Urinary Incontinence: Help available to treat involuntary loss of urine

Approximately 3-10% of men will encounter symptoms of urinary incontinence during their lifetime.
People may experience urinary incontinence more frequently as they age
People may experience urinary incontinence more frequently as they age

NEW DELHI: Do you leak urine when you cough, sneeze, or laugh? Do you often feel a sudden, strong need to urinate, even if you have just gone to the bathroom? Do you have difficulty emptying your bladder and need to strain when peeing? These symptoms may indicate a problem with your bladder function. Urinary incontinence (UI) can be a source of embarrassment when experienced in social settings or when it interferes with interpersonal activities. It is a common issue for men and women, albeit with differing etiologists, and can be managed.

People may experience urinary incontinence more frequently as they age, but it should not be automatically associated with aging. While it is more prevalent in women over 50, UI can affect individuals of any age. Additionally, it is essential to note that it is not categorised as a standalone disease; it can function as a symptom of an underlying medical condition.

The normal flow of urine from the kidneys to the bladder occurs through tubes known as ureters. The bladder serves as a reservoir for urine until a signal is sent to the brain, indicating the bladder is full.

Urinary Incontinence occurs due to issues within the urinary tract, says Dr Vimal Dassi, director of the department of urology, uro-oncology, robotics, and kidney transplant at Max Healthcare, Vaishali and Noida, Uttar Pradesh. He explained that structural changes in the pelvic floor area can be a potential cause of urinary Incontinence.

Three distinct types of UI exist. The first is stress incontinence, which manifests as leakage during activities that exert pressure on the bladder, such as coughing, sneezing, laughing, or exercising. The second type, urge Incontinence, is characterised by a sudden, intense urge to urinate, resulting in involuntary leakage. The third type, overflow incontinence, is marked by incomplete bladder emptying, leading to frequent or continual dribbling of urine.

Approximately 3-10% of men will encounter symptoms of urinary incontinence during their lifetime. According to Dr Dassi, about 80% of men with urinary incontinence experience urge incontinence, compared to 31% of women.

For men, the most prevalent change is an enlarged prostate, known as benign prostatic hyperplasia. The expansion of the prostate may lead to frequent or urgent urination, nocturia (nighttime urination), and various other symptoms. According to Dr Shalabh Agrawal, consultant, urology, CK Birla Hospital, Gurgaon, the most common cause of urine leak in women is primary overactive bladder, in which the bladder becomes weak and unable to hold enough urine.

Citing an example, he said that a woman might have the recurrent urge to pass urine, and when rushing to the washroom, she may leak a few drops or a large volume of urine even before reaching the washroom. "In such cases, women patients might suffer from increased frequency, which increases during the night and is known as nocturia. Sometimes women might feel pain in the bladder," said Agrawal. Most women suffer from UI because of pregnancy and vaginal delivery, which can damage or weaken pelvic floor muscles. Also, it can happen due to changes in her body function that may result from diseases, use of medications, or the onset of an illness or an infection like urinary tract infection (UTI).

"Women are most likely to develop urinary incontinence during pregnancy and after childbirth, or after hormonal changes of menopause. Bacteria can sometimes infect part of the urinary tract. The infection can irritate your bladder and cause Incontinence," Dassi added.

As the causes vary between men and women, so does their treatment.

Dr Sumit Bansal, Consultant, Urology, Manipal Hospital, Dwarka, Delhi, added that understanding both causes and symptoms is essential for accurate diagnosis and effective management of urinary Incontinence.

There is a combination of treatments, including less-invasive treatments like behavioural therapies. Most people suffering from UI are first recommended to make lifestyle changes, diet modifications, vaginal weight training (for women), and pelvic muscle rehabilitation, including pelvic floor muscle exercises.

Doctors may suggest pelvic floor electrical stimulation in which mild electrical pulses stimulate muscle contractions.

Various medications can relax bladder neck muscles and muscle fibres in the prostate to make it easier for them to empty the bladder.  Bansal said they recommend ⁠Kegel's exercise, which is helpful in post-operative and mild incontinence cases. But if urinary incontinence continues to affect your daily activities, don't hesitate to see your doctor. "There are many therapies that can be done on a daycare basis and have a rapid recovery and excellent results. Many women are not aware of these kinds of surgeries, and they tend to suffer for very long periods," added Agrawal.

Dr Bansal said they perform a TOT sling, a procedure for women with stress urinary incontinence when their condition doesn't improve with medication. It involves placing a sling to support the urethra and prevent leaks during activities like coughing or lifting. For men, implants are also available. Pressure device implants can help control urine leakage by applying gentle pressure to the urethra. Besides, there is a male artificial sphincter for men with complete UI. Bansal says it mimics the function of a natural sphincter, allowing the patient to control when to release urine.

However, doctors said many people recover by making simple changes in their lifestyle and diet, maintaining a healthy weight, practicing pelvic floor exercises, avoiding smoking, managing chronic conditions like diabetes and constipation, and staying hydrated.

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