Urinary Incontinence: Types, Causes and Treatment

Urinary Incontinence is a problem caused due to loss of bladder control and it leads to uncontrollable leaking of urine that can be after stress (sneezing or coughing) or without stress. It can be an embarrassing problem for the patient. There are several causes of urinary incontinence and commonly seen in geriatric age group and in women after giving birth.

Urinary Incontinence Causes and Types

Urinary incontinence in elderly-

There are multiple causes of UI in elderly people. These are-

Genitourinary

• Decrease in detrusor contractility or detrusor overactivity
• Bladder or urethral obstruction due to tumor or Benign Prostate hypertrophy
• Pelvic floor or uretheral sphincter weakness

Neurologic 

• Multiple sclerosis
• Disc herniation
• Parkinson disease
• Spinal cord injury

Other causes/ Reversible causes like Delirium, UTI, Stool impaction etc.

Urinary incontinence in Women-

• Stress Incontinence- There will be leakage of urine with activities like coughing, sneezing , laughing and Valsalva.
• Urgency Incontinence- There is sudden and frequent need to void and there can be voiding before reaching to the restroom.
• Mixed Incontinence-  Features of both stress and urgency incontinence can be seen.
• Overflow incontinence- There will be constant involuntary dribbling of urine seen which can be due to incomplete emptying of the bladder.

Also Read: Abnormalities in Small Intestine

Urinary Incontinence symptoms

• There is inability to hold the bladder at any random situation.( Urge incontinence)
• Discomfort to pass urine and the urine stream can be less than normal.
• There will be difficulty to start micturition.
• Stress incontinence can be embarrasing for the person and can have psychological effects and can effect routine life of the individual.
• Continuous dribbling after urination.

Also Read: Abdominal Trauma in Pregnancy

Urinary Incontinence Diagnosis

• In elderly, UTI is the most important and common cause of the incontinence and therefore once infection is ruled out additional tests should be performed.
• In women, the type of Urinary incontinence is diagnosed clinically by taking proper history.
• Q-tip test can be done to check for abnormal urethrovesical angle in stress incontinence.

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Urinary Incontinence Treatment

• Like mentioned earlier, in elderly UTI should be ruled out first and then other issues like BPH or any tumour should be resolved.
• In a patient with stress incontinence, Pelvic floor exercises( kegel exercises) are advised along with weight loss . If still patient is experiencing the symptoms midurethral sling procedure can be done.
• For urge incontinence, timely voiding and antispasmodics like oxybutynin can be prescribed.
• Advice patient about reducing caffeine intake and smoking cessation.

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Nemonic potentially reversible causes of Urinary Incontinence in elderly

DIAPPERS- 

• Delirium 
• Infection 
• Atrophic urethritis
• Pharmaceuticals( alpha blockers, diuretics)
• Psychological ( Depression) 
• Excessive urine output( Diabetes)
• Restricted motility
• Stool impaction

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