Urinary incontinence
Summary/Definition
Urinary incontinence is a condition in which urination occurs against a person’s will. Urinary incontinence symptoms can be classified according to their causes and are divided into four categories. Urgent urinary incontinence is a condition in which urine leaks when the urge to urinate cannot be contained. Stress urinary incontinence occurs when there is an involuntary discharge of urine during coughing or body movement. If the symptoms of urgent and stressful urinary incontinence occur simultaneously, this is called mixed urinary incontinence. Urinary incontinence during overflow is associated with filling and excretion of a larger volume of urine than the bladder is able to accommodate. It is necessary to distinguish between these types of urinary incontinence, since their causes and mechanisms of development are different. Stress urinary incontinence is caused by a weakening of the structures supporting the area under the bladder and urethra, or a weakening of the urethral sphincter — the muscle that compresses the urethra. Hyperactive bladder, in turn, is associated with impaired functioning of the nerves that regulate the functioning of the bladder, and a possible increase in the sensitivity of the receptors that control the muscles of the bladder. Urinary incontinence with overflow is finally caused by disorders in the central nervous system (for example, with a stroke or spinal cord injury), peripheral nerve abnormalities and muscle weakness. Stress urinary incontinence accounts for about 70-80% of all cases of urinary incontinence and is most common in women aged 30 to 50 years, while urgent urinary incontinence accounts for about 20% of all cases of urinary incontinence.
Symptoms
Stress urinary incontinence is a condition in which urine is released uncontrollably when the abdominal cavity is strained. This happens when, for example, you cough, sneeze, laugh, climb stairs or engage in physical activity. Urgent urinary incontinence is a symptom in which urine is involuntarily released due to urgent urge to urinate. Urine leakage occurs at the time of going to the toilet or even when you hear the sound of water. Urinary incontinence due to overflow is a condition in which urine is often excreted in small amounts due to the filling of the bladder. At the same time, the feeling of urge to urinate often decreases.
Diagnostics
Various methods are used for diagnosis, including analysis of medical history, physical examination, urination diary, urodynamic tests, etc. The urodynamic test is used in cases where there is a suspicion of diseases that can cause neurological disorders, before surgical treatment, with relapses or with mixed types of urinary incontinence. Analysis of the patient’s medical history allows you to determine the circumstances under which the symptoms occurred, the type and degree of incontinence, as well as to assess the level of discomfort. The assessment includes data on childbirth, surgery, menopause and other factors, including related diseases, such as spinal cord injury, stroke, neuropathy and Parkinson’s disease. The questionnaire objectively reveals the degree and type of symptoms, the presence or absence of prolapse of the uterus, bladder, rectum, etc., and the degree of weakening of the pelvis and the presence of concomitant pathologies are confirmed by physical examination. Additional methods may also be recommended, including keeping a urination diary and conducting urodynamic tests and tests in which urinary incontinence is caused by an increase in intra-abdominal pressure.
Treatment and course of the disease
Urinary incontinence in itself does not pose a health hazard. However, it can cause sanitary or social difficulties. In addition, urinary incontinence can have different causes, and treatment methods vary depending on its type and source. Drug treatment includes the use of anticholinergic drugs, beta-3-adrenergic agonists, serotonin and norepinephrine reuptake inhibitors, cholinergic drugs and alpha-blockers. Behavioral treatments include pelvic floor exercises, urination control training, and stress management techniques. Surgical methods of treatment may include operations with the use of a midurethral sling, operations to support the urethra and urethroplasty.
