Urine leaks may vary from minor to severe. Frequent leaks to total loss of bladder control are called urinary incontinence (UI). Urinary incontinence is caused because of the weakened pelvic floor muscle, constipation, hormonal changes, and nerve damage urinary tract infections.
Different types of urinary incontinence:
Stress incontinence: The leakage of urine occurs during the activity which can increase the abdominal pressure.
Urge incontinence: The intense and sudden urge to urinate, which is followed by an involuntary bladder contraction, which can lead to leakage of urine.
Overflow incontinence: Inability to empty the bladder, which leads to constant or frequent leakage of urine.
Functional incontinence: It occurs when cognitive or physical impairment which prevent a person to use the toilet in time.
Epidemiology
Urinary incontinence is a prevalent disease among the elder people. It can affect all the ages of people. There is a lack of reporting and diagnosis of urine incontinence. About 5% of the people who are living in the community and about 2% of the people will get the proper medical treatment and care.
This disease is seen in women more frequently than men. Conditions like childbirth, menopause, and pregnancy contribute to this. These conditions may weaken the pelvic floor muscles and increase the possibility of stress.
Anatomy
Pathophysiology
The main cause of urinary incontinence is injured or weakened tissues and pelvic muscle floor. Apart from this activities which can increase the intra-abdominal pressure like sneezing, coughing, lifting, or laughing. This can weaken the bladder, neck, and urethra to move downhill, which can lead to urine leakage.
The other cause of urinary incontinence of bladder is an involuntary contractions of the detrusor muscle. The smooth muscle layer which is present in the bladder wall contracts and empty the bladder. There is a sudden and strong urge to urinate, which increases from the involuntary contractions. This can lead to the frequent urine flow before the person goes to the restroom.
Etiology
Urinary incontinence may result from the nervous system dysfunction. It impairs the control system of the bladder. Urethral hypermobility is the most common cause of stress incontinence in female because of the improper pelvic support. Females who have experienced surgery, childbirth, post-menopausal estrogen loss, or specific disease which can impair the tissue strength and lose the pelvic support are at the risk of this disease.
The urge of urinary incontinence may result from the overactivity of the detrusor muscle, which regulates the bladder construction.
Genetics
Prognostic Factors
The prognosis may vary depending on the type of urine incontinence. It is necessary to identify the main cause or contributing factors.
Impair bladder function can occur because of the comorbidities or any changes in the age-related issues. Aging can affect the prognosis of UI in older patients. The evaluation of the function and strength of the pelvic floor muscles in patients like these may help in prognosis result.
Clinical History
Age Group:
Urinary incontinence is common in children, specifically during early childhood. For the 18 years to 45 years of age group, UI may occur because of the factors like childbirth and pregnancy, hormonal changes, weakness in pelvic floor muscle, and obesity.
Physical Examination
General examination: To assess the vital signs, overall health status, and general appearance.
Abdominal examination: Palpate the abdomen for masses, tenderness, or organ enlargement, which can lead to conditions like bladder distension, pelvic organ prolapse, or urinary retention.
Genitourinary examination: It evaluates the signs of prostate enlargement or any abnormality of the genitalia in men, which can lead to UI.
Neurological examination: It assess the neurological function which include the moor strength, reflexes, sensation, and coordination.
Age group
Associated comorbidity
Associated Comorbidity or Activity:Â
UI may be caused by pelvic organ prolapse, a condition in which one or more pelvic organ drop into the vaginal space. Benign prostatic hyperplasia, enlargement of the prostate gland is a frequent problem in older men. This can cause urinary symptoms like frequency, urgency, weak urinary stream, and overflow UI. Diabetes mellitus, when improperly controlled, can affect the function of the bladder and lead to UI.
Associated activity
Acuity of presentation
Acuity of Presentation:
Acute urinary incontinence can cause because of the UTI, neurological diseases, and urinary retention. Some cases of UI occur sudden and acute, and the symptoms appear within a short period of time from hours to days. It gradually develops over the time. In some cases, the progression of symptoms are slow and will noticeable over weeks, months or years.
Differential Diagnoses
Stress Urinary Incontinence (SUI): Individuals who may experience the stress and urge of UI. Structural abnormalities like urethrocele or cystocele can lead to symptoms like SUI.
Urge Urinary Incontinence (UUI): UUI includes an intense, sudden urge to urinate that followed by an involuntary urine leakage.
Overactive bladder (OAB): Any symptoms which are frequent and urgent without incontinence may lead to OAB instead of UUI.
Overflow Urinary Incontinence (OUI): OUI causes when the bladder cannot empty completely, and this can lead to chronic urinary retention and dribbling of urine.
Benign prostatic hyperplasia (BPH) in men: Enlargement of the prostate gland may obstruct the bladder outlet and lead to symptoms of urinary retention and overflow UI.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Lifestyle Modifications: Behavioral interventions like scheduled voiding, bladder training, and fluid management may help to improve the bladder control and decrease the urinary urgency and frequency.
Pelvic Floor Muscle Exercises: Pelvic floor muscle exercise is an necessary component to manage the stress of UI.
Bladder Training: Bladder training includes the scheduled voiding and continuously elevating the interval between voids to improve bladder control and capacity.
Surgical Interventions: Surgical procedures can be suggested for pelvic organ prolapse or stress UI, which does not respond to the conservative treatment.
Accessible Bathrooms: Make sure that bathrooms are easily accessible specifically for those individuals who have mobility issues. To provide stability and support, install grab bars in the shower, toilet or bathtub.
Adequate Lighting: Make sure the pathways to the bathroom and bathroom has well light to decrease the risk of falls specifically during the nighttime.
Non-Slip Flooring: Use non-slip rugs or mats in the bathroom to avoid slips and falls near the toilet, shower, and bathtub.
Waterproof Protection: Use absorbent bed pads and waterproof mattress protectors to protect bedding from accidental urine during sleep.
Accessible Clothing: Choose undergarments and clothing which are easy to remove and replace specifically for those who have limited mobility.
Communication and Support: Encourage an open communications and provide emotional support to those who are dealing with UI.
Use of Alpha-Adrenergic Agonists
Midodrine: Midodrine stimulates the alpha-adrenergic receptors. It causes vasoconstriction and an elevation in blood pressure. It enhance the urethral closure and decrease the stress UI by elevating the sympathetic tone and enhancing the smooth muscle contraction in the neck and urethra of bladder.
Use of Anticholinergic Agents
Dicyclomine: Dicyclomine is an anticholinergic drug. It relaxes the smooth muscle and prevent the acetylcholine to act at parasympathetic areas in smooth muscles and secretory glands.
Use of Antispasmodic Drugs
Flavoxate: Flavoxate is used to treat the symptoms of prostatitis, urethritis, incontinence, and cystitis which can lead to nocturia and dysuria. Flavoxate directly inhibit the phosphodiesterase to relax the smooth muscle. It relaxes may types if spasms in smooth muscle.
Use of Beta3 Agonists
Mirabegron: Mirabegron is suggested for OAB symptoms, which include frequency, urgency, and urge UI.
Use of Serotonin/Norepinephrine Reuptake Inhibitors
Duloxetine: Duloxetine inhibits the norepinephrine and neuronal serotonin uptake. It has antidepressant effects. It has the potential for noradrenergic and CNS serotonergic effects.
Use of Alpha-Adrenergic Blockers
Prazosin: Prazosin may help to empty the bladder by decreasing the tome of internal sphincter and elevating the urine flow.
Mid-urethral Sling Placement: The surgeon creates small incisions in the vaginal wall and sub-urethral space during the procedure. A synthetic mesh sling, which is made of polypropylene, is placed underneath the mid-urethra for support. The sling is places to provide the support to the urethra during the elevation in the intra-abdominal pressure like sneezing, lifting, or coughing.
use-of-phases-in-managing-urinary-incontinence
Assessment and Diagnosis: The initial phase of management includes a comprehensive assessment of the type, severity, and underlying cause of UI.
Conservative Management: Conservative management include the first line approach for UI and can be initiated depending on the underlying type and severity of symptoms.
Pharmacological Therapy: If conservative management is not sufficient to control the symptoms, then pharmacological treatment can be considered as an adjunctive treatment. Medications like beta-3 adrenergic agonists, anticholinergics, or mirabegron can be used to reduce the urinary urgency.
Follow-up and Long-Term Management: Long-term management of UI includes ongoing monitoring, follow-up, and adjustments to treatment as needed.
Urine leaks may vary from minor to severe. Frequent leaks to total loss of bladder control are called urinary incontinence (UI). Urinary incontinence is caused because of the weakened pelvic floor muscle, constipation, hormonal changes, and nerve damage urinary tract infections.
Different types of urinary incontinence:
Stress incontinence: The leakage of urine occurs during the activity which can increase the abdominal pressure.
Urge incontinence: The intense and sudden urge to urinate, which is followed by an involuntary bladder contraction, which can lead to leakage of urine.
Overflow incontinence: Inability to empty the bladder, which leads to constant or frequent leakage of urine.
Functional incontinence: It occurs when cognitive or physical impairment which prevent a person to use the toilet in time.
Urinary incontinence is a prevalent disease among the elder people. It can affect all the ages of people. There is a lack of reporting and diagnosis of urine incontinence. About 5% of the people who are living in the community and about 2% of the people will get the proper medical treatment and care.
This disease is seen in women more frequently than men. Conditions like childbirth, menopause, and pregnancy contribute to this. These conditions may weaken the pelvic floor muscles and increase the possibility of stress.
The main cause of urinary incontinence is injured or weakened tissues and pelvic muscle floor. Apart from this activities which can increase the intra-abdominal pressure like sneezing, coughing, lifting, or laughing. This can weaken the bladder, neck, and urethra to move downhill, which can lead to urine leakage.
The other cause of urinary incontinence of bladder is an involuntary contractions of the detrusor muscle. The smooth muscle layer which is present in the bladder wall contracts and empty the bladder. There is a sudden and strong urge to urinate, which increases from the involuntary contractions. This can lead to the frequent urine flow before the person goes to the restroom.
Urinary incontinence may result from the nervous system dysfunction. It impairs the control system of the bladder. Urethral hypermobility is the most common cause of stress incontinence in female because of the improper pelvic support. Females who have experienced surgery, childbirth, post-menopausal estrogen loss, or specific disease which can impair the tissue strength and lose the pelvic support are at the risk of this disease.
The urge of urinary incontinence may result from the overactivity of the detrusor muscle, which regulates the bladder construction.
The prognosis may vary depending on the type of urine incontinence. It is necessary to identify the main cause or contributing factors.
Impair bladder function can occur because of the comorbidities or any changes in the age-related issues. Aging can affect the prognosis of UI in older patients. The evaluation of the function and strength of the pelvic floor muscles in patients like these may help in prognosis result.
Age Group:
Urinary incontinence is common in children, specifically during early childhood. For the 18 years to 45 years of age group, UI may occur because of the factors like childbirth and pregnancy, hormonal changes, weakness in pelvic floor muscle, and obesity.
General examination: To assess the vital signs, overall health status, and general appearance.
Abdominal examination: Palpate the abdomen for masses, tenderness, or organ enlargement, which can lead to conditions like bladder distension, pelvic organ prolapse, or urinary retention.
Genitourinary examination: It evaluates the signs of prostate enlargement or any abnormality of the genitalia in men, which can lead to UI.
Neurological examination: It assess the neurological function which include the moor strength, reflexes, sensation, and coordination.
Associated Comorbidity or Activity:Â
UI may be caused by pelvic organ prolapse, a condition in which one or more pelvic organ drop into the vaginal space. Benign prostatic hyperplasia, enlargement of the prostate gland is a frequent problem in older men. This can cause urinary symptoms like frequency, urgency, weak urinary stream, and overflow UI. Diabetes mellitus, when improperly controlled, can affect the function of the bladder and lead to UI.
Acuity of Presentation:
Acute urinary incontinence can cause because of the UTI, neurological diseases, and urinary retention. Some cases of UI occur sudden and acute, and the symptoms appear within a short period of time from hours to days. It gradually develops over the time. In some cases, the progression of symptoms are slow and will noticeable over weeks, months or years.
Stress Urinary Incontinence (SUI): Individuals who may experience the stress and urge of UI. Structural abnormalities like urethrocele or cystocele can lead to symptoms like SUI.
Urge Urinary Incontinence (UUI): UUI includes an intense, sudden urge to urinate that followed by an involuntary urine leakage.
Overactive bladder (OAB): Any symptoms which are frequent and urgent without incontinence may lead to OAB instead of UUI.
Overflow Urinary Incontinence (OUI): OUI causes when the bladder cannot empty completely, and this can lead to chronic urinary retention and dribbling of urine.
Benign prostatic hyperplasia (BPH) in men: Enlargement of the prostate gland may obstruct the bladder outlet and lead to symptoms of urinary retention and overflow UI.
Lifestyle Modifications: Behavioral interventions like scheduled voiding, bladder training, and fluid management may help to improve the bladder control and decrease the urinary urgency and frequency.
Pelvic Floor Muscle Exercises: Pelvic floor muscle exercise is an necessary component to manage the stress of UI.
Bladder Training: Bladder training includes the scheduled voiding and continuously elevating the interval between voids to improve bladder control and capacity.
Surgical Interventions: Surgical procedures can be suggested for pelvic organ prolapse or stress UI, which does not respond to the conservative treatment.
Nephrology
Urology
Accessible Bathrooms: Make sure that bathrooms are easily accessible specifically for those individuals who have mobility issues. To provide stability and support, install grab bars in the shower, toilet or bathtub.
Adequate Lighting: Make sure the pathways to the bathroom and bathroom has well light to decrease the risk of falls specifically during the nighttime.
Non-Slip Flooring: Use non-slip rugs or mats in the bathroom to avoid slips and falls near the toilet, shower, and bathtub.
Waterproof Protection: Use absorbent bed pads and waterproof mattress protectors to protect bedding from accidental urine during sleep.
Accessible Clothing: Choose undergarments and clothing which are easy to remove and replace specifically for those who have limited mobility.
Communication and Support: Encourage an open communications and provide emotional support to those who are dealing with UI.
Nephrology
Midodrine: Midodrine stimulates the alpha-adrenergic receptors. It causes vasoconstriction and an elevation in blood pressure. It enhance the urethral closure and decrease the stress UI by elevating the sympathetic tone and enhancing the smooth muscle contraction in the neck and urethra of bladder.
Urology
Dicyclomine: Dicyclomine is an anticholinergic drug. It relaxes the smooth muscle and prevent the acetylcholine to act at parasympathetic areas in smooth muscles and secretory glands.
Urology
Flavoxate: Flavoxate is used to treat the symptoms of prostatitis, urethritis, incontinence, and cystitis which can lead to nocturia and dysuria. Flavoxate directly inhibit the phosphodiesterase to relax the smooth muscle. It relaxes may types if spasms in smooth muscle.
Urology
Mirabegron: Mirabegron is suggested for OAB symptoms, which include frequency, urgency, and urge UI.
Urology
Duloxetine: Duloxetine inhibits the norepinephrine and neuronal serotonin uptake. It has antidepressant effects. It has the potential for noradrenergic and CNS serotonergic effects.
Urology
Prazosin: Prazosin may help to empty the bladder by decreasing the tome of internal sphincter and elevating the urine flow.
Nephrology
Urology
Mid-urethral Sling Placement: The surgeon creates small incisions in the vaginal wall and sub-urethral space during the procedure. A synthetic mesh sling, which is made of polypropylene, is placed underneath the mid-urethra for support. The sling is places to provide the support to the urethra during the elevation in the intra-abdominal pressure like sneezing, lifting, or coughing.
Urology
Assessment and Diagnosis: The initial phase of management includes a comprehensive assessment of the type, severity, and underlying cause of UI.
Conservative Management: Conservative management include the first line approach for UI and can be initiated depending on the underlying type and severity of symptoms.
Pharmacological Therapy: If conservative management is not sufficient to control the symptoms, then pharmacological treatment can be considered as an adjunctive treatment. Medications like beta-3 adrenergic agonists, anticholinergics, or mirabegron can be used to reduce the urinary urgency.
Follow-up and Long-Term Management: Long-term management of UI includes ongoing monitoring, follow-up, and adjustments to treatment as needed.
Urine leaks may vary from minor to severe. Frequent leaks to total loss of bladder control are called urinary incontinence (UI). Urinary incontinence is caused because of the weakened pelvic floor muscle, constipation, hormonal changes, and nerve damage urinary tract infections.
Different types of urinary incontinence:
Stress incontinence: The leakage of urine occurs during the activity which can increase the abdominal pressure.
Urge incontinence: The intense and sudden urge to urinate, which is followed by an involuntary bladder contraction, which can lead to leakage of urine.
Overflow incontinence: Inability to empty the bladder, which leads to constant or frequent leakage of urine.
Functional incontinence: It occurs when cognitive or physical impairment which prevent a person to use the toilet in time.
Urinary incontinence is a prevalent disease among the elder people. It can affect all the ages of people. There is a lack of reporting and diagnosis of urine incontinence. About 5% of the people who are living in the community and about 2% of the people will get the proper medical treatment and care.
This disease is seen in women more frequently than men. Conditions like childbirth, menopause, and pregnancy contribute to this. These conditions may weaken the pelvic floor muscles and increase the possibility of stress.
The main cause of urinary incontinence is injured or weakened tissues and pelvic muscle floor. Apart from this activities which can increase the intra-abdominal pressure like sneezing, coughing, lifting, or laughing. This can weaken the bladder, neck, and urethra to move downhill, which can lead to urine leakage.
The other cause of urinary incontinence of bladder is an involuntary contractions of the detrusor muscle. The smooth muscle layer which is present in the bladder wall contracts and empty the bladder. There is a sudden and strong urge to urinate, which increases from the involuntary contractions. This can lead to the frequent urine flow before the person goes to the restroom.
Urinary incontinence may result from the nervous system dysfunction. It impairs the control system of the bladder. Urethral hypermobility is the most common cause of stress incontinence in female because of the improper pelvic support. Females who have experienced surgery, childbirth, post-menopausal estrogen loss, or specific disease which can impair the tissue strength and lose the pelvic support are at the risk of this disease.
The urge of urinary incontinence may result from the overactivity of the detrusor muscle, which regulates the bladder construction.
The prognosis may vary depending on the type of urine incontinence. It is necessary to identify the main cause or contributing factors.
Impair bladder function can occur because of the comorbidities or any changes in the age-related issues. Aging can affect the prognosis of UI in older patients. The evaluation of the function and strength of the pelvic floor muscles in patients like these may help in prognosis result.
Age Group:
Urinary incontinence is common in children, specifically during early childhood. For the 18 years to 45 years of age group, UI may occur because of the factors like childbirth and pregnancy, hormonal changes, weakness in pelvic floor muscle, and obesity.
General examination: To assess the vital signs, overall health status, and general appearance.
Abdominal examination: Palpate the abdomen for masses, tenderness, or organ enlargement, which can lead to conditions like bladder distension, pelvic organ prolapse, or urinary retention.
Genitourinary examination: It evaluates the signs of prostate enlargement or any abnormality of the genitalia in men, which can lead to UI.
Neurological examination: It assess the neurological function which include the moor strength, reflexes, sensation, and coordination.
Associated Comorbidity or Activity:Â
UI may be caused by pelvic organ prolapse, a condition in which one or more pelvic organ drop into the vaginal space. Benign prostatic hyperplasia, enlargement of the prostate gland is a frequent problem in older men. This can cause urinary symptoms like frequency, urgency, weak urinary stream, and overflow UI. Diabetes mellitus, when improperly controlled, can affect the function of the bladder and lead to UI.
Acuity of Presentation:
Acute urinary incontinence can cause because of the UTI, neurological diseases, and urinary retention. Some cases of UI occur sudden and acute, and the symptoms appear within a short period of time from hours to days. It gradually develops over the time. In some cases, the progression of symptoms are slow and will noticeable over weeks, months or years.
Stress Urinary Incontinence (SUI): Individuals who may experience the stress and urge of UI. Structural abnormalities like urethrocele or cystocele can lead to symptoms like SUI.
Urge Urinary Incontinence (UUI): UUI includes an intense, sudden urge to urinate that followed by an involuntary urine leakage.
Overactive bladder (OAB): Any symptoms which are frequent and urgent without incontinence may lead to OAB instead of UUI.
Overflow Urinary Incontinence (OUI): OUI causes when the bladder cannot empty completely, and this can lead to chronic urinary retention and dribbling of urine.
Benign prostatic hyperplasia (BPH) in men: Enlargement of the prostate gland may obstruct the bladder outlet and lead to symptoms of urinary retention and overflow UI.
Lifestyle Modifications: Behavioral interventions like scheduled voiding, bladder training, and fluid management may help to improve the bladder control and decrease the urinary urgency and frequency.
Pelvic Floor Muscle Exercises: Pelvic floor muscle exercise is an necessary component to manage the stress of UI.
Bladder Training: Bladder training includes the scheduled voiding and continuously elevating the interval between voids to improve bladder control and capacity.
Surgical Interventions: Surgical procedures can be suggested for pelvic organ prolapse or stress UI, which does not respond to the conservative treatment.
Nephrology
Urology
Accessible Bathrooms: Make sure that bathrooms are easily accessible specifically for those individuals who have mobility issues. To provide stability and support, install grab bars in the shower, toilet or bathtub.
Adequate Lighting: Make sure the pathways to the bathroom and bathroom has well light to decrease the risk of falls specifically during the nighttime.
Non-Slip Flooring: Use non-slip rugs or mats in the bathroom to avoid slips and falls near the toilet, shower, and bathtub.
Waterproof Protection: Use absorbent bed pads and waterproof mattress protectors to protect bedding from accidental urine during sleep.
Accessible Clothing: Choose undergarments and clothing which are easy to remove and replace specifically for those who have limited mobility.
Communication and Support: Encourage an open communications and provide emotional support to those who are dealing with UI.
Nephrology
Midodrine: Midodrine stimulates the alpha-adrenergic receptors. It causes vasoconstriction and an elevation in blood pressure. It enhance the urethral closure and decrease the stress UI by elevating the sympathetic tone and enhancing the smooth muscle contraction in the neck and urethra of bladder.
Urology
Dicyclomine: Dicyclomine is an anticholinergic drug. It relaxes the smooth muscle and prevent the acetylcholine to act at parasympathetic areas in smooth muscles and secretory glands.
Urology
Flavoxate: Flavoxate is used to treat the symptoms of prostatitis, urethritis, incontinence, and cystitis which can lead to nocturia and dysuria. Flavoxate directly inhibit the phosphodiesterase to relax the smooth muscle. It relaxes may types if spasms in smooth muscle.
Urology
Mirabegron: Mirabegron is suggested for OAB symptoms, which include frequency, urgency, and urge UI.
Urology
Duloxetine: Duloxetine inhibits the norepinephrine and neuronal serotonin uptake. It has antidepressant effects. It has the potential for noradrenergic and CNS serotonergic effects.
Urology
Prazosin: Prazosin may help to empty the bladder by decreasing the tome of internal sphincter and elevating the urine flow.
Nephrology
Urology
Mid-urethral Sling Placement: The surgeon creates small incisions in the vaginal wall and sub-urethral space during the procedure. A synthetic mesh sling, which is made of polypropylene, is placed underneath the mid-urethra for support. The sling is places to provide the support to the urethra during the elevation in the intra-abdominal pressure like sneezing, lifting, or coughing.
Urology
Assessment and Diagnosis: The initial phase of management includes a comprehensive assessment of the type, severity, and underlying cause of UI.
Conservative Management: Conservative management include the first line approach for UI and can be initiated depending on the underlying type and severity of symptoms.
Pharmacological Therapy: If conservative management is not sufficient to control the symptoms, then pharmacological treatment can be considered as an adjunctive treatment. Medications like beta-3 adrenergic agonists, anticholinergics, or mirabegron can be used to reduce the urinary urgency.
Follow-up and Long-Term Management: Long-term management of UI includes ongoing monitoring, follow-up, and adjustments to treatment as needed.
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