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Urinary incontinence is a common condition that affects people of all ages, with challenges that go beyond physical discomfort. In this article, you will understand the impact of this condition on daily life, explore different types and causes of incontinence, and learn about the diagnostic process.
◉ What is urinary incontinence?
L'incontinence urinaire (IU), ou la fuite urinaire, est la perte involontaire des urines par l'urètre, elle est une affection très courante et souvent embarrassante dont personne ne veut parler.
It is a condition that affects people of all ages, although it is more common in older people, especially women.
Incontinence can be a temporary problem caused by a urinary tract infection, constipation, or certain medications, or it can be a chronic condition.
Severity ranges from occasionally leaking urine when you cough or sneeze to having the urge to urinate so sudden and strong that you can't get to the bathroom in time.
If you suffer from urinary incontinence and it interferes with your daily activities, it is strongly recommended that you make an appointment with your doctor.
◉ Types of urinary incontinence
There are several types of urinary incontinence, including:
1- Stress urinary incontinence
- It is one of the most common types of urinary incontinence. This type of incontinence occurs when the muscles that control the bladder are weakened, causing urine to leak during activities that put pressure on the bladder and urethra.
- Sudden movements, physical activity, or everyday actions that use the pelvic floor muscles (eg coughing, sneezing, or laughing) can cause urine to leak.
2- Urge Incontinence (Overactive Bladder)
- This occurs when there is a sudden, intense urge to urinate and the bladder constricts before the person can go to the toilet. It is often linked to an overactive bladder.
- Overactive bladder is more likely in men with prostate problems and in women after menopause.
3- Mixed Incontinence
- Means you have more than one type of incontinence. It is usually a combination of stress and urge incontinence.
4- Overflow incontinence
- This happens when the bladder does not empty completely (the bladder muscle does not contract (tighten) as it should). This causes too much urine to remain in your bladder, resulting in constant leakage of small amounts of urine.
5- Functional incontinence
- It is a type of incontinence that occurs when a person, usually with intact bladder and sphincter function, has a physical or cognitive impairment that prevents them from getting to the bathroom in time to urinate.
6- Reflex incontinence
- It occurs when the bladder empties out of control, due to spinal cord injury or another neurological condition.
◉ Causes of urinary incontinence
Urinary incontinence can be caused by everyday habits, underlying medical conditions, or physical problems. These causes can be classified as temporary or chronic:
◉ Temporary urinary incontinence is usually caused by a specific trigger or event and goes away once the underlying cause is treated:
- Urinary tract infection: Cystitis, Pyelonephritis.
- Constipation
- Vaginal irritation
- Pregnancy
- Certain drinks or foods: Alcohol, Caffeine, Chocolate, Peppers.
- Certain medications: High doses of vitamin C, blood pressure medications, sedatives, and muscle relaxants. Incontinence often goes away when you stop taking the drug.
◉ Chronic urinary incontinence, on the other hand, is a long-term condition that may require ongoing management and treatment:
- Pelvic Floor Disorders: When the pelvic floor muscles are weak or damaged (multiple pregnancy, difficult childbirth, genital prolapse), they may not be able to properly support the bladder and urethra.
- Prostate problems: Enlarged prostate (BPH), prostate adenoma or cancer, etc.
- Bladder problems: Overactive bladder muscles, bladder cancer, stones.
- Hormonal Changes (Menopause): Changes in hormone levels, especially a decrease in estrogen, can cause changes in the bladder and urethra that can contribute to urinary incontinence.
- Neurological disorders: Multiple sclerosis (MS), stroke, Alzheimer's disease, Parkinson's, spinal injury, etc.
- Anatomical problems: urethral diverticulum, fistula, etc.
- Surgery: After surgery on the abdomen or pelvis (e.g. prostate surgery for prostate adenoma, prostate cancer, hysterectomy).
◉ Risk factors
Urinary incontinence can affect people of all ages, genders and backgrounds, but it is more common in certain groups.
- Gender: Women are more likely to suffer from incontinence, especially after pregnancy, childbirth and/or menopause.
- Are a man with prostate problems.
- Age: As you age, the muscles in your bladder and urethra lose some of their strength.
- Certain diseases: Neurological diseases (Parkinson's disease or multiple sclerosis) or diabetes.
- Having a birth defect that affects the structure of your urinary tract.
- Being overweight: Excess weight can put pressure on the bladder and pelvic muscles.
- Smoking
- Chronic cough: Conditions that cause chronic cough (e.g. asthma or chronic bronchitis) can put pressure on the bladder and lead to incontinence.
- Chronic constipation
- Family history of urinary incontinence.
◉ What are the symptoms of urinary incontinence?
The main symptom of urinary incontinence is involuntary leakage of urine. However, specific symptoms can vary depending on the type and severity of incontinence. Some common symptoms of urinary incontinence include:
- Sudden, strong urges to urinate or the feeling that you might not get to the bathroom in time.
- Leakage of urine during normal activities such as lifting, bending, coughing, or exercising
- Frequent urination, often more than eight times a day (overactive bladder).
- Constant feeling of wetness without the feeling of leaking urine.
- Sensation of incomplete emptying of the bladder.
- Leakage of urine without feeling the urge.
- Nocturia: Waking up from sleep to urinate.
◉ Diagnosis
The diagnosis of urinary incontinence usually involves a thorough history, physical examination and various additional tests:
- Medical history: Your doctor will ask about your symptoms, timeline, risk factors, etc.
- Physical exam: to look for signs of pelvic floor muscle weakness, nerve damage, or other potential causes of incontinence.
- Urine and/or blood tests.
- Urodynamic test: This test includes several tests that check your bladder capacity and the functioning of your urethral sphincter muscle.
- Imaging tests: Ultrasound or cystoscopy may be used to examine the bladder and urinary tract for signs of abnormalities.
Your doctor will work with you to determine the most appropriate diagnostic methods.
◉ Treatment of urinary incontinence
The treatment will depend on several factors, such as the type of incontinence, its severity, the age and lifestyle of the patient. The simplest and safest treatments should be tried first. Among the treatments available for urinary incontinence:
Behavioral therapy and rehabilitation
- Pelvic floor muscle strengthening exercises, such as Kegel exercises.
- Lifestyle adjustments can help reduce symptoms of urinary incontinence, such as managing fluid intake, avoiding foods that irritate the bladder, managing weight, and establishing a regular schedule for bathroom visits.
- Rehabilitation techniques, such as planned urinary retention and bladder rehabilitation.
Medical devices
Medical devices such as vaginal rings or urethrostimulators can be used to support pelvic floor tissues or stimulate bladder nerves.
Medications
- Anticholinergics: These drugs block the receptors for acetylcholine, a neurotransmitter involved in muscle contraction of the bladder (thereby reducing involuntary contractions and the urgent need to urinate).
- Alpha-blockers: Are generally used in the treatment of male urinary incontinence caused by benign prostatic hyperplasia (BPH)
- Topical Estrogen: Helps maintain healthy urethral and pelvic floor tissues, reducing symptoms of urinary incontinence related to tissue atrophy.
Surgical procedures
- Male Sling : It consists of placing a band (sling) under the urethra. It is an option for the patient suffering from mild stress urinary incontinence
- Alpha blockers: A small incision is made in the abdomen to hold and support the tissues around the neck of the bladder, usually for the treatment of female stress urinary incontinence .
- Prolapse repair: Treatment of vaginal wall prolapse is individualized and aimed at improving quality of life.
It is important to consult a medical professional to get an accurate diagnosis and discuss appropriate treatment options based on your particular situation.