Incontinence is the accidental leakage of urine. The act of urination goes out of one’s control in such a condition. Bladder control develops earlier in females than in males. Men and women both are affected by this condition. As age advances men become more vulnerable to this condition due to prostate enlargement but this may not be a rule.
The functioning of the bladder is controlled at the local level by a micturition reflex and by the spinal cord and the brain at the higher level. The brain has centers that tell the individual if it is the right place and time to urinate. These centers are affected in conditions like Stroke, Parkinsonism, Alzheimer’s and Brain tumor because of which the person may urinate immediately after he gets the urge. The person may pass urine in bed, in a gathering etc. This is a type of urge incontinence.
At times the person may suffer from spinal cord injury. The spinal cord has nerves that carry sensation of bladder fullness from the bladder to the brain. As soon as the brain senses bladder fullness, it instructs the individual to go to the washroom to relieve him. Till such a place is found the brain sends signals through other nerves to keep the bladder opening closed. But in cases of spinal cord injury, this connection between the brain and bladder is lost as the spinal cord nerves are cut. In this case the person gets the urgency to void urine and he does it immediately. This is also a type of urge incontinence. Also in spinal cord injury the bladder gets spastic or overactive. A little bit of urine causes reflex contraction of bladder resulting in its contraction and expulsion of small amounts of urine with increased frequency. This is known as overactive bladder.
In conditions such as diabetes mellitus or other nerve diseases, the bladder muscles become weak and nerves causing the bladder contraction are diseased. As a result even after the bladder is full, there is no reflex contraction and emptying of bladder and the bladder keeps filling up till it overflows. This is known as overflow incontinence or dribbling.
Another variety is the stress incontinence which is found more commonly. The neck of the bladder has a ring of muscle called the sphincter. This sphincter is usually fully contracted to keep the bladder mouth closed. This muscular ring is supported by pelvic muscles. When the pelvic floor muscles get weakened, this ring also gets weak. As a result the mouth of the bladder in not totally closed at all times. So in instances where there is an increase in abdominal pressure as in laughing, coughing, sneezing, lifting weights etc., there is leakage if urine as the bladder is compressed. Enlarged prostate puts pressure on the bladder causing premature outflow of urine that cannot be voluntarily controlled.
The condition can be diagnosed by various methods. Digital rectal examination can help to see whether the prostate is enlarged. The abdominal and pelvic Ultrasonography can identify any external factors that may be compressing the bladder. Urodynamics can help to identify stress incontinence. Maintaining a diary on number of times you need to go to the washroom to relieve yourself is also a good indicator of incontinence.
Incontinence is curable. The methods and the time taken for cure will vary from person to person.
• Behavioral modification : Involves bladder training and timed voiding. Adjusting the time of fluid intake before bedtime or before going for a car trip or party can help avoid accidents during sleep or parties. Also timed voiding involves emptying of bladder after regular intervals. This technique is suitable for people with mechanical compression of bladder or overflow incontinence.
• Kegel exercise : Involves strengthening of the pelvic floor muscles which help to keep the sphincter muscles tight which in turn keep the bladder outlet closed during strenuous activities. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Repeat, but do not overdo it. Work up to 3 sets of 10 repeats. This is possible with the help of biofeedback also. This helps people with stress incontinence.
• Medications : Certain medications help to relax the bladder and surrounding muscles to allow full emptying (Alpha blockers). Some medicines help to reduce the level of hormone that enlarges the prostate, which in turn helps to reduce the mechanical pressure on the bladder and eases urine flow (5-alpha reductase inhibitors). Antispasmodics relieve the bladder muscle spasm thus preventing sudden bladder contractions.
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