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Urine Leakage - Urinary Incontinence





Urine leakage in women is common, in all age groups. This refers to the inability to control the urine resulting in leakage of urine. This can be particularly bothersome symptom, as it can lead to embarassment, and can result in the woman avoiding certain situations or activities due to the fear of the incontinence. There are different types of incontinece.


Stress urine incontinence - this refere to leakage of urine whenever there is increased pressure applied to the bladder, usually this happens with sneezing, coughing, laughing, exercise/movements etc. This is the the type of incontinence that often occurs after giving birth vaginally resulting in weak pelvic floor muscles and structure.


Urge urine incontinence - this refers to leakage that occurs when one is unable to "hold the urine in", i.e. occurs at the same time as the urge or feeling to pass urine occurs, usually associated with not being able to make it to the toilet in time. There are often factiors that may provoke this need to pass urine and the subsequent incontinence, for example cold weather or hearing running water. This is often accompanied byt other symptoms such as frequency if urination and needing to pass urine at night, and may be due to an "overactive" bladder.


Mixed urine incontinence - Many women have a combination of stress and urge incontinence, termed "mixed" incontinence.


Urine Incontinence Causes


The chief causes of urine incontinence include weakened pelvic floor due to vaginal childbirth, as well as "overactive bladder". An "overactive bladder" can have multiple factors that bring on the symptoms or make the symptoms worse, such as the drinking of caffeine and certain foods. Sometimes these symptoms can come on suddenly and may be related to a urine infection. Urine infections usually have other symptoms, such as painful urination, smelly/ cloudy urine and frequency. Sometimes these symptoms can persist despite succefully treating the infection with antibiotics.


Certain factors can make urine incontinence worse or exacerbate the symptoms - this includes habitual frequency of urine, being overweight, preganct, smoking, having a chronic cough (due to a cold or from chronic smoking), drinking too much ceffeine or alcohol, constipation, not drinking enough fluids. Certain medications can also predispose to incontinence, for example diurectics.


Somtimes there are more serious conditions that can result in urine incontinence. This might include neurological conditions such as Parkison's Disease, Multiple Sclerosis, Spinal Injury etc, or other anatomical causes such as a bladder tumour.


Urologists are well trained in evaluating incontinence and in excluding serious causes.



Urine Incontinence Diagnosis


The first thing a urologist would do is take a full history, including history of your symptoms, past medical history, and current medications. You can also expect that the urologist would want to do a physical examination, including vaginal examination to check for prolapse and check for growths/ tumours. The differetiation between stress, urge and mixed urine incontinence is often based on the history taken from the patient.


One of the most important tool that a urologist might use is the bladder diary. The Urologist might ask you to fill out a diary of your drinking and toilet habits, and to mark at which points during the day you experience your symptoms. This is very important, as it will help you and your urologists identify lifestyle factors that may be making your symtpoms worse, and the urologist would be able to give you tailored advise on managing or controlling your symptoms.


Depending on your symptoms, the urologist may want to check your urine for a urine infection. The urologist might also want to do a cystoscopy (camera test in the bladder usually done under local anaesthetic) to make sure there are no bladder stones or growths in the bladder. Additionaly, the urologist may want to get some scans done to ensure nothing serious is missed, and may also want to check you urine "flow rate" to ensure there is no obvious blockage when you pass urine.


Depending on the severity of your symptoms, the urologist may also request a very specialised test called "Urodynamics", that is essential in differentiating between stress and urge incontinence and in dictating surgical treatment. This test involves the placement of very small catheters in the bladder and the back passage, and the gradula filling of your bladder with water - the test looks to replicate your symptoms while also assessing your bladder pressures to see if you have stress incontincen or an "overactive" bladder.


Urine Incontinence treatment


Once the above tests are done, the urologist would be able to guide your treatment based on the diagnosis. This would often include lifestyle measures to help you control your symptoms. Lifetstyle measures to help you control your symptoms include the avoidance of certrain foods and drinks (such as caffeine), managing constipation, and may also include "Bladder Ret-raining" exercises.


Bladder re-training exercises is aimed to "re-set" the way your mind and bladder interpret a full bladder. This is done by systematically and gradually delaying urination, thereby "training" your bladder and mind to hold more urine in the bladder and thus to go to the toilet less frequently. This is an extremely helpful method to help people gain bladder control, but does not work for everyone.


The urologist might also suggest referring you to a Pelvic Floor Physiotherapist who can train you in pelvic floor exercises. These are extremely effective in helping to manage urine incontinence, but does require you to do ongoing regular pelvic floor exercises.


If lifestyle factors above are not beneficial or only partially beneficial, the urologist might add on certain medications to help control "overactive" bladder symptoms or urge incontinence and frequency.


The urologist might also offer surgery for stress urine incontinence, if the above lifestyle measures fail. As with any surgery, there are risks entailed, but the surgery can be highly beneficial in the right scenario and the urologist should be able to guide you on this.






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