Urinary incontinence - Female
Between 10-12% of women experience urinary incontinence. The most common form of urinary incontinence among women is Stress Urinary incontinence. This is followed by Urge Incontinence, and many women experience both forms of incontinence with a mixture of symptoms.
When a woman presents with reported symptoms of urinary incontinence, it is most important to rule out other pathology before making a diagnosis of stress urinary incontinence (SUI), urge incontinence (UUI), or mixed incontinence. This should involve a medical history including any head, neck or back injury, relevant conditions, e.g. diabetes, sports activity, parity, family history and both urinary symptom analysis and physical examination.
Symptom analysis includes reported episodes and nature of incontinence. Urinary analysis to test for bladder or urinary tract infection and to exclude hematuria should always be undertaken. If feasible, direct her to fill out a urinary diary to document both time and amount of voiding, and the volume and nature of her fluid intake.
Physical examination should rule out constipation, prolapse, masses or tumors, fistulae and damage from pregnancy, childbirth or previous surgery or injury. Neurological symptoms and mental state should be assessed in case of head trauma, multiple sclerosis, Parkinson’s disease, Alzheimer’s, etc.
STRESS URINARY INCONTINENCE
Stress urinary incontinence describes the complaint of involuntary leakage of urine upon effort or exertion, or upon sneezing or coughing. This may be a small amount, but it can sometimes be significant.
Review lifestyle for food and fluid intake, weight reduction and smoking. Overweight people have a greater tendency for stress incontinence because of increased abdominal pressure. Smokers cough more, which can result in an increased incidence of leakage.
- Remain adequately hydrated. Reducing fluid intake to decrease urine may produce further irritation of the bladder and promote infection.
- Avoid caffeine, carbonated drinks and alcohol, all of which may irritate the bladder.
- Review current medication for interaction or iatrogenic effects.
Urge incontinence, or overactive bladder, refers to the overactivity of the detrusor muscle of the bladder that creates an increased urgency with little or no warning, and it is often accompanied by urine leakage. In severe cases, the volume of leakage can be large. Urinary frequency (more than eight times per day) and nocturia (one or more per night) may also occur. A full environmental assessment can be completed to address safety and ease of access.
Make getting to the bathroom as easy as possible. An full environmental assessment can be completed to address safety and ease of access. This may involve special adaptations to the Individual's living area. A raised toilet seat, handrails, commodes in the bedroom, may all help the Individual, as may clothes that can be opened easily if manual dexterity is a problem.
Bladder retraining is a behavioral technique designed to increase the capacity of the bladder and decrease the frequency of urination. Over time, the bladder becomes less irritable and able to cope with larger volumes of urine. A urinary diary is the first step in assessing urge incontinence and setting up a course of bladder retraining.
With mixed incontinence, the symptoms of stress urinary incontinence co-exist with those of urge incontinence. The most recent guidelines of the International Committee on Incontinence recommend treating the predominant symptom first.
OTHER FORMS OF INCONTINENCE
There are other forms of incontinence that may not fall into the above categories.
- Functional incontinence: The inability to reach the bathroom to urinate either due to disability (physical or mental) or infirmity.
- Overflow incontinence: As the name implies, there is a constant flow of urine, as if the bladder is ‘overflowing.’ This is often caused by a mechanical obstruction such as fecal impaction, nerve damage, or urethra abnormatlities.