diease

Incontinence


Incontinence overview and Definition

Incontinence is the involuntary movement of leaking of the Urine from the bladder.


Pathophysiology

Bladder smooth muscle (the detrusor) contracts via parasympathetic nerves from spinal cord levels S2 to S4. Urethral sphincter mechanisms include proximal urethral smooth muscle (which contracts with sympathetic stimulation from spinal levels T11 to L2), distal urethral striated muscle (which contracts via cholinergic somatic stimulation from cord levels S2 to S4), and musculofascial urethral supports. In women, these supports form a two-layered “hammock" that supports and compresses the urethra when abdominal pressure increases. Micturition is coordinated by the central nervous system: Parietal lobes and thalamus receive and coordinate detrusor afferent stimuli; frontal lobes and basal ganglia provide signals to inhibit voiding; and the pontine micturition center integrates these inputs into socially appropriate voiding with coordinated urethral relaxation and detrusor contraction until the bladder is empty. Urine storage is under sympathetic control (inhibiting detrusor contraction and increasing sphincter tone), and voiding is parasympathetic (detrusor contractor and relaxation of sphincter tone). When any interference occurs in these stimulus which might result in the dysfunction of the various muscles and also the centers as the parietal lobes and thalamus.


Clinical signs & symptoms

  • burning with urination
  • involuntary control of urine
  • increased frequency of urination without passing much urine
  • increased urgency of urination
  • lethargy
  • bloody urine
  • cloudy urine
  • urine that looks like cola or tea
  • urine that has a strong odour
  • pelvic pain in women
  • rectal pain in men
  • constipation
  • pain during micturition
  • oliguria(small amount of urine in the increased time of interval)
  • loss of apetite


Differential Diagnosis

Cystoscopy:

It is the small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens and also it emits light and what happens in the inside of your urethra and bladder, to examine these structures for signs of disease.

Biopsy:

It is the procedure of removing the tissue from the kidney

In cystoscopic procedure , it has some specialized  tool through which the scope and into your bladder to collect a cell sample (biopsy) .

Examining a urine sample (urine cytology). A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.

   Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or        retrograde pyelogram, are used to reveal the structures in the urinary tract.

During a CT urogram, a contrast dye is injected intravenously by the hand and eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract

Retrograde pyelogram:

It is an X-ray exam used to get a detailed look at the upper urinary tract. The threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

  Blood tests: A blood cell count can help identify organ problems.

CT scan: A medical professional might use a barium liquid to show up any cellular abnormalities.

MRI: Special types of MRI may be able to identify the organ cancer in its early stages.

Ultrasound: High-frequency sound waves create an image of the target area on a monitor.

 


Prognosis

The prognosis is good with the proper treatment


Prevention

Maintain the normal weight

Do pelvic strengthening exercises

Avoid stressful activities

Intake large amount of water

Avoid chronic exposure to chemicals

Be hygienic while voiding urine and during sexual practices

Avoid smoking

Avoid consumption of alcohol

Take lots of fiber containing fruits and vegetables