Urine is produced by the kidneys and stored in a urinary bladder passed out from the body through a tube called urethra. Urinary incontinence is the loss of bladder control that can cause accidental leakage of urine from the body. This is due to the problem with a person’s urinary tract. For example, a person may feel a strong urgency to urinate just before losing a large amount of urine. This is called urgency incontinence. It can be slightly bothersome as for some people; the chance of embarrassment keeps them away from enjoying many activities like exercising, cycling, dancing etc causing more emotional distress.
Urinary incontinence can occur more often in older men than in young men. It can happen due to several reasons that include:
• Bladder when squeezes too hard causes urine leakage.
• Damaged or weak muscles around the urethra
• When bladder gets too full, urine leaks out
• Any obstruction or blockage in the urethra, can build up the urine in the bladder. This can cause leaking.
• Birth defects (urinary tract development problem)
• History of prostate cancer (due to radiation or surgery)
• Chronic coughing that may increase pressure on the bladder and pelvic muscles
• Neurological problems like Parkinson’s disease
• Physical inactivity
• Benign prostatic hyperplasia (BPH)
• Spinal injury
• Over active bladder
• Urinary Incontinence can be short or long (chronic) term. Other health problems or treatments can often cause short-term incontinence. Following are the different types of long or chronic urinary incontinence.
• Stress Incontinence is urine leakage when person sneezes, cough, laugh, lift something or do something that puts stress on his bladder.
• Urge Incontinence is a strong urge to urinate that man even can't make it to the toilet in time. This can also occur when a man is having only a small amount of urine in his bladder.
• Overflow Incontinence is when a man have the urge to urinate, but is able to release only a small amount. Since the bladder doesn't empty as it should, it may leaks urine later.
• Total Incontinence is when a man is always leaking urine. It happens when the sphincter muscle no longer works.
• Functional Incontinence means that a person can't make it to the bathroom in time to urinate due to physical disability or external obstacles. For example man in a wheelchair may have trouble going to toilet in time, Arthritis pain and swelling of the joints may make it hard for a man to walk to the toilet quickly.
There are several tests to diagnose the urinary incontinence such as:
• Medical history – doctor will ask patient to provide medical history, a review of symptoms, eating habits, pattern of urination and urine leakage like the amount and type of liquid he drinks, number of times he urinates in a day or how much urine is released, how often he has accidental leaks, since how long the symptoms have been occurring etc.
• Physical exam – to help in diagnosing urine incontinence, doctor will perform physical exam to look for signs which is causing UI.
• Digital rectal exam – it is a physical exam of the prostate and rectum. Patient has to bend over a table or lie on his side while holding his knees close to his chest. Doctor will slide a gloved, lubricated finger into the patient’s rectum and feels the part of the prostate that lies in front of the rectum. The digital rectal exam is used to check for stool or masses in the rectum and to assess whether the prostate is enlarged or tender, or has any other abnormalities.
• Diagnostic tests – such as urinalysis, urine culture, blood tests, urodynamic testing etc
Treatment for urinary incontinence depends on its underlying cause, type of incontinence and severity. A combination of treatments may be required and may include one or more lifestyle changes in addition to medication. Doctor will likely to recommend least invasive treatments initially and will move on to more advance procedure or surgery only if these techniques fail. These treatment options may include:
1. Lifestyle and behavioral changes
• Fluid and diet management - may help in better control of urge to go. Person with UI should drink water or other beverages in smaller amounts throughout the day instead of drinking large amounts at once. He should also avoid or control excessive intake of alcohol, caffeine or acidic foods. Losing weight and increasing physical activity can help in ease the problem.
• Bladder training – scheduling toilet trips may help person to avoid urge to go. Person may require delaying a trip to the toilet each time he gets an urge to urinate. This may help bladder and urinary tract to grow stronger. The main aim is to lengthen the time between trips to the toilet.
• Pelvic floor muscle exercises – also known as Kegel exercises that may help in rebuilding strength and tighten muscles in the pelvis and urinary tract system. These exercises are especially effective for stress incontinence. In pelvic floor muscle exercise, person should try to stop urine flow and then contract the muscles and then relax for 5 seconds. Keep holding the contractions for 10 seconds at a time. Should try to do at least three sets of 10 repetitions each day. Doctor may suggest doing this with the help of physical therapist to get the right technique of contracting muscles.
• Electrical stimulation – In this technique, electrodes are temporarily inserted into the rectum to strengthen the pelvic floor muscles. Light stimulation can prove effective for stress incontinence and urge incontinence but patient may require multiple treatments for several months.
• Alpha – blockers are given to men with enlarged prostate which can help them with an urge or overflow incontinence. these medications helps relaxing bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder
• Mirabegron – helps relaxing bladder muscles and increase the amount of urine bladder can hold. These will also help a patient to empty their bladder completely each time they urinate.
• Botulinum – type of botox injected the bladder to help ease bladder muscles.
• Anticholinergics – to calm overactive bladder muscles and urge incontinence
3. Medical devices
• Catheters –this may help in emptying the bladder completely. This catheter, a thin, flexible tube is placed into the bladder through the urethra. The urine drains out and catheter is removed.
• Urinary collection devices - A condom catheter is placed over the penis and collects leaked out urine. This can be used for a short time and prolonged use can increase the risk of developing urinary tract infections and skin irritation.
• Underwear guards - absorbent pads stick to the underwear to absorb urine which will not stop the leaks but can prevent any wetness or spotting.
• Artificial urinary sphincter balloon surgery (AUS) – a small fluid filled balloon ring is inserted around the neck of the bladder that helps in keeping the urinary sphincter shut until it’s time to urinate. When a person wants to urinate he can press a valve placed under the skin to deflate the balloon and allows urine from bladder to flow.
• Sling procedure – doctor will take a strips of body tissue, synthetic material or mesh to create a supportive sling around the bladder neck. The sling keeps the urethra closed, even when a person coughs, laugh, run or sneezes. This procedure is used to treat stress incontinence. The recovery after surgery can take anywhere from several hours to several days.
Urinary incontinence may interfere with many activities in person’s life. Although it can be treated but still person can have concerns about certain aspects of his life. Activities concerns with urinary incontinence may include sexual activities, physical activities such as exercising, running; hiking etc seems difficult to deal with.
Urinary incontinence may not be preventive due to certain factors like age, neurological conditions etc but controlling one’s lifestyle habits like eating balanced diet, regular exercise, weight loss, strengthening pelvic floor muscles etc may help ease the condition.