What is urinary incontinence?

12-06-2018

Urinary incontinence or involuntary urination is a condition, when leakage of urine occurs uncontrolled, which may have a large impact on quality of life. Despite the fact, that several treatments are available for the problem, only one in ten patients visit a urologist.

What kind of urinary incontinences exist?

In terms of severity, urinary incontinence could be mild, moderate or severe. The severity depends on the amount of urine loss. In case of a mild incontinence, the urine loss is less than 140 ml, in a moderate condition it is between 140-300 ml, above 300 ml we talk about severe incontinence. Severe cases are typical in elder age.

We can differentiate 4 main types of urinary incontinence by the type of problem and symptoms: stress incontinence, urge incontinence, overflow incontinence, and reflex incontinence.

Stress incontinence is caused by the weakening or damage of the urethral sphincter or the pelvic floor muscle or both of these structures. Urine leaking occurs during activities that increase intra-abdominal pressure, such as coughing, sneezing, or bearing down. Lifestyle changes, stress relief and exercising the muscles of the pelvis might help to dissolve the symptoms. If none of these were effective, surgical treatment might be considered.

If the patient feels overwhelming urge to urinate, which is immediately followed by loss of urine, the condition is related to urge incontinence. In the background of the condition, there are innervation disorders, which can be treated with medications.

In case of an overflow incontinence, something blocks urine from flowing normally out of the bladder or the bladder muscle becomes underactive, so the patient doesn’t feel the urge to urinate. As a result, the bladder becomes overfilled, pulling the urethra open and allowing urine to leak out. The residual urine could cause urinary tract infection or the widening of the upper urinary tract, which could cause renal failure too.

Reflex incontinence can happen as a result of damage to the nerves that normally warn the brain about the filling of the bladder, so urine leaks without any warning or urge. This kind of incontinence usually appears in people with serious neurological impairment.

How is incontinence diagnosed?

The urologist starts the consultation with a thorough questioning of the patient about the start and intensity of the complaints, the type of the urge of urination, and the approximate amount of urine loss. After that, further examinations might be needed to set the diagnosis: urinalysis, blood tests, cystoscopy, and urodynamics if needed.

Urinary incontinence is not a disease, it is a syndrome, which could deteriorate the quality of life. Anxiety and embarrassment keep the patient to visit a urologist, although the involuntary leaking of urine can be treated successfully.

What are the treatments for urinary incontinence?

Different treatments are available for the different types of incontinences. For urge incontinence, pharmacotherapy is recommended and for mild stress incontinence lifestyle changes, and exercising the muscles of the pelvis could be effective. A severe condition could be treated with surgery only.

Several surgical solutions are available for incontinence, all of them are based on the suspension of the urethra. During the incontinence surgery, a synthetic material or mesh is placed under the urethra. This tape supports the urethra and the bladder like a hammock.

In case of a TOT surgery the tape is placed from the sides of the groin, and in case of a TVT surgery, the tape is placed through the space behind the pubic bone. The success rate of the TOT surgery is 80-85% in terms of total continence, which means the termination of urine leaking.

After the surgery a one-day hospital stay is recommended, the time of recovery is relatively short, usually 3-5 days.