diease

Incontinence


OVERVIEW OF Incontinence :

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


CAUSES :

 

Types of Incontinence:

Stress Urinary Incontinence:

This type of urinary incontinence occurs due to stress. In this type the pelvic muscle let the urine escape. It is common among the women when compared to men. Physical activity of the bladder such as exercising, jumping, bending, lifting, sneezing or coughing can cause the drop leak from the urinary bladder.

Kegel exercise provides better relief.

Overactive Bladder (OAB):

The another common type is the overactive bladder. It is also called as urgency incontinence. The bladder muscles are too active. They has the fear of leaking out urine involuntarily.

Mixed incontinence:

This type include both the stress urinary incontinence and overactive bladder.

Overflow incontinence:

With overflow incontinence the bladder is full than they do accommodate 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.


COMMON CLINICAL SIGNS AND 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


DIAGNOSTIC :

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.

 


TREATMENT AND PROGNOSIS :

These treatment will depend on several factors such as the type of incontinence, the patient’s age, general health and their mental state.

Stress incontinence:

Pelvic floor exercises which is also known as Kegel exercises helps to strengthen the urinary sphincter and pelvic floor muscles the muscles that help to control the urination.

Bladder training:

Delaying the event:

the main goal is to control the urge. The patient knows how to delay the urination process whenever there is urge to go the bathroom.

Double voiding:

This involves urinating, then the patient is asked to wait for another couple of minutes then urinating again.

Toilet timetable:

The person schedules bathroom at set times during the day , for example every 2 hours.

Bladder training helps the patient gradually regain control over the bladder.

Medications that are used for the urinary incontinence:

If medicines are used , this is usually in combination with other techniques or exercises.

The following medications are prescribed to treat urinary incontinence.

Anticholinergics such as Oxybutynin, tolterodine calm overactive bladders and might help the patients with urge incontinence.

Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.

Imipramine is the tricyclic antidepressant.

 

Medical devices:

The following are the medical devices which are used for the females.

Urethral inserts :

A woman inserts the device before activity she wants to do and then take that out after she urinates.

Pessary:

A rigid ring like instrument is passed into the vagina and it might aids to hold the bladder up and prevent the leakage.

Radiofrequency therapy:

Tissues in the lower urinary tract is heated and when it heals it is usually firmer often resulting in better urinary control

Botox ( Botulinum toxin type A):

Injected into the bladder muscle this can help those with an overactive bladder

Bulking agents:

Injected into the tissues around the urethra and these help to keep the urethra closed.

Sacral nerve stimulation:

This is implanted under the skin of the buttock. A wire connects it to nerve that runs from the spinal cord to the bladder. The bladder emits an electrical pulse that stimulates the nerve , helping the bladder to control.

 

Surgery:

Surgery is an option if other therapies do not work. Women who plan to have children should discuss surgical options with a doctor before making the decision.

Sling procedures:

 A mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out.

Colposuspension:

 Lifting the bladder neck can help relieve stress incontinence.

Artificial sphincter:

 An artificial sphincter, or valve, may be inserted to control the flow of urine from the bladder into the urethra.

Urinary Catheter: A tube that goes from the bladder, through the urethra, out of the body into a bag which collects urine.

Absorbent pads: A wide range of absorbent pads is available to purchase at pharmacies and supermarkets.

 


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