Urinary Incontinence (Part Two)

Risk Factors

The factors that increase the risk of incontinence are:

• Gender. Women are more prone to stress incontinence. Pregnancy, childbirth, menopause, and the normal anatomy of the female are factors unique to women. However, men with prostate problems have an increased risk of urgency incontinence and overflow incontinence.
• Age. As age increases, the muscles of the bladder and urethra lose their strength. With aging, changes occur that affect the reduction of the bladder's capacity to hold urine, increasing the possibility of involuntary urination.
• Overweight. Being overweight increases pressure on the bladder and the surrounding muscles, weakening them, so the process of coughing and sneezing is accompanied by involuntary urine leakage.
• Other diseases. Neurological diseases and diabetes can increase the risk of incontinence.

Complications

The complications of chronic incontinence include:

• Skin problems. Since the skin is continuously wet, it can become red, infected, and inflamed.
• Urinary tract infections. Incontinence increases the risk of repeated urinary infections.
• Impact on personal life. Incontinence can damage social, work, and personal relationships.

Examinations and Diagnosis

It is important to determine the type of incontinence. Based on this, the method of treatment is decided. The doctor starts by asking about the medical history and continues with a physical examination. At the same time, the patient is asked to perform a simple action consisting of closing the mouth, pinching the nose with fingers, and being asked to strain as if to exhale. After this, the doctor will ask for:

• Urine analysis. This is done to see if there are signs of infection, blood in the urine, or other anomalies.
• Bladder diary. The patient keeps a diary for several days recording the amount of fluids consumed, the time when urinating, the amount of urine eliminated, cases when there is an urgent need to urinate, and the number of incontinence episodes.
• Measurement of urine left in the bladder after urinating. The patient is asked to urinate into a container to measure the accumulated urine. Then, the doctor measures the remaining urine in the bladder using ultrasound or a catheter. A large amount of remaining urine in the bladder indicates the possibility of a blockage in the urinary tract or a problem related to the nerves and muscles of the bladder.

Special Examinations

If further information is required, the following may be recommended:

• Urodynamic examination. This consists of inserting a catheter through the urethra into the bladder to fill it with water. Meanwhile, a pressure monitor measures and records the pressure inside the bladder. This test helps in measuring the strength of the bladder and the condition of the sphincter. This is an important tool for determining the type of incontinence.
• Cystoscopy. Cystoscopy is a thin tube equipped with lenses and light that is inserted through the urethra into the bladder. With it, anomalies of the urinary tract can be seen.
• Cystogram. The doctor inserts a catheter into the urethra and bladder and injects a special substance (contrast). After removing the catheter, the patient urinates, eliminating the contrast. During urination, several radiographic images are taken which help in detecting problems with the urinary tract.
• Pelvic ultrasound. Anomalies of the urinary or genital tract can be discovered.

Treatment and Medication

The treatment of urinary incontinence depends on the type of incontinence, the severity of the symptoms, and its causes. A combined treatment may be required. Initially, the doctor recommends the simplest medication and then suggests other options if the first does not produce results.

Assistive Techniques

• Bladder training, to delay urination when there is an urgent need to urinate. It starts with holding urine for 10 minutes whenever there is an urgent need to urinate. The goal is to extend the time between urinations to two or four hours.
• Double voiding. This means a normal urination, then waiting a few minutes and trying to urinate again. It helps in completely emptying the bladder to avoid overflow incontinence.
• Urination schedule, to urinate every two or four hours instead of urinating as needed.
• Diet and fluid management, to regain control of the bladder. Alcohol, coffee, and acidic foods should be avoided. Reducing fluid intake, losing weight, or increasing physical activity can ease the problem.