Controlling incontinence
Incontinence is a manageable condition. Report it to a doctor and seek help immediately, says Shreya Sethuraman
Urinary incontinence, or uncontrollable loss of urine, affects millions. Both men and women, at any age, can suffer from incontinence; while women outnumber men eight times till the age of 70, an equal number of men and women suffer from the condition thereafter. Only half of these cases get reported, though, because of either embarrassment or the perception that incontinence is a part of ageing and doesn’t call for medical attention. However, those suffering from it face considerable loss of self-esteem. They find it hard to go shopping and visit friends and relatives, and have to give up sports and exercise, all because they don’t have control over their bladder. The problem is so serious that, unfortunately, sometimes it is even the deciding factor in children abandoning their parents or institutionalising them. A related problem is faecal incontinence, which is rare.
Here’s the good news: urinary incontinence is treatable, and in most cases curable. The first step is to talk to your doctor and arrive at an understanding of the physiology of incontinence and possible causes. The urethra (the route out for urine) is surrounded by muscles, which control the flow of urine from the urinary bladder. Collectively, these muscles are called urethral sphincter and are supported by connective tissue called fascia. Further, fascia extends into the muscles of the pelvic floor, which support the bladder, uterus (in case of women) and bowel. The contraction of urethral sphincter causes closing of the urethra and stops the flow of urine. If the urethral sphincter, fascia or pelvic floor is weak, then the problem of incontinence arises.
TYPES OF URINARY INCONTINENCE
Stress incontinence: This occurs owing to weak pelvic floor muscles putting pressure on the abdomen when a person coughs, walks or indulges in any hectic activity. It’s common in women and occurs after childbirth and/or during menopausal years, as both phases cause weakening of pelvic muscles and fascia.
Urge incontinence: This is involuntary loss of urine for no apparent reason, along with the urge to urinate. The most common cause is involuntary contractions of the detrusor muscle (contracting muscle in the bladder that helps to expel urine). Normally, the bladder first contracts and then opens to release urine. Sometimes, because of a neural problem or infection, the bladder becomes overactive and contracts and retracts without any stress. This condition is treatable with drugs.
Overflow incontinence: Here, the passage in the urethra narrows owing to a lack of hormones (especially in women during menopause). Thus, the bladder doesn’t empty itself completely. At the same time, the bladder keeps getting filled. When it can’t retain any more or any longer, it begins to leak.
Functional incontinence: Functional incontinence occurs when a person does not recognise the need to urinate, recognise where the toilet is, or get to the toilet in time owing to confusion, dementia, poor eyesight, mobility or dexterity, or unwillingness to use the toilet because of depression, anxiety or anger. In this case, urine loss may be heavy.
CAUSES OF INCONTINENCE
Apart from gender (women suffering from incontinence outnumber men) and age (it’s more common in elderly than young people who are primarily women after childbirth), obesity is one of the main causes. Urinary tract infection, major prostate surgery, illnesses like diabetes and multiple sclerosis, some disorders of the nervous system, and surgery involving the pelvic floor could be other reasons.
Most of these factors either cause local nerve damage or weakening of pelvic floor muscles or fascia resulting in loss of support to the bladder. Pons, a neural point in the central nervous system, also controls the bladder. So, patients of Alzheimer and Parkinson’s with lesions in the brain tend to suffer from incontinence.
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