Urinary incontinence is a much more common and often embarrassing problem than most people realize. Urinary incontinence is the involuntary leakage of urine which is more common among women than men. It is estimated that 30 percent of women aged 30-60 years suffer from it in their lifetime.

The severity ranges from occasionally leaking urine on coughing or sneezing to having a sudden urge to urinate and a person does not reach a toilet in time.

Urinary incontinence is of several types depending upon the underlying causes. Types of urinary incontinence include:

Stress incontinence

It is the common type of Urinary incontinence. In this case Urine leaks when a pressure is exerted on the bladder due to any of the following actions:

• Lifting something heavy
• Laughing
• A sudden cough
• Sneezing
• Exercise

Causes of stress incontinence include:

• Age-with advancement of age, muscles get weaken.
• Menopause
• Obesity
• A hysterectomy – surgical removal of the uterus (womb)
• Pregnancy
• Childbirth (labor)
• Some other surgical procedures

Urge incontinence

This form of incontinence is also termed as Overactive Bladder. After stress incontinence, urge continence is considered as the second most common type. One has a sudden, intense urge to urinate followed by an involuntary loss of urine.  Urge incontinence may be occurred by a mild condition like infection, or a more severe condition such as neurologic disorder or diabetes.

The urge to urinate may be caused by:

• Cystitis: Inflammation of the lining of the bladder
• Central nervous system problems – examples are multiple sclerosis, stroke, and Parkinson’s disease
• An enlarged prostate: The bladder may drop, and the urethra could become irritated
• Infection
• The sound of running water for some people
• Sex especially during orgasm

Overflow incontinence.

This is the condition in which urinary bladder cannot hold as much urine as the body is producing. This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. One experience frequent or constant dribbling of urine from the urethra due to a bladder that doesn’t empty completely.

This happens when there is an obstruction or blockage to the bladder. The following may cause an obstruction:

• An enlarged prostate gland
• A tumor pressing against the bladder
• Urinary stones
• Constipation
• Urinary incontinence surgery which went too far

Functional incontinence

As the name depicts, in this type of continence person cannot make it to the toilet in time due to some physical or mental impairment.

Mixed incontinence.

When one experiences more than one type of urinary incontinence at the same time is termed as Mixed Incontinence.

1. There are certain drinks, foods which act as diuretics: Stimulating the bladder hence increasing the volume of urine. They include:
   • Alcohol
   • Carbonated drinks
   • Caffeine
   • Tea and Coffee
   • Artificial sweeteners
   • Foods that are high in spice, sugar or acid, especially citrus fruits
   • Large doses of vitamins B or C
   • Corn syrup
   • Certain medications also act as diuretics such as Heart and blood pressure medications, sedatives, and muscle relaxants
2. Urinary tract infection: Infections can irritate urinary bladder leading to have strong urge to urinate and sometimes incontinence. Urinary tract infection is associated with a burning sensation while urinating and foul-smelling urine.
3. Other Causing factors:
   • Pregnancy
   • Childbirth
   • Changes with age
   • Menopause
   • Hysterectomy
   • Enlarged prostate
   • Prostate cancer
   • Obstruction
   • Neurological disorders

• Urinalysis: A urine test which is done to check for any infection or any other abnormalities.
• Cystogram: It is an X-ray procedure to visualize the bladder. In this a catheter is inserted into patient’s Urethra and bladder and a special dye is injected.
• Cystoscopy: In this procedure a Cystoscope which is a thin tube with a lens at the end is inserted into the urethra to view abnormalities in the urinary tract if any.
• Blood test: It is done to assess kidney function.
• Pelvic Ultrasound: It is done to check any abnormality in Urinary Tract or Genitals.
• Urodynamic Study: A catheter is inserted into patient’s Urethra and Bladder to fill the Bladder with water. Meanwhile, a pressure monitor measures and records the pressure within the bladder. This study helps determine how much pressure the bladder and urinary sphincter muscle can withstand.

Treatment for urinary incontinence will depend on several factors, such as the type of incontinence, its severity, underlying cause, the patient’s age, general health, and their mental state. Treatment options include the following:

1. Behavioral techniques

   • Bladder training: A patient is made to learn how to delay or hold off for few minutes whenever there is an urge to urinate. Bladder training helps the patient gradually gain back control over their bladder.
   • Double voiding: This involves waiting for a couple of minutes after urination, then urinating again.
   • Scheduled toilet trips: Urinate at a regular interval, every two to four hours rather than waiting for the need to go.
   • Fluid and diet management

2. Pelvic floor muscle exercises

3. Medical devices

   Certain devices are designed to treat females with incontinence. These include:

   • Urethral insert: This insert is a Tampon like disposable device which acts as a plug to prevent leakage, and is removed before urination.
   • Pessary: It is a rigid ring which is inserted into the vagina. It is worn all day. The device helps hold the bladder up and prevent leakage
   • Bulking material injections: A synthetic material is injected into tissue surrounding the urethra which helps keep the urethra closed and reduce urine leakage. This is less effective than other treatments such as surgery for stress incontinence and typically needs to be repeated regularly.
   • Botox Therapy: Botox injections into the bladder muscle may benefit patients with an overactive bladder. Botox injections are recommended to those patients who are not benefitted by medications.
   • Sacral Nerve stimulators: A device is implanted under the skin of patient’s buttock which stimulates the sacral nerves which therefore can control urge incontinence if other therapies haven’t worked.

If other treatment options are not effective then Surgery is the ultimate option to get rid of Urinary Incontinence. Few effective surgical procedures include:

• Sling procedures: A mesh or synthetic material is inserted under the neck of Bladder to create a pelvic sling around the Urethra to help support the urethra and stop urine from leaking out. This procedure is used to treat stress incontinence.
• Bladder neck suspension: This procedure involves an abdominal incision, so it’s done during general or spinal anesthesia. In this the neck of bladder is lifted.
• Prolapse surgery: Surgery involving a combination of sling procedure and prolapse surgery is performed in women with mixed incontinence and pelvic organ prolapse.
• Artificial urinary sphincter(valve): Artificial urinary sphincters are helpful for men whose incontinence is associated with treatment of an enlarged prostate gland or prostate cancer. An artificial sphincter may be inserted to control the flow of urine from the bladder into the urethra.