Suggest Treatment For Urinary Incontinence While Treating Anxiety

Posted on Fri, 3 Nov 2017

Question: Hi,
I am writing to seek answers to below questions. I am 29 years old male and I am facing urinary incontinence issues since about a year. I dribble little urine especially after bowel movement or after I get up from sitting position. If I do hip abductor strengthening exercises I feel better for a few hours. However I regress to incontinence pretty soon. My symptoms worsens if I am stressed or am facing anxiety. In anxiety sometimes I feel weakness in my legs and leak quite a lot without sensing it.

I have already got ultra-sound of my urinary tract and all components seem to be normal in ultra-sound. My blood tests were normal too.

1. I want to understand if anxiety is causing my incontinence or is it vice-versa ? Which should be treated first ?

2. My symptoms also worsens if I do leg workout in gym. Is it possible that these symptoms are physiological ?

3. How do I know if my symptoms are nerve related, physiological or something else ? Should I start with physiotherapy, then proceed to nerve treatment and then to other methods ?

4. What is usually the treatment for this ? If left untreated, what complications could arise ?

5. Can this lead to infertility issues later ?

It will really be a big help if you can answer all the above questions in dea

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Read answers to our questions as detailed below

Detailed Answer:
Hello
Thanks for query .

The problem of incontinence that you are facing is mainly due to weakness of Urethral Sphincter that controls urination .

I would answer your queries point to point as detailed below

1) Anxiety is one of the mast important factor that initiates and causes incontinence of urine .

2) Working out exercises of leg should not cause weakness of urethral sphincter .

3)Isolated deficiency or neuronal nerve damage to nerve innervation of sphincter urethra is unknown .It is always peripheral neuritis that involves multiple nerve issues causing varied symptoms like tingling ,numbness,weak in lower limbs etc associated with incontinence.It should be our aim in such situation to strengthen the sphincter muscles by doing Kegel's Exercises for 15 minutes three times daily expecting to achieve satisfactory results after 3-4 months,

4) It is always advisable to get Urodynamic study of bladder and endoscopic examination of bladder (Cystoscopy) done to rule out neurogenic bladder done to rule out Neurogenic bladder and neurological cause for incontinence.
Treatment is doing regular and meticulous Kegel's exercises thrice daily helps to improve and resolve the issue within 6 months .Taking Vit B12 orally or injectables does help to achieve your goal.

5) It will not lead to infertility as it is unrelated to sperm production or transmission.

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (10 hours later)

Thanks for replying to my queries.

I have heard that cystoscopy is an invasive procedure with varied side-effects such as blood in urine, weakening of bladder wall leading to more incontinence, UTI, and in some cases, decrease in number of functionally competent sperm production. Hence I was thinking if may be we can start with physiotherapy and then with nerve and if nothing improves then only go for a risky procedure like cystoscopy. Will this do any harm ?

I happen to have a right duplex kidney. I am not sure if that has to do anything with this incontinence. Also, its not just urine that gets leaked. If I am very anxious then transparent sticky liquid also gets out sometimes.

I am told that given my age, no matter what, these things should not happen to me. Do you think taking anti-anxiety meds can treat incontinence automatically if issue is anxiety related ?

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
Cystoscopy is not risky procedure at all .

Detailed Answer:
Hello
Thanks for follow up .

You have misconception about Cystoscopy .

It is a very simple procedure done routinely and very helpful test that gives lot of information and helps to diagnose many urological problems .

Duplex moiety of the collecting system has no relations to your symptoms .

Taking anti anxiety drug may help to reduce incontinence .Consult qualified Psychiatrist for help and guidance .

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. P. T. Patil (24 hours later)

I am trying to understand this from perspective of cause of incontinence and its treatment for a 29 years old male who does not consume tea/coffee/alcohol and who is not sexually active. Please help me understand if I got this correctly -

1. Anxiety - Anxiety treatment as it will automatically treat incontinence

2. Physiological - Some muscle imbalance causing nerve to get irritated. Treatment will include physical therapy to correct muscle imbalance

3. Other causes - cystoscopy to identify what exactly is the cause and then subsequent treatment.

If I am right about this, then I would prefer to try 1 and 2 first and if they do not work then only go for 3 (just for peace of my mind). Just wanted to confirm if this approach has any downside.

Thanks for answering my queries.

Answered by Dr. Dr. P. T. Patil (8 hours later)

Brief Answer:
You can try two modality for few months .

Detailed Answer:
Hello
Thanks for follow up .

The primary aim is to establish the cause of your incontinence .
Doing Cystoscopy and Urodynemic study and Cystometry will rule out any neurological cause for your problem .

However you can follow two modalities that you have planned for and decide after few months about doing these tests .
Thanks and Regards.
Dr.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar