Female urethral function is influenced by estrogen. The lack of estrogen at menopause leads to atrophy and replacement of submucosa (ie, vascular plexus) by fibrous tissue. When estrogen is administered to postmenopausal women with atrophic vaginitis, the mucosa regains its turgor, with simultaneous up-regulation of alpha-receptors and angiogenesis of vascular plexus. Lack of estrogen is a risk factor for developing intrinsic sphincter deficiency, but estrogen replacement may reverse its effects.
OAB significantly impairs QoL, increases depression scores, and reduces quality of sleep. OAB that involves urgency incontinence is associated with the most severe impairment. Persons with OAB who have poor sleep quality report chronic fatigue and difficulty performing daily activities. An increased number of hip fractures due to falls in elderly persons have been attributed to OAB because of the nocturia component. Many such falls involve the individual tripping or losing balance while getting out of bed.
Bulking material injections. A synthetic material is injected into tissue surrounding the urethra. The bulking material helps keep the urethra closed and reduce urine leakage. This procedure is generally much less effective than more-invasive treatments such as surgery for stress incontinence and usually needs to be repeated regularly.
Retropubic suspension uses surgical threads called sutures to support the bladder neck. The most common retropubic suspension procedure is called the Burch procedure. In this operation, the surgeon makes an incision in the abdomen a few inches below the navel and then secures the threads to strong ligaments within the pelvis to support the urethral sphincter. This common procedure is often done at the time of an abdominal procedure such as a hysterectomy.
Older women experience UI more often than younger women. But incontinence is not inevitable with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery.
Overflow incontinence occurs because the bladder is too full and urine passively leaks or overflows through the urinary sphincter. This can occur if the flow of urine out of the bladder is constricted or blocked (bladder outlet obstruction), if bladder muscle has no strength (detrusor atony), or if there are neurologic problems. Common causes of bladder outlet obstruction in men include benign prostatic hyperplasia (BPH or nonmalignant enlargement of the prostate gland), bladder (vesical) neck contracture (narrowing of the outlet from the bladder due to scarring or excess muscle tissue), and urethral narrowing (strictures). Bladder outlet obstruction can occur in women with significant pelvic organ prolapse (such as a prolapsed uterus). It may even occur after surgery to correct incontinence (such as the sling or bladder neck suspension procedures); this is called iatrogenic induced overflow incontinence.
Several severity scales exist. The Cleveland Clinic (Wexner) fecal incontinence score takes into account five parameters that are scored on a scale from zero (absent) to four (daily) frequency of incontinence to gas, liquid, solid, of need to wear pad, and of lifestyle changes. The Park’s incontinence score uses four categories:
Jump up ^ Harris, Richard (December 2009). “Genitourinary infection and barotrauma as complications of ‘P-valve’ use in drysuit divers”. Diving and Hyperbaric Medicine. 39 (4): 210–2. PMID 22752741. Retrieved 2013-04-04.
Urinary incontinence or bladder incontinence is the involuntary release of urine. There are a number of different types including stress incontinence, urge incontinence and overactive bladder syndrome. Learn more about the causes, symptoms and treatment of urinary incontinence conditions here.
Medical conditions that cause urge incontinence may be neurologic or non-neurologic. The urethra is healthy, but the bladder is hyperactive or overactive. Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen.
^ Silva, LA; Andriolo, RB; Atallah, AN; da Silva, EM (Sep 27, 2014). “Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery”. The Cochrane Database of Systematic Reviews. 9: CD008306. doi:10.1002/14651858.CD008306.pub3. PMID 25261861.
Risk factors include age, female gender, urinary incontinence, history of vaginal delivery (non-Caesarean section childbirth), obesity, prior anorectal surgery, poor general health and physical limitations. Combined urinary and fecal incontinence is sometimes termed double incontinence, and it is more likely to be present in those with urinary incontinence.
For men, as you get older, you may notice an increase in urination frequency, often considered a normal sign of aging. If your trips to the bathroom have significantly increased recently, it may be a sign of an enlarged prostate gland pressing up against your bladder and triggering the urge to urinate. (5) Often in this situation, only small amounts of urine are voided each trip. Talk to your doctor if these symptoms sound familiar.
Functional incontinence occurs when physical disability, external obstacles, or problems in thinking or communicating keep a person from reaching a place to urinate in time. For example, a man with Alzheimer’s disease may not plan ahead for a timely trip to a toilet. A man in a wheelchair may have difficulty getting to a toilet in time. Arthritis—pain and swelling of the joints—can make it hard for a man to walk to the restroom quickly or open his pants in time.