Tuesday, September 27, 2022

How To Treat Urge Urinary Incontinence

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What You Can Do

Treating stress and urge incontinence from home

To get ready for your appointment, it helps to:

  • Be aware of any pre-appointment restrictions, such as restricting your diet
  • Write down your symptoms, including how often you urinate, nighttime bladder activity and episodes of incontinence
  • Make a list of all your medications, vitamins and supplements, including doses and how often you take the medication
  • Write down key medical information, including other conditions you may have
  • Ask a relative or friend to accompany you, to help you remember what the doctor says
  • Take a notebook or electronic device with you, and use it to note important information during your visit
  • Write down questions to ask your doctor

For urinary incontinence, some basic questions to ask your doctor include:

  • What’s the most likely cause of my symptoms?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • Is my urinary incontinence temporary?
  • What treatments are available?
  • Should I anticipate any side effects of the treatment?
  • Is there a generic alternative to the medicine you’re prescribing for me?
  • I have other health conditions. How can I best manage these conditions together?

Don’t hesitate to ask other questions during your appointment as they occur to you.

Enhancing Healthcare Team Outcomes

Urge incontinence is a complicated condition, and patients often present late to their primary care providers. Therefore, primary care providers should be proactive in gathering a thorough history, physical examination, perform office-based investigations to rule out reversible causes, and decide when to refer to a specialist . A culture of shared and informed decision making with the patient should be developed. In this process, patients and their family members or caregivers should also be included. A clear cut discussion on the treatment goal and different treatment options often leads to better patient compliance.

A thorough review of all possible reasons for the failure of treatment, side effects of various medications, and measures of improvement of quality of life should also be included. For example, not all patients will achieve complete incontinence free life. Still, many will see a significant reduction in bothersome symptoms that might lead to a considerable improvement in the quality of life. The ethical responsibility of the clinician is to always offer the least invasive treatment option depending on the patient’s co-morbidities. An interprofessional team approach involving excellent communication among specialists, primary care providers, patients/families, nurses, and pharmacists often leads to improved treatment outcomes, patient-centered care, and better patient safety.

Complications From Other Diseases

In some cases, symptoms of an overactive bladder develop as a complication of a nerve- or brain-related disease. Examples are following a stroke or spinal cord damage, or with illnesses such as Parkinson’s disease or multiple sclerosis . Similar symptoms may occur if there is irritation in the bladder. Bladder irritation can occur when you have a urinary tract infection or stones in your bladder.

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Conservative Ways To Treat Urinary Incontinence Include:

  • Dietary changes Try to eliminate or cut back on how much caffeine you consume, such as in coffee and tea. In addition, limit the amount of carbonated drinks and acidic foods, such as oranges and pineapples, in your diet. Caffeine prompts your body to get rid of fluids, which causes you to need to urinate. Also, the acids in carbonated drinks and some foods can irritate your bladder and cause you to go more often.
  • Manage constipation For some people, urinary incontinence is a symptom of constipation. Your rectum is located near your bladder and shares many of the same nerves. Hard, compacted stool in your rectum can cause these nerves to be overactive and increase urinary frequency.
  • Physical therapy A therapist can explain different exercises to do to strengthen the muscles that help control urination. Also known as Kegels, these exercises are especially effective for stress incontinence but also may help urge incontinence.

What Causes Urinary Incontinence

Avoid the Urge to Let Urinary Incontinence Leak into Your Life

It helps to know that male urinary incontinence is not a disease but rather a symptom of an underlying problem, per Michigan Medicine. To understand this, its important to know some basic physiology:

After urine is produced in the kidneys, it goes to reside in the bladder, and then it travels through the urethra to exit your body. When urine is residing in the bladder, the urethra muscles are contracted while the bladder is relaxed. When its time to pee, the urethra muscles relax while the bladder works to move the urine out. If either of these muscles doesnt do its job properly, incontinence can occur. Naturally, there are various potential causes for this.

Hopkins Medicine explains that there are usually two types of incontinence. The first is stress incontinence, in which the muscles in your urinary system malfunction due to stress put on the abdomen from sneezing, coughing, or other activities. The other typical occurrence is urge incontinence, in which your brain, spinal cord, and bladder dont work together properly to allow you to hold and release urine at the right time. Its important to know that both types can happen at the same time. There are other possible causes, as well. Its also important to know that male incontinence doesnt occur entirely out of your control. Following are some ways to prevent it.

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Types Of Urinary Incontinence

There are different types of incontinence:

  • Stress incontinence occurs when urine leaks as pressure is put on the bladder, such as during exercise, coughing, sneezing, laughing, or lifting heavy objects. Its the most common type of bladder control problem in younger and middle-aged women. It also may begin later, around the time of menopause.
  • Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimers disease, Parkinsons disease, multiple sclerosis, or stroke.
  • Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
  • Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Causes Of Urinary Incontinence

Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.

Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder.

Overflow incontinence is often caused by an obstruction or blockage in your bladder, which prevents it from emptying fully.

Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a small, tunnel like hole that can form between the bladder and a nearby area .

Certain things can increase the chances of urinary incontinence, including:

  • pregnancy and vaginal birth

Find out more about the causes of urinary incontinence.

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What Are Urge Incontinence Symptoms

An urgent, uncontrollable need to pee is the top sign of urge incontinence. You may or may not leak urine. If you do have urine leaks, the amount tends to be larger than with other types of urinary incontinence.

Other signs of urge incontinence include:

  • Frequent urination or nocturia .
  • Leaking urine before you can make it to the bathroom or just after you peed.
  • Wetting the bed at night.

Surgical Treatments For Pop

Treating Urinary Incontinence

Women with symptomatic POP often benefit from surgical treatment in the setting of severe prolapse, failure of conservative therapy, or when definitive management is desired. It is estimated that by age 80, 30% of the women with POP will have undergone at least one reconstructive surgery.59 The choice of a primary POP repair is affected by many patients and surgical factors, including age, POP stage, medical comorbidities such as obesity, and desire for future sexual activity.1 The most common surgical approaches for POP treatment will be reviewed here, including both native-tissue and mesh-based repairs. An evaluation of treatment efficacy, trends, controversies, and opportunities for further research for each repair method is also outlined.

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Medications For Urinary Incontinence

If medications are used, this is usually in combination with other techniques or exercises.

The following medications are prescribed to treat urinary incontinence:

  • Anticholinergics calm overactive bladders and may help patients with urge incontinence.
  • Topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
  • Imipramine is a tricyclic antidepressant.

Treatments For Stress Incontinence

Stress incontinence occurs when weakened pelvic floor muscles cant hold up to the pressure on the bladder and urethra. These muscles may have weakened due to age, vaginal birth, or obesity.

If the issue may be related to weight, well talk about weight loss. As little as an 8 percent weight loss can decrease incontinence by half. I also recommend that patients work with a physical therapist who specializes in pelvic floor exercises. These exercises strengthen the muscles that control urination.

Another option is a pessary, which is a device that supports the walls of your vagina and lifts the bladder and urethra. Its a non-surgical fix. If were still not finding relief after trying a pessary, the surgical option is a urethral sling, which is a type of mesh thats placed under the urethra.

When you cough, for example, and the urethra moves, the mesh provides extra support for the muscles that arent doing their job.

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What Causes Urge Incontinence

Most people with urge incontinence have overactive bladders. Your bladder is the organ in your urinary system that holds urine.

An overactive bladder causes your muscles in your bladder to squeeze more often than they should. This makes you feel like you have to pee before your bladder is actually full.

The squeezed bladder also causes your sphincter muscle inside your urethra to relax. When this muscle opens, it lets urine leak out.

Stick To A Healthy Diet

Urinary Incontinence USMLE Types Stress Urge Overflow Female Bladder ...

To prevent UI, be careful about your food choices. In several studies, urinary leakage has been tied to symptoms of obesity. One study found that men with metabolic syndrome have larger prostates, a leading cause of UI. Men with both metabolic syndrome and enlarged prostates bear an 80% greater risk of experiencing a sudden, intense urge to urinate, often during the night.

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Cut Back On Diuretics Like Caffeine And Alcohol

Caffeine and alcohol are both double trouble, says Ramin. Theyre diuretics and they stimulate bladder function. If you suffer from urinary incontinence, one of your worst enemies can be caffeinated beverages, he says. Though it can be much easier said than done, limiting or eliminating caffeine altogether has been known to be successful in diminishing and resolving issues of urinary incontinence in some women.

Similarly, he adds, alcoholic beverages act as bladder stimulants and diuretics in most people. So when you have a problem with urinary continence, consuming even slight amounts of alcohol can make matters worse.

If you cant function without your daily cup of coffee, try to keep it to the morning so youre not getting up to pee at night. And if you like having a glass of wine to wind down, at least limit it to one and keep it as far from bedtime as possible. Or, just take a break from caffeine or alcohol for a week or two, and see if the benefits you notice are worth it.

Posterior Tibial Nerve Stimulation

Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor. It is thought that stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pass urine.

During the procedure, a very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and causing your foot to move. You may need 12 sessions of stimulation, each lasting around half an hour, one week apart.

Some studies have shown that this treatment can offer relief from OAB and urge incontinence for some people, although there is not yet enough evidence to recommend tibial nerve stimulation as a routine treatment.

Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medication and you don’t want to have botulinum toxin A injections or sacral nerve stimulation.

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Why Have I Suddenly Become Incontinent

Its possible youve had mild symptoms for a while. Over time, symptoms from an overactive bladder can get worse and become more noticeable. If your incontinence came on after a recent medical procedure, injury or the start of a new medication, contact your healthcare provider. A nerve injury or another problem may be causing the incontinence.

Can Urge Incontinence Be Prevented

Urinary Incontinence (Stress, Urge, Overflow & Functional) | Causes, Symptoms, Diagnosis, Treatment

Urge incontinence can’t be prevented in every case, but there are some general things you can do that may reduce the chance of it happening. These include:

  • Maintaining a healthy lifestyle and weight
  • Reducing alcohol intake
  • Strengthening your pelvic floor through pelvic floor exercises
  • Staying active

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Types Of Bladder Control Problems

Anyone can have bladder control problems or incontinence. Incontinence caused by cancer or cancer treatment can last a short time or a long time, and it can be mild or severe. There are different types of bladder control problems.

Stress incontinence. Urine leaks out during activities such as coughing, laughing, sneezing, or exercising.

Overflow incontinence. Urine leaks out when your bladder is full.

Urge incontinence. You feel the urge to go to the bathroom right away and urine leaks before you can get to the bathroom.

Continuous incontinence. Urine leaks out constantly, and you cannot control it.

These bladder problems can make you feel uncomfortable or embarrassed. Sometimes, people avoid activities they enjoy because of bladder problems. That can affect your quality of life. These are reasons why it is important to tell your health care provider about your experiences. They can help you treat incontinence. The treatment of side effects is an important part of your cancer care and treatment, called palliative care or supportive care. Talk with your health care team about how to treat or manage incontinence.

What Are Urge Incontinence Treatments

If pelvic floor exercises and other techniques dont help, your healthcare provider may recommend one of these treatments:

  • Medications or bladder botulin toxin injections to relax your bladder muscle so it can hold more urine.
  • Nerve stimulation using a device that sends electrical pulses to your nerves. These impulses act as a bladder pacemaker to relax and regulate overactive bladder squeezes. Your healthcare provider may recommend a surgical procedure to place a sacral nerve stimulation device. Or you may have an in-office procedure for percutaneous tibial nerve stimulation .
  • to enlarge your bladder using tissue taken from your intestine.
  • Urinary diversion surgery to redirect your ureters to a urine drainage bag outside of your body instead of into your bladder.

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Drink Plenty Of Water

Drink 6 to 8 glasses of fluid a day unless your doctor advises you otherwise.

Many people with urinary incontinence avoid drinking fluids as they feel it causes more problems. However, limiting your fluid intake makes incontinence worse because it reduces your bladders capacity.

Not drinking enough fluid can also cause constipation or make it worse.

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Tips For Living With Urinary Incontinence

PPT

With a little planning, you can manage your urinary incontinence so it doesnt affect your life too much. There are many products available to help you live with incontinence, such as pads, catheters or bedding protection. Some of these are subsidised by the government.

It can help to get into a routine. Plan for outings, make sure you have enough products and spare clothes in case you have an accident, and know how to find the nearest toilet.

Other tips include:

  • Avoiding lifting. Lifting puts strain on your pelvic floor muscles, so avoid it wherever you can. When you do need to lift something, such as when picking up children or shopping bags, tighten your pelvic floor muscles before and during the lift.
  • Drinking plenty of water. Many people with urinary incontinence avoid drinking fluids as they feel it causes more problems. However, limiting your fluid intake makes incontinence worse because it reduces your bladder’s capacity. Some medical conditions may require you to limit your fluid intake, so ask your doctor if youre unsure how much water you should drink each day.
  • Avoiding certain foods. Spicy and acidic foods, such as curries and citrus fruits, can irritate the bladder and make symptoms worse.
  • Download the National Public Toilet Map, which shows the location of more than 19,000 public and private public toilet facilities across Australia.

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When To See A Health Care Provider And What To Expect

Talk to your health care provider if you have urinary incontinence or any signs of a bladder problem, such as:

  • Needing to urinate more frequently or suddenly
  • Cloudy urine
  • Urinating eight or more times in one day
  • Passing only small amounts of urine after strong urges to urinate
  • Trouble starting or having a weak stream while urinating

Your doctor may recommend urodynamic testing and perform the following to try to figure out what might be causing your bladder problem:

  • Give you a physical exam and take your medical history.
  • Ask about your symptoms and the medications you take.
  • Take urine and blood samples.
  • Examine the inside of your bladder using a cystoscope a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
  • Fill the bladder with warm fluid and use a cystoscope to check how much fluid your bladder can hold before leaking.
  • Order or perform a bladder ultrasound to see if you are fully emptying your bladder with each void.
  • Ask you to keep a daily diary of when you urinate and when you leak urine. Your primary care doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.

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