Urinary incontinence is the inability to control urination, leading to leakage or dribbling before one can reach a restroom. Sometimes, urine may leak without the individual even realizing it.
This condition can occur during pregnancy, when coughing or sneezing, or during activities that increase pressure on the bladder. It may also be linked to urinary tract infections, pelvic injuries, radiation therapy, or caused by certain neurological disorders or other body systems. Alcohol, coffee, and some medications can contribute to or exacerbate urinary incontinence. In some cases, simply hearing the sound of running water can trigger leakage. In extreme cases of fear, it is not uncommon for someone to become so frightened that they wet themselves.
Urinary incontinence is more common in women than in men, primarily because the female urinary tract is significantly shorter. In younger women, the most common cause is a lack of support at the neck of the bladder (the area where the bladder meets the urethra). In older women, the issue is often due to a weakened or overactive bladder.
Individuals with urinary incontinence often hesitate to discuss their condition with doctors due to embarrassment. Statistics indicate that in the United States, only about 50% of those suffering from urinary incontinence seek medical treatment. However, this is a common issue, affecting approximately 13 million people in the U.S. The prevalence of urinary incontinence in women younger than 65 is between 10 to 25 percent. For women over 60 who do not reside in nursing homes, the rate is 15 to 30 percent, while in nursing home residents, it exceeds 50 percent.
The primary symptom of urinary incontinence is, of course, involuntary leakage. This leakage can be frequent and significant, or infrequent and minimal. For those who are active (such as working or attending social events), even one incident of leakage per week (especially at inappropriate times) can be considered excessive.
Accompanying symptoms may include:
– Frequent urination more than once every two hours, or more than seven times a day.
– The need to wake up at least twice during the night to urinate.
– Urgency in urination.
– Bedwetting.
For appropriate treatment, doctors will need to conduct a detailed medical history and appropriate tests. Initially, this includes:
– Current medications.
– The number of pregnancies.
– Other medical conditions aside from urinary incontinence.
– Frequency and volume of leakage within a 24 to 72-hour period.
– The amount of water and fluid intake (such as soups, broths) during that time.
– Activities, laughter, coughing, or other actions that occur at or prior to the leakage.
– The amount of coffee and alcohol consumed, which may assist the doctor in diagnosing urinary incontinence.
After taking the medical history, the doctor will conduct a general health examination, pelvic examination, and perform tests to measure the amount of urine produced each time and the residual urine in the bladder after urination.
Testing urine for infections and assessing kidney function are also crucial for an accurate diagnosis.
Some tests may include observing urine leakage (when the bladder is full) while coughing, using pads to measure urine output, and measuring the pressure and volume of the bladder when full, among others, to classify urinary incontinence and determine suitable treatments.
Once a correct diagnosis is made, there are several effective ways to treat urinary incontinence.
First, the simplest step is to treat or avoid factors that may contribute to urinary incontinence and bedwetting. For example, reducing fluid intake in the evening and cutting down on alcohol and coffee if they are potential triggers. After reviewing current medications, doctors may discontinue or switch those that could contribute to urinary leakage.
Practicing regular urination even when not feeling the urge can also help reduce urinary incontinence. In cases where leakage is due to weakened bladder control muscles, a relatively simple exercise program for the pelvic floor muscles (known as Kegel exercises) will be recommended to help improve bladder control.
If coughing or sneezing is causing the leakage, addressing these symptoms will also significantly help. Various other medical conditions, whether general or neurological, may be underlying causes, and treating them can often effectively resolve the symptoms.
There are numerous medications available to treat urinary leakage symptoms. These may include medications that control bladder contractions or strengthen the muscles that control the urethra.
If an infection is present, the doctor will prescribe antibiotics. In some cases, estrogen may be needed to enhance the elasticity of pelvic muscles in postmenopausal women. However, this will only be used when absolutely necessary and at the lowest effective dose. Estrogen creams may help alleviate symptoms while being less absorbed into the body compared to patch or oral forms.
Some devices may also be used to help train the muscles in the urinary tract to contract more effectively.
Finally, when other methods have failed, surgery may be beneficial. There are various surgical approaches available.
In many cases, women can prevent (or treat) urinary incontinence through simple exercises that enhance the flexibility and strength of muscles surrounding the urethra, vagina, and anus (Kegel exercises). Doctors and nurses can provide guidance on how to perform these exercises effectively.
Weight loss, abdominal exercises, reducing coughing, avoiding heavy lifting, quitting smoking, and treating constipation can also help prevent urinary incontinence.
Regular urination even when not feeling the urge can also help prevent urinary incontinence.
In summary, urinary incontinence is a common condition, just like any other health issue. One should not feel too embarrassed to the point of hiding it from their doctor, as this can prevent appropriate treatment at an early stage. Depending on the cause, there are numerous methods ranging from (usually) simple to complex that can effectively treat and prevent urinary incontinence. When symptoms arise, it is advisable to consult a doctor promptly for accurate diagnosis and appropriate treatment.
Dr. Nguyen Tran Hoang
