Urinary Incontinence Causes

1. Stress incontinence: In men, stress incontinence is often due to surgery (eg, after radical prostatectomy) or trauma to the bladder neck/urethral sphincter. But in women it is usually result from weakness or disruption of the pelvic floor muscle and ligaments leading to poor support of the vesicourethral sphincteric unit.

   Generally stress incontinence can result from:

   • Aging and elderly people
   • Childbirth and pregnancy
   • Surgical procedures that cause weakness of the pelvic floor muscles.
   • Neurologic dysfunction
   • Obesity

2. Urge incontinence (overactive bladder): Causes of urge incontinence include:

   • Myogenic causes: those involving the smooth muscle of the bladder (e.g overactive bladder associated with bladder outlet obstruction).
   • Neurogenic causes of overactive bladder include stroke, Parkinson disease and multiple sclerosis.
   • Bladder infection or inflammation (cystitis) or bladder stones.
   • Prostatic Hyperplasia.

3. Overflow incontinence: Overflow incontinence occur with retention of urine owing to obstruction of the bladder neck.

   It occurs often in men with prostatic obstruction, following spinal cord injury or in women with cystoceles or after gynaecological surgery.

   The most common causes of overactive incontinence include:

   • Enlargement of prostate gland
   • Constipation (dry, hard feces in the r*e*c*t*u*m).
   • Sacral lower motor nerve dysfunction

4. Mixed incontinence: This disorder is associated with urethral sphincter underactivity, and also comprises an element of detrusor dysfunction. This occurs most commonly in women.

Urinary Incontinence Treatment

Treatment of urinary incontinence usually depends on the type of the urinary incontinenece. Treatments could range from changing the lifestyle to medications to surgery.

Behavioral and Lifestyle Changes:

Lifestyle modifications could help in some people to control the symptoms, this may include:

• Weight loss in obese and overweight people.
• Caffeine and alcohol reduction will improve incontinence symptoms.
• Bladder retraining and urethral sphincter exercises (e.g, progressively increasing voiding intervals, and pelvic muscle exercises) help to correct voiding patterns and improve the ability to suppress urge and increase bladder capacity.
• Pelvic floor muscle (“Kegel”) exercises can reduce the frequency of incontinence by strengthen the urethral sphincter and pelvic floor muscles.

Medication

When lifestyle changes doesn’t work doctors may prescribe medication for some patients with urinary incontinenece.

• Anticholinergic agents suppress involuntary bladder contractions, helping the bladder muscle to relax and thus reduce the symptoms of urinary incontinenece. Anticholinergic medication include oxybutynin (Ditropan), tolterodine (Detrol), fesoterodine (Toviaz), propiverine, and trospium (Sanctura).
• More selective M3 receptor antagonists, solifenacin (Vesicare) darifenacin (Enablex), have also demonstrated good efficacy, safety, and patient tolerance.
• Mirabegron (Myrbetriq), is the first β3-agonist. Stimulation of β3-receptors helps to relax the bladder and increase storage capacity, and this drug can be used for patients who do not respond to anticholinergics or tolerate them.
• α-Blockers could be prescribed by doctors for patients with an enlarged prostate. These medications relax bladder neck muscles and muscle fibers in the prostate.
• Topical estrogen therapy has been used to increase α-adrenergic responsiveness and improve urethral mucosa and smooth muscle tone. Prescription of oral estrogen for the treatment of incontinence is not recommended.
• Intravesical botulinum toxin A has shown significant benefits to treat urinary incontinence, prostatic enlargement, and neurogenic detrusor overactivity.

Surgery

Surgical therapy is indicated for patients with incontinence resulting from:

• Anatomic abnormalities (eg, cystocele, prolapse)
• Outlet obstruction resulting in urinary retention, especially in the setting of urinary retention due to benign prostatic hyperplasia.
• Surgical treatment of female urinary incontinence is to provide support of the vesicourethral segment or the midurethra.

Electrical Nerve Stimulations

Are used to stimulate contractions of the pelvic floor muscles or inhibit overactive bladder contractions. Noninvasive stimulation electrodes can be placed in the v*a*g*i*n*a or the a*n*u*s. It can also be embedded in the sacral nerve roots, the peripheral tibial nerve or the bladder.

Pads, Garments, Pessaries and Catheterization

• Absorbent pads and undergarments are useful in patients with infrequent and predictable incontinence and who cannot tolerate the side effects of medications. The main purpose of these pads and garments is to contain urine loss.
• Pessaries are intrav*a*g*i*n*al devices used in patients with genitourethral prolapse, Which help to maintain the position of the pelvic organs.
• Urethral catheterization is sometimes indicated in cases of overflow incontinence or in patients for whom no other measures have been effective.