Incontinence

Urinary incontinence is the involuntary leakage of urine. Prevalence of urinary incontinence in entire population ranges upto 45%.

The different types of urinary incontinence include:

• Stress incontinence: involuntary leakage of urine on exertion or sneezing or coughing. This is due to an weak outlet (incompetent sphincter).
• Urge incontinence: involuntary urine leakage preceded by urgency. There is a sudden and compelling desire to urinate that cannot be deferred.
• Mixed incontinence: A combination of urge and stress incontinence comprises of mixed incontinence.
• Overflow incontinence: usually seen in chronic bladder outflow obstruction. After bladder has filled completely extra urine over and above the full capacity leaks involuntarily. Overflow incontinence may also be due to a neurogenic bladder.
• True incontinence: may be due to an abnormal connection between urinary tract and its neighbouring structures. There is continuous leakage of urine.

Risk Factors:

Women – Pregnancy, Prolonged labour, Pelvic surgeries, Pelvic floor weakness,
UTI
Constipation – Impacted stools
Neurological problems
Obstruction – Examples are BPH in men and Urethral meatal stenosis in women

Evaluation – Needs to be tailored to each case. Evaluation would range from a simple urinanalysis to advance tests like urodynamics and endourological evaluations depending on the case.

Treatment :

Medicines – Antimuscarinics
Physiotherapy – Kegel’s exercise, Pelvic floor strengthening
Injection Botox
Biofeedback
Sacral neuromodulation
Surgical repair of Pelvic floor / Transobturator taping / Travnsvaginal taping / Bladder capacity enahancemntetc..