URINE INCONTINENCE AMONG WOMEN:TITBITS FROM URO-GYNECOLOGIST

Urinary incontinence is a very common urinary problem in female patients, and one in three women over the age of 60 years are estimated to have bladder control problems. One reason why women are more affected is the weakening of pelvic floor muscles by childbirth.

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They present with urine leak having great impact on quality of life in the sense of social , occupational,sexual & psycological.Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners

TYPES:

                                     

STRESS URINARY INCONTINENCE:
Stress urinary incontinence is caused by loss of support of the urethra which is usually a consequence of damage to pelvic support structures as a result of childbirth.
It is characterized by leaking of small amounts of urine with activities which increase abdominal pressure such as coughing, sneezing and lifting. 

URGE URINARY INCONTINENCE:
Involuntary loss of urine occuring for no apparent reason with feeling of urgency.Urge urinary incontinence is caused by uninhibited contractions of the detrusor muscle. It is characterized by leaking of large amounts of urine in association with insufficient warning to get to the bathroom in time.
       
MIXED  URINARY INCONTINENCE:
Stress + urge urinary incontinence

OVERFLOW  URINARY INCONTINENCE:
Involuntary loss of urine from an overtly full bladder ,in absence of any urge to urinate.


PHYSIOLOGY:
During urination, detrusor muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract (detrusor muscle) or muscles surrounding the urethra suddenly relax (sphincter muscles).

HOW TO DIAGNOSE ?:
Patients with incontinence should be referred to a medical practitioner specializing in this field.Urologists specialize in the urinary tract, and some urologists further specialize in the female urinary tract.

 A uro-gynecologist is a gynecologist who has special training in urological problems in women or female urologist with special expertise in gynecological diseases causing urine problems.
 Family physicians and internists see patients for all kinds of complaints, and are well trained to diagnose and treat this common problem. These primary care specialists can refer patients to urology specialists if needed.

Other important points include straining and discomfort, use of drugs, recent surgery, and illness.

The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

Other tests include:

Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine

Urinanalysis– urine is tested for evidence of infection, urinary stones, or other contributing causes.

Blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
Ultrasound– sound waves are used to visualize the kidneys, ureters, bladder, and urethra.
Cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.
Uro-dynamic study– various techniques measure pressure in the bladder and the flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

It can be diagnosed with symptoms , physical examination, urine examination,by an experienced uro-gynecologist .The diagosis may be further confirmed by  cystocopy and/or urodynamic study.

TREATMENT:
Different types of incontinence require different treament modalities.
                               
Treatment options range from conservative treatment, behaviour management, bladder retraining,pelvic floor therapy,, medications and surgery. The success of treatment depends on the correct diagnoses. Weight loss is recommended in those who are obese.

                                          
Exercising the muscles of the pelvis such as with kegel exercises are a first line treatment for women with stress incontinence.
Efforts to increase the time between urination, known as bladder training, is recommended in those with urge incontinence. Both these may be used in those with mixed incontinence.
                                               
A number of medications exist to treat incontinence including:fesoterodine,oxybutynin.Medications are not recommended for those with stress incontinence and are only recommended in those who have urge incontinence who do not improve with bladder training.
Surgery may be used to alleviate incontinence after other treatments have been tried and found not to be effective

 Stress urinary incontinence requires transvaginal tape surgery.

The tension-free transvaginal tape(TVT) sling procedure treats urinary stress incontinence by positioning a polypropylene mesh tape underneath the urethra. The 20-minute outpatient procedure involves two miniature incisions and has an 86-95% cure rate. The transobturator tape (TOT) sling procedure aims to eliminate stress urinary incontinence by providing support under the urethra
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Urge incontinence mostly treated by medications like Anti -cholinergics.

Overflow incontinence requires to relieve bladder outlet obstruction.

ALWAYS A TEAM OF EXPERTS IS MORE RELIABLE