1.Aging
With age there is a decrease in the bladder capacity to store urine.

2.Enlarged prostate in men
BPH or benign prostatic hypertrophy is associated with aging and can obstruct the urethra and block urinary flow resulting in urge or overflow incontinence.

3.Prostate Cancer in men
Prostate cancer can cause incontinence if untreated. However the incontinence in prostate cancer patients may be a side effect of treatment e.g. surgery, radiation therapy.

4.Prostatitis in men
Inflammation of the prostate gland sometimes can cause constriction of the urinary flow and incontinence.

5.Gynecological problems such as prolapsed uterus, enlarged utrue due to fiboids, ovarian cysts or tumours can pulled on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening

5.Surgery involving the organs near the bladder
Any operations involving organs such as the ovary, uterus, prostate, rectum can cause inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.

6.Urinary tract obstruction
Any enlarged tumours along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.

7.Neurological conditions
Stroke, Parkinson's disease, tumours in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can can affect the nerves to the bladder and weakening of the bladder opening muscles.

What are the Types of urinary incontinence?
-----------------------------------------------

Urinary incontinence may be categorised into 4 main types. It is possible however to have more than one type of urinary incontinence

1.Stress incontinence
Leakage of urine occurs because of weakness of the pelvic floor muscles. When there is pressure exerted on the bladder - e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy, the muscles at the opening of the bladder comes under stress and opens to allow leaking of urine.


2.Urge incontinence
There is an uncontrollable leakage of urine while suddenly feeling the urge to urinate.

3.Overflow incontinence
There is a constant dribbling of urine even after finishing urination. There is an inability to completely empty the bladder.

4.Functional incontinence
There is physical or mental impairment resulting in the failure to realise the need to urinate.As a result the person fail to get to the toilet in time and pass out the urine. Examples are people who suffer from dementia, parkinson or is incapacitated by poor physical movement.

Other types of urinary incontinence include enuresis(bed wetting ) which is common in chilldren,
Transient incontinence which is temporary and sometimes caused by medications.

What are the symptoms of urinary incontinence?
------------------------------------------------

The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be small and rare.
Some other symptoms of urinary incontinence include:

Urgency - a strong desire to urinate even when the bladder is not full together with pelvic discomfort or pressure

Frequency - urinating more than once in a two-hour period or more than seven times a day

Nocturia - the need to wake up and urinate at least twice during sleep

Dysuria - painful urination

Enuresis - bed-wetting or urinating while sleeping

How do you make the Diagnosis of urinary incontinence?
----------------------------------------------------------

1. history taking is important especially the pattern of urine leakage. Other history include symptoms of straining and discomfort, use of drugs, surgery, and illness.

2. physical examination will look for signs of medical conditions causing incontinence, such as pelvic tumors, stool impaction, and poor reflexes or sensations.

3. measurement of bladder capacity and residual urine for signs of poor functioning bladder muscles.

4.Stress test - the patient coughs vigorously as the doctor watches for loss of urine.

5.Urinalysis - urine is tested for infection, urinary stones.

6.Blood tests - for PSA( in case of Cancer of prostate) or alphafoetoprotein (in case of cancer of the ovaries)

5.Ultrasound -to visualize the kidneys, ureters, bladder, and urethra.

6.Cystoscopy - a thin lighted tube is used to see the inside of the urethra and bladder.

7.Urodynamics - measurement of pressure in the bladder and the flow of urine.

What is the Treatment of urinary incontinence?
-----------------------------------------------

Elderly patient tend to believe that the only way to prevent embarrassment is to wear absorbent pads or padded undergarments like adult Pampers. However the wetness may lead to rashes, sores, or infections.

Treatment involves:
A. making certain lifestyle changes.

1.Timed Voiding
Timed voiding (urinating) means writing a chart of your urination and leakage patterns for several days. This will then tell you which times of day you normally need to empty your bladder before leakage may occur.

2.Bladder training
This involves training your bladder to control the urge to urinate.

3.Changing Fluid Intake
Restricting your fluid intake, or changing the timing of fluid intake will help you to gain more control over the bladder. Restriction of alcohol, tea, coffee and other caffeinated beverages can reduce the amount of urine from your body

4.Exercises
Exercising the muscles of the pelvis(Kegel exercises) may strengthen the muscles of the affected area.

5.Vaginal cone therapy
This exercise for women involves the use of a set of five small vaginal cones of increasing weight. The patient simply places the small plastic cone within her vagina and hold it in by a mild reflex contraction of the pelvic floor muscles. This exercise is done twice a day for fifteen to twenty minutes.As the pelvic floor muscles becomes stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.

6.Electrical stimulation
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles and strenthen the pelvic muscles.
This can reduce stress and urge incontinence.

7.Biofeedback
Using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can slowly control movement of these muscles.

B.Treating the cause of the incontinence:

1.Medications:
drugs may be given to treat urinary tract infections or inhibit contractions of an overactive bladder.

2,Pessaries
A pessary is a ring shaped medical device that is inserted into the vagina. It compresses the urethra against the pubic bone and elevates the bladder neck.

3.Surgery
Surgery to reduce the size of your prostate gland ( transurethral resection of the prostate or TURP) helps to reduce urinary incontinence in men.

Bladder repositioning
In older women incontinence results from the bladder dropping down toward the vagina. Surgery involves pulling the bladder up to a more normal position. Using an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

Marshall-Marchetti-Krantz
This procedure also known as retropubic suspension or bladder neck suspension surgery, is performed using an incision across the abdomen. Stitches are placed in these tissues near the bladder neck and the urethra is then lifted, and the stitches are attached to the pubic bone or to tissue behind the pubic bone. The bladder neck is supported helping the patient to control the urine flow.

Slings
The sling procedure uses synthetic mesh material in the shape of a narrow ribbon that is placed under the urethra through one vaginal incision and two small abdominal incisions. The purpose is to provide support under the urethra. There are the Transobturator Tape Sling, the Tension-free Transvaginal Sling, and the Minisling.

Artificial urinary sphincter
Rarely the surgeon implants an artificial urinary sphincter a doughnut-shaped sac surrounding the urethra. To close the urethra A fluid fills and expands the sac. Pressing a valve implanted under the skin, the artificial sphincter can be deflated allowing urine from the bladder to pass.

4.Catheterization
A catheter may be inserted to drain the urine if your bladder never empties completely or if your bladder cannot empty because of poor muscle tone, post surgery or spinal cord injury. This can be done on a if required basis.Prolonged catherisation may lead to infection of the urinary tract.

5. Botox injections
Botox injection has been tried to reduce the sensitivity of the nerves at the opening of the bladder. It appears more successful for women than in men.

How do you prevent urinary incontinence?
----------------------------------------

Reduce your risk of urinary incontinence:

1.Maintain a healthy weight.

2.Obesity can lead to urinary incontinence.

3.Avoid constipation by drinking sufficient amounts of fibre and fluids in your diet.

4.Avoid drinks which can irritate your bladder such as coffee, tea, carbonated drinks and alcohol.

A Simple Guide to Benign Prostatic Hyperplasia

A Simple Guide to Benign Prostatic Hyperplasia
-------------------------------------------------------------------

What is Benign Prostatic Hyperplasia?
--------------------------------------------------------

Benign Prostatic Hyperplasia or BPH is a common condition where older men over fifty years of age have enlargement of the prostate.

What are the Causes of Benign Prostatic Hyperplasia?
------------------------------------------------------------

The prostate is a gland present only in males which produces the secretions nourishing the sperms in the semen.

It is a walnut size gland encircling the lower urinary outlet of the bladder.

With age, the prostate gland enlarges and squeezes the bladder outlet and the urinary passage like a clamp. An enlarged prostate gland can obstruct the urethra and block urinary flow resulting in damage to the bladder and kidneys.

The cause of the enlarged prostate gland is usually due to age and the prolonged exposure to the male hormones from puberty causing hyperplasia(overgrowth) of the prostatic cells.

What are the symptoms and signs of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------

The symptoms of BPH varies from person to person.
Sometimes an enlarged prostate may cause little or no problem while a smaller prostate may may compress the the neck of the bladder giving to problems in passing urine.

Symptoms:
1. difficulty in starting urination

2. straining at urination to produce a weak flow of urine

3. dribbling of the urine after urination

4. feeling of incomplete emptying of bladder even after urination.

5. nocturia -getting up at night more frequently to pass urine

6. frequency of urination

7. interrupted urine flow

8. urgent need to pass urine immediately with uncontrolled leakage(incontinence)

Signs:
1.physical examination
A rectal examination may show the enlargement of the prostate

2.urine examination to exclude infections

3.blood tests to check on kidney function

4.an ultrasound to have a better look at the prostate and also any damage to kidneys

5.a urine flow test(Uroflow) to see how fast you can pass urine

6. a blood test for prostatic specific antigen(PSA) to exclude prosate cancer

7. Cystoscopy - a ligted tube to examine the inside of the bladder especially to find where the blockage is or if there is blood in the urine

8.Urodynamics test - to measure the voiding pressure(pressure in the bladder)

What are the complications of Benign Prostatic Hyperplasia?
--------------------------------------------------------------------

Prolonged blockage of the urine by BPH can cause serious complications:

1.Acute retention of urine( sudden inability to pass urine ) with enlargement of the bladder and abdominal pain

2. Urine leakage or incontinence

3. recurring urine infections

4. bladder stone formation

5. blood in the urine

What is the treatment of Benign Prostatic Hyperplasia?
----------------------------------------------------------------

BPH sufferers may be referred to an Urologist for review. As lonas Prostate Cancer has been ruled out, treatment depends on the severity of the BPH.

In mild BPH,there is no significant blockage of the bladder. Symptoms are usually not bothersome. Treatment is by :
1.adjustment of fluid intake

2.regular exercise,

3.proper diet with less red meat , more vegetables and fruits.

In moderate BPH, if the blockage is not severe but the symptoms are bothersome, treatment include the above as well as :

4. medications to relax the bladder outlet or help shrink the the prostate, to improve the flow of urine.

In Severe BPH. if the blockage is severe and the person is unable to empty bladder completely,

5.catherisation and drainage of the urine may be necessary in acute retention of the urine

6.Surgery may be necessary.
This operation called TURP or transUrethral Resection of the Prostate removes the obstructing part of the prostate using a resectoscope inserted via the urinary tract.
Recovery usually takes 3-4 days.
TURP is usually safe and low risk. Less than 10 % may have some bleeding and infection. Less than 1% may have loss of urinary control.
Less than 4% will have impotence or erectile dysfuction problems.

7. Antibiotics may be given for urinary infections

What are the preventive measures taken in Benign Prostatic Hyperplasia?
--------------------------------------------------------------------

1.Changing Fluid Intake

You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder. Restricting intake of alcohol and coffees can also help by reducing the amount of urine.

2.Bladder training & periuretharal muscle exercises
This involves training your bladder to control the urge to void.

3.Maintain a healthy weight.

4.Avoid constipation by including sufficient amounts of fibre and fluids in your diet.

What is the prognosis of Benign Prostatic Hyperplasia?
---------------------------------------------------------------

Very good after treatment.