Leaky Bladder (Urinary Incontinence) - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

The leaky bladder is a problem in which control over the bladder is lost. As a result, the urine leaks out while coughing, sneezing, and exercising. Pregnancy and menopause are also responsible for this condition because they affect the muscles of the bladder. So this condition is commonly seen in women, and they feel uncomfortable discussing this problem with the doctor. However, it becomes necessary to consult the doctor on time because bladder problems harm life if left untreated.

What Is a Leaky Bladder?

The urinary system consists of organs designed to carry out their specific functions. The urinary system filters blood, and the waste products are separated and converted to urine. The major component of urine is urea formed due to amino acid metabolism. The urinary system also maintains the fluid volume of the body by controlling the amount of water excreted in the urine. The organs present in the urinary system are listed below:

1. Kidneys.

2. Ureters.

3. Urinary bladder.

4. Urethra.

The kidneys form urine which reaches the urinary bladder through the ureters. As soon as the bladder receives the urine, the nerves present around it transmit messages to the brain that the patient needs to pass urine. The muscles present in the bladder contract and push the urine out of the body through the urethra. Therefore, when the bladder functions normally, the person has enough time to reach the bathroom to urinate. In the case of a leaky bladder, the urine flows out of the body before the person reaches the toilet. It is because the muscles and nerves of the bladder do not function correctly, leading to a condition called urinary incontinence (urine leakage).

What Are the Major Causes of a Leaky Bladder?

There are several reasons why a person suffers from urinary incontinence or leaky bladder. The causes can be temporary (short-term) or permanent (long-term). The causes have been described below:

1) Temporary Causes - It includes the health conditions that subside after the treatment. The urinary leakage problem also gets resolved after the condition has been treated. The temporary causes have been listed below:

• Urinary Tract Infection - It is the infection of the urinary system due to bacterial entry. The patient experiences pain and frequently needs to rush to the bathroom to urinate. If the condition is treated at the right time, the urine leakage problem also subsides in a short time.

• Constipation - In this condition, the patient feels difficulty in passing stools. As a result, the stools remain within the organ known as the rectum. It is located near the urinary bladder and shares a common network of nerves. The stools put pressure on the bladder and the nerves causing the urine to leak out. If the constipation is treated with suitable medications, the bowel movement becomes normal, and the urinary leakage problem gets resolved.

• Pregnancy - The uterus expands during pregnancy to accommodate the baby. As a result, the pressure on the bladder increases, and the urine might leak out. The condition usually subsides a few weeks after the delivery.

2) Drugs - The medications that can cause leaky bladder or urinary incontinence are listed below:

• Diuretics - Hydrochlorothiazide, Furosemide, and Bumetanide.

• Narcotics - Morphine, Oxycodone, and Meperidine.

• Antihistamines - Chlorpheniramine and Diphenhydramine.

• Sedatives - Diazepam, Lorazepam, and Chlordiazepoxide.

3) Permanent Causes - The permanent or long-term causes of a leaky bladder are listed below:

• Pelvic Disorders - The pelvis consists of muscles that support the bladder and control urine flow. If the pelvic muscles become weak, they cannot support the bladder resulting in urine leakage.

• Menopause - Menopause, or the cessation of the menstrual cycle (periods) in females, occurs at 45 to 50 years. It is when the hormone levels change drastically, particularly estrogen levels. As a result, the women produce less estrogen, which decreases the strength of the pelvic muscles resulting in urine leakage.

• Neurological Disorders - The nerves run from the bladder to the spinal cord to transmit the signals to the brain. As a result of this communication, the person gets a message that he needs to urinate in the brain. However, in the case of neurological disorders like multiple sclerosis, stroke, spinal injury, and brain tumor, the brain, and the bladder network are lost. Hence the urine leaks out from the bladder without the knowledge of the person.

• Prostate Gland Problems - If the prostate gland increases in size, it puts pressure on the bladder, resulting in urine leakage. If the patient undergoes surgery for prostate cancer, the muscles that control the urine flow might get damaged, resulting in urine leakage.

• Peripheral Neuropathy - In this condition, the nerves become damaged due to high blood sugar levels (diabetes). The nerves around the bladder cannot carry the signals to the brain. As a result, the bladder loses control, and the urine leaks out.

What Are the Symptoms of a Leaky Bladder?

The only symptom that the patient presents with is the leakage of urine. The urine leaks out while doing activities that put pressure on the bladder, like coughing, sneezing, lifting heavy objects or weights, and bending. Under normal conditions, the patient has time to reach the bathroom to urinate. In the case of a leaky bladder, the urine flows before the person reaches the toilet. Due to urine leakage at night, the patient might wet his bed.

What Are the Types of Urinary Incontinence?

The different types of urinary incontinence are listed below:

1) Stress Incontinence:

• The urine leakage occurs during activities like coughing, sneezing, laughing, jumping, running, and lifting something heavy.

• The pelvic muscles that support the bladder become weak in stress incontinence.

2) Urge Incontinence:

• The patient feels a strong urge to pass urine. However, it is so intense that the person cannot reach the bathroom and leaks some amount of urine.

• It happens due to infections, overactive bladder, nerve damage, and obesity.

3) Overflow Incontinence:

• It occurs due to the incomplete emptying of the bladder. As a result, small amounts of urine keep dripping throughout the day.

4) Functional Incontinence:

• If a person is physically challenged and has walking difficulties (arthritis), it becomes impossible for him to rush to the bathroom to urinate.

• The bladder functions are normal in such people, but the urine leaks out because of the delay in reaching the bathroom.

5) Mixed Incontinence:

• If a person experiences more than one type of urinary incontinence, it is known as mixed incontinence. For example, the person might experience stress and urge incontinence together.

What Are the Methods to Diagnose a Leaky Bladder?

The methods used to diagnose a leaky bladder are listed below:

• Medical History - The patient needs to fill out a medical history form that contains questions like the following:

  • How many times does the patient need to urinate throughout the day and night?

  • Has the patient experienced the condition in the past?

  • Does the urine leak before reaching the bathroom?

  • How many times does urine leakage occur during the day?

• Physical Examination - In this procedure, the doctor examines the patient to check if any conditions cause urine leakage. Pelvic examination is done in females, and prostate examination is done in males as part of physical examination. The surgeon inserts a gloved finger in the vagina to examine the uterus and the ovaries in the pelvic examination. In the case of prostate examination, the doctor feels the prostate gland by inserting a finger through the rectum. Enlargement of the prostate gland and weakening of the pelvic muscles are some of the causes of urinary incontinence. The doctor might ask the patient to do activities like coughing, running, or jumping to see if the urine leakage occurs or not.

• Urinalysis - The patient is asked to collect the urine in a container. It is then sent to the laboratory for examination under a microscope. The presence of blood, white blood cells, bacteria, and other conditions affecting the urine flow can be detected.

• Ultrasound - It is a type of imaging test in which sound waves are sent to the body organs with the help of a device known as a transducer. The doctor moves the transducer at different angles to obtain images of the urinary system, including the bladder. It allows the doctor to detect the abnormalities present in the bladder.

• Post-void Residual Urine Test - In this test, the patient is asked to urinate in the bathroom to empty the bladder. Next, the doctor checks the amount of urine left in the bladder by inserting a catheter through an ultrasound. If a large quantity of urine is left in the bladder, the bladder muscles have problems.

What Are Some of the Treatment Options for a Leaky Bladder?

Several treatment options are available for leaky bladder or urinary incontinence, depending on the severity and cause of the condition. The treatment options are listed below:

• Behavioral Training: The following instructions are to be followed:

  1. The patient needs to hold the urine for ten minutes after he feels the urge to urinate. It helps to increase the time between bathroom visits.

  2. If the patient cannot empty the bladder at once, he needs to wait and try again to empty the bladder.

  3. It is essential to go to the bathroom every two to three hours to urinate instead of rushing when the need arises.

• Kegel Exercises: These exercises are recommended by doctors to strengthen the pelvic floor muscles and help the patient overcome stress and urge incontinence. The patient needs to contract and relax the muscles that stop the flow of urine (pelvic muscles) for five seconds. As the patient becomes comfortable, the contraction time should be increased to ten seconds.

• Antibiotics: The following medications are recommended to increase bladder strength and relax the bladder muscles so that it holds urine for long:

  1. Darifenacin.

  2. Oxybutynin.

  3. Mirabegron.

  4. Tamsulosin.

  5. Alfuzosin.

  6. Doxazosin.

  7. Solifenacin.

  8. Trospium chloride.

• Vaginal Electrical Stimulation: A low-intensity electric current is passed to the pelvic muscles by inserting the electrodes into the vagina. As a result, the pelvic muscles start contracting and controlling the urine flow in stress and urge incontinence.

• Medical Devices: The following devices can be inserted in women to deal with urinary incontinence:

  1. Pessary: It is a ring-like device that is inserted into the vagina. The patient needs to wear the device the whole day. It supports the urethra, thereby preventing urine leakage.

  2. Urethral Inserts: As the name suggests, the device is inserted into the urethra and left in place. It is a disposable device, so it needs to be removed before urinating. It prevents urine leakage during sports and other activities.

• Surgeries: The following surgical methods are usually performed:

  1. Sling Surgery: The doctor creates a sling from the body tissues or a mesh under the urethra and the bladder neck (the area where the bladder joins with the urethra). The sling closes the urethra during coughing, sneezing, and laughing to prevent urine leakage.

  2. Bladder Neck Suspension Surgery: The bladder neck meets the urinary bladder and the urethra. This procedure is done to support the urethra. It is carried out under general anesthesia, and the bladder neck is stitched next to the pubic bone.

  3. Artificial Urethral Sphincter: In this procedure, a ring is placed around the urinary bladder to keep the urinary sphincter under control (a muscle that controls the urine flow). The patient can press the valve attached to the skin to urinate.

  4. Bulking Agents: A special type of material (bulking agent) is injected around the urethra to keep it closed and prevent urine leakage. It is helpful in the case of stress incontinence.

  5. Botulinum Toxin Injections (Botox): Botulinum toxin (Botox) is injected into the urinary bladder to relax the bladder muscles and enable it to hold urine for a prolonged period. The patient needs to undergo this treatment repeatedly.

• Absorbent Pads: If the urine keeps dripping throughout the day, the patient can wear disposable pads that help absorb the urine.

What Are the Complications of a Leaky Bladder?

If the urine leakage continues, the surrounding skin continues to remain wet. As a result, the patient experiences skin infection, itching, rashes, and sores. The risk of urinary tract infections also increases because urine provides a medium for bacterial growth. It also negatively impacts the personal and professional life of a person.

Conclusion:

People usually ignore the problem of leaky bladder or urinary incontinence, thinking that it is normal and occurs with aging. As a result, the condition becomes worse and creates a negative effect on the life of a person. Sometimes, the patient feels embarrassed to discuss the problem with the doctor and leaves it untreated. This should not happen because there are various treatment options available for the condition. It is not necessary for the patient to undergo surgery in all cases. The condition can be prevented by maintaining a healthy weight, doing exercises to tighten the pelvic muscles, and cutting down on the consumption of alcohol, coffee, and other carbonated drinks. So, consult the doctor on time to deal with the problem in the best possible way.