Introduction:
Urination is an important physical process. The toxic byproducts are eliminated by this process. In childhood, babies donnot have any control over urination. Gradually control over the process of urination is developed. But, the sudden passage of urine during physical activity has a social and psychological impact.
What Is Urinary Incontinence?
Urinary incontinence is the leakage of urine accidentally. In such cases, patients complain of involuntary urine leakage during physical activity. This is most commonly seen in women. Different types of urinary inconsistency are seen based on several situations and pathological conditions.
A. Etiology:
The causative factors for urinary inconsistency are:
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Stress Urinary Incontinence: This type of urinary inconsistency occurs due to a sudden increase in intraabdominal pressure. Such things usually occur during coughing, sneezing, and exertion. This is also seen in sports persons during sports activity. Urethral sphincter or pelvic floor weakness is the root cause of this type of urinary inconsistency.
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Urge Urinary Incontinence: This type of urinary leakage is related to urinary urgency. Due to detrusor inconsistency, such complications happen. The contraction of the detrusor muscle is caused by bladder irritation and neurologic control.
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Mixed Urinary Incontinence: This type of urinary inconstancy occurs due to a combination of both stress and urgency.
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Overflow Urinary Incontinence: This type of urinary inconsistency occurs due to an overdistended bladder. This type of overdistension is due to impaired detrusor contractility. Bladder outlet obstruction may also be responsible for this. Such type of bladder outlet obstruction happens due to pathological factors like Skene's gland cyst (cyst in the Skene's gland which is located at the lower end of the urethra), presence of the Mullerian duct remnants, urethral diverticulum (presence of unwanted sac in the urethra), and ectopic ureterocele (presence of extra tube in the urinary system). Cervical carcinoma, vaginal cancer, and urethral carcinoma are also associated with bladder obstruction. Functional conditions like dysfunctional voiding and external sphincter pseudodyssynergia (unusual contraction of the sphincter during voiding) are also related to this. Neurological disorders like spinal cord injury, multiple sclerosis, and Parkinson's disease may also cause bladder obstruction.
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Functional Urinary Incontinence: Such types of urinary inconsistency occur due to environmental factors or physical barriers to toileting.
Stress urinary incontinence is the most common among all these etiological factors. It is seen among 24 to 45 percent of women over 30 years of age. In contrast, urge urinary inconsistence is seen in 31 percent of women over 75 years of age and 42 percent of men over 75 years of age. The pelvic floor plays a pivotal role in such types of urinary incontinence. The urethral support system of the pelvic floor consists of the anterior vagina, endopelvic fascia, arcus tendinous fasciae pelvis, and pelvic floor muscles. Another part of the pelvic floor is the sphincteric closure system which is made up of urethral striated muscles, urethral smooth muscle, and vascular elements. The major part of the pelvic floor is made up of pelvic floor muscles. These muscles are between the tailbone (coccyx) and the pelvic bone. These muscles are arranged in three layers and form the urogenital diaphragm.
The function of the sphincter closure depends upon factors like the urethra, state of the urethra, voluntary contraction of pelvic floor muscles, impact, posture, and age. The voluntary closure mechanism of pelvic floor muscles helps in the occlusion of the bladder, neck, and mid-urethra. This contraction happens every time except before and during voiding. During this contraction, the muscles move inward direction and prevent the downward movement of the urethra. But a decrease in the closing force is seen due to several risk factors. These factors are increased age, gynecological surgeries, vaginal birth, and obesity.
B. Diagnosis:
The diagnosis of urinary incontinence is based mainly based on careful history-taking serotonin–noradrenaline reuptake inhibitors and physical examination. Apart from this, several diagnostic tests can be done for the identification of underlying pathology.
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One of the main causative factors for urinary incontinence is urinary tract infections. Urinalysis can be done for the detection of changes in the pH and other factors in the urine. This is helpful in the diagnosis of bacteremia.
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Ultrasonography method can be used for the analysis of post-void residual (PVR) volume determination. This method measures the completeness of bladder emptying.
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Pad testing is a useful method for determining the incidence of urinary incontinence. A pad is worn for 24 hours for determination of volume loss and correlation with symptoms.
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The functions of the lower urinary tract are assessed by urodynamic studies. Tests like uroflowmetry, voiding cystometry, filling cystometry, urethral function, and provocative maneuvers can be used for the determination of urinary incontinence.
What Are the Different Treatment Options?
Different treatment options for urinary incontinency are:
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Low-dose estrogen can be applied to the vaginal wall, which can be helpful in improving blood supply and reducing the symptoms of lower urinary tract symptoms. Also, medications like anticholinergic drugs can be used, which are helpful in reducing voiding symptoms. Apart from this, drugs like alpha-adrenergic agonists (Example, Phenylpropanolamine), beta 3-adrenergic receptor agonists (Mirabegron), and serotonin–noradrenaline reuptake inhibitors (Duloxetine) can be used for this condition.
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Stress incontinence surgery can be performed in severe cases. Also, the application of electrical stimulus can be helpful.
What Are the Benefits of Exercise in Preventing Urinary Incontinence?
The exercises that can be used for the treatment of urinary incontinence are known as pelvic floor training exercises or kegel exercises. These exercises are responsible for strengthening the pelvic floor muscles and increasing the contractile ability of the muscles. Increased muscle contraction increases the pelvic floor's volume and lifts the levator plate. Stiffness due to the contraction of muscles is responsible for increased intraabdominal pressure.
What Is the Process of Exercise?
The process of the kegel exercise is simple. This exercise should be performed on an empty stomach. Pearson should lie on the floor, resting their back on the floor. The legs should be bent, and the hand must be spread on both sides. After that, the person should try to elevate the abdomen from the ground as much as he can. Ideally, the back portion of the neck and the chest should touch the ground, and the rest of the body should make an arch. This position should be held for five to ten seconds. During this period, the person should take deep breaths in and out slowly. The contraction of the muscle around the anus can be felt easily. This process should be repeated 10 to 15 times in a set of two to three.
Conclusion:
Urinary incontinence is the accidental leakage of urine during physical activity. Overactive bladder and loss of contractility of the pelvic floor muscle are responsible for this. Surgical or pharmacological treatment options can be used in such cases. But, all these treatment options have several side effects. Pelvic floor exercises are really helpful in strengthening the pelvic floor muscle and increasing the contractility of such muscles.
