Urinary incontinence is a term given to involuntary leakage of urine. Disease impacts the quality of life of a person and is a distressing situation. Urinary incontinence generally results secondary to a underlying medical condition which is often treatable. If there is problem with stools the condition is known as fecal incontinence.

 

Continence and micturition is due to balanced activity of detrussor muscle and urethral closure. Urethral pressure is normally more than bladder pressure which results in residual urine in the bladder. Normal voiding is due to changes in urethral and bladder pressure.

Management of Incontinence

Weight loss - It has been proved in studies that weight reduction can help in reducing the incidences of incontinence especially in women who have a BMI of more than 25. Persons who are overweight and suffering from incontinence should consider reduced diet and exercise plans to manage incidences of incontinence.

 

Absorbent products - Various absorbent products like shields, undergarments, protective underwear, briefs, diapers and underpads can be prescribed to the patients.

 

Exercises - Strengthening the pelvic muscles by exercising is proved to be of good help in the incontinence patients. Kegel exercises are generally prescribed which will strengthen the pelvic floor muscles and sphincter muscles which lead to reduction of stress incontinence leakage. Benefits of the exercise will decrease as the age advances. It is advisable to perform more than 20 daily contractions of the pelvic muscles for at least 6 weeks. The tone of the pelvic floor muscles can be assessed using a Kegel perineometer. In women incontinence after the childbirth can be controlled by pelvic floor strengthening exercises.

 

Electrical stimulation - Electrical stimulation is used in cases of both stress incontinence and urge incontinence. In this procedure electrodes are placed in the vagina or rectum and doses of electrical stimulation are given to stimulate nearby muscles which simulates to exercising the muscles. . This can stabilize overactive muscles and stimulate contraction of urethral muscles.

 

Biofeedback - In this procedure measuring devices are used to help the patient become aware of his or her body's functioning. Use of electronic devices or diaries to track the bladder and urethral muscles contraction is done so that the patient can gain control over these muscles. It is used to relieve stress and urge incontinence.

 

Bladder training - In this technique a patient uses a diary to record the voiding and filing time which is calculated by biofeedback, so it is helpful in a way that patient is able to know the time of his/her voiding and they can empty their bladder before it leads to incontinence. These techniques are effective for urge and overflow incontinence.

 

Medications - Many medications and hormones are used in this condition which will act on bladder muscles and nerves that supply the bladder. As these medications may have some side effects so they should be taken only after consultation with the doctor. Some of the commonly used drugs are –

1. Tolterodine
2. Oxybutynin
3. Propantheline
4. Darifenacin
5. Solifenacin
6. Trospium
7. Imipramine
8. Pseudoephedrine
9. Duloxetine

Vaginal Pessaries - It is recommended to women and is of ring shape. It compresses the urethra due to which there can be relief in stress incontinence.

 

Surgery - Surgery is also advised when all other treatments have failed to control the incontinence and it is hampering the quality of life. Various surgical options advised are –

1. Bladder repositioning
2. Marshall-Marchetti-Krantz procedure
3. Sling procedure
4. Tension-free transvaginal sling
5. Transobturator tape sling
6. Mini sling procedure
7. Bladder augmentation surgery
8. Artificial urinary sphincter
9. Catheterization