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Urinary stress incontinence – Types – surgery – treatment

Dr.Kut | Jan 29, 2010 | Comments 0

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When we have an urge to urinate and there is no restrooms around we tend to control our urinary bladder for a while. But in some cases, individuals have no control over their urinary bladder and this condition is what we call urinary incontinence. Urinary incontinence is defined as an involuntary leakage of urine and is mostly a distressing and embarrassing problem that influences an individual’s quality of life. Symptoms of urinary incontinence include leaking of urine and uncontrolled wetting. This condition increases in age and is more common among the elderly.

There are different types of incontinence and most of the problems rely on the poor bladder control which is caused by urethral muscles or bladder muscles which may either be too weak or too active. Urinary stress incontinence is a type of incontinence wherein the pelvic muscles that keep your bladder closed are weak. The tendency is you can’t hold urine effectively and small amounts of urine may be loss due to certain increase in pressure such as when you cough, sneeze, laugh, lift a heavy object, exercise, or any movements that increases your intra-abdominal pressure that increases pressure in your bladder as well. Since urethra is supported by the pelvic floor, any weakening of the pelvic muscles may move the urethra downward during increased abdominal pressure and urine may pass out uncontrollably. Other causes of stress incontinence are hormonal imbalance in women, bladder nerve damage from diseases like diabetes, stroke, Parkinson’s disease, pelvic cancers, surgery, radiation or chemotherapy treatments. On the other hand, urge incontinence or overactive bladder happens when bladder muscles are too active and you feel a strong urge to go to the bathroom when actually there is only a little amount of urine in your bladder. The common causes of urge incontinence are involuntary and inappropriate detrusor muscle contractions. Urge incontinence is otherwise known as spastic bladder, overactive bladder or reflex incontinence. Individuals with this condition may experience urge incontinence during sleep, after drinking small amount of water, or when they touch or hear water running. The involuntary actions of the bladder muscles in this condition are often associated with nerve damage caused by nervous system disease or to the muscles itself. Such neurologic diseases may include Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke and injury to the bladder during surgery such may include prostate removal, cesarean section, hysterectomy, and intestinal or rectum surgery. Other causes of urge incontinence are tumors or cancer of the uterus, bladder or prostate, interstitial cystitis (inflamed bladder wall), prostatitis (inflamed prostate).

Among elderly patients with arthritis, Parkinsons’ disease or Alzheimer’s disease; functional incontinence is the most commonly seen. These individuals are unable to control their bladder and usually they pass urine before reaching the bathroom due to limited mobility. Causes of this condition consist of confusion, dementia, poor eyesight, poor mobility, poor dexterity, depression, anxiety, anger, and drunkenness.

Overflow incontinence are often seen on individuals cannot completely empty their bladder causing a frequent urination or dribbling of urine. This is caused by weak bladder muscles due to nerve damage from diabetes and other diseases, as well as blocked urethra brought by urinary stones, tumors, and enlarged prostate among men.

When physical problems in the urinary system are involved they are called structural type of incontinence. This condition is rare but is common among children with defective urinary systems. Causes of structural incontinence include urinary reflux or vesicoureteral reflux disease, blocked bladder or urethra, nerve damage associated with birth defects spina bifida, and ectopic ureter.

Enuresis, also known as Bedwetting is another type of urinary incontinence defined as bed-wetting during sleep. This is common among children and is more prevalent on boys compared to girls. Most children outgrow bedwetting when they reach 6 years old.

Other less common types of urinary incontinence are mixed and transient incontinence. Mixed incontinence is common among female elderly and is sometimes associated with urinary retention causing urinary infection which needs a more upstaged or aggressive treatment. Transient incontinence is a temporary type of incontinence that are caused by medications, urinary tract infections, mental impairment, restricted mobility, and severe constipation which pushes the urinary tract and therefore obstructs the outflow.

Women experience urinary incontinence more often than men that is why female stress incontinence is very common. Oftentimes, pregnancy, childbirth, menopause poses some physical changes on urinary system of females. Childbirth can injure the scaffolding which supports the bladder and in most cases pelvic floor muscles may also weaken thus causing stress incontinence. When pelvic muscle weakens, the bladder can move downward and can push the bottom of the pelvis towards the vagina. This causes an effect on the normal function of the urethra to shut and the result is urine may leak out during increased physical stress. During menstruation, stress incontinence may worsen due to lowered estrogen levels that create a lower muscular pressure on the urethra. On menopausal women, stress incontinence increases because a decrease in estrogen during menopause weakens the sphincter muscle.

On the other hand, males did not escape the problems of urinary incontinence. They too suffer stress incontinence due to various types of bladder control problems. Male stress urinary incontinence commonly is caused by prostate surgery which injures the sphincter muscle, or valve, leading to a defect on the urinary flow. Most of these prostate surgeries are indicated for benign prostatic hyperplasia (enlarged prostate) and prostate cancer.

Urinary stress incontinence is treatable and in most cases, symptoms are improved dramatically. Noninvasive treatments of urinary stress incontinence may include behavioral therapy, pelvic floor muscle exercises or Kegel exercises, and biofeedback and electrostimulation devices. Medications are also utilized to prevent unwanted bladder contractions, tighten the bladder or urethra muscle or to relax the bladder.

When all treatment options fail, surgery is the last resort. Urinary stress incontinence surgeries are often needed to remove blockages, change the bladder position, add bulk to tissues or add support to weak pelvic muscles. Some cases need an artificial urinary sphincter. These surgical treatments are Pubovaginal fascial slings, suburethral slings, sacral nerve stimulation, enlarging the bladder, and laparoscopic surgery.