Urinary incontinence

(Urine passed without control)

Causes
The most common causes of urinary incontinence in women are stress urinary incontinence and urge urinary incontinence. Women with both problems have mixed 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.

  • Polyuria (excessive urine production) of which, in turn, the most frequent causes are: uncontrolled diabetes mellitus, primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus. Polyuria generally causesurinary urgency and frequency, but doesn’t necessarily lead to incontinence.
  • Caffeine or cola beverages also stimulate the bladder.
  • Enlarged prostate is the most common cause of incontinence in men after the age of 40; sometimes prostate cancer may also be associated with urinary incontinence. Moreover drugs or radiation used to treat prostate cancer can also cause incontinence.
  • Disorders like multiple sclerosis, spina bifida, Parkinson’s disease, strokes and spinal cord injury can all interfere with nerve function of the bladder.

Types:

  • Stress incontinence, also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles.
  • Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.
  • Overflow incontinence: Sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine. It is as if their bladders were constantly overflowing, hence the general name overflow incontinence.
  • Mixed incontinence is not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.
  • Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood (for example, anectopic ureter). Fistulas caused by obstetric and gynecologic trauma or injury are commonly known as obstetric fistulas and can lead to incontinence. These types of vaginal fistulas include, most commonly, vesicovaginal fistula and, more rarely, ureterovaginal fistula. These may be difficult to diagnose. The use of standard techniques along with a vaginogram or radiologically viewing thevaginal vault with instillation of contrast media.

Tretment:
Medications
A number of medications exist to treat incontinence including: fesoterodine, tolterodine and oxybutynin. While a number appear to have a small benefit, the risk of side effects are a concern. For every ten or so people treated only one will become able to control their urine and all medication are of similar benefit.

TOT

What is the procedure?
Trans-obturator foramen Tension-free vaginal tape (TOT) procedure is a lot less invasive than major surgery. It involves inserting a tape to act as a sling around the tube from the bladder to the outside (urethra), so that it is supported and stays in the right position even when there is pressure on it. The tape is put into place through small openings made in the skin and the vagina.

What does the procedure involve?
Tape is made from an artificial material that is usually accepted by your body. The tape may be inserted under spinal, general or local anaesthesia. A small vaginal incision is made. Another small skin incision is made in the skin on the inside of your leg, next to the labia on each side. The tape is positioned without tension behind the urethra. The procedure may be done on its own, or as part of prolapse repair surgery. On your return to the ward, and when you manage to pass urine twice freely and without difficulties, you will be able to go home on
that day or after an over night stay.