Reflex Incontinence - An Analysis

Introduction

Bladder control problems affect the way person controls their bladder. Bladder control is the voluntary action that helps the person to release or hold the urine. The leakage of urine, accidentally known as urinary incontinence of overactive bladder, is the most common bladder control issue. One of the types that leads to this condition is reflex incontinence.

What Is Reflex Incontinence?

Reflex incontinence is a condition where the urine leaks without warning or an urge to urinate. This type of incontinent condition happens when the nerves of the bladder are damaged, and the signals are not sent to the brain correctly. This discoordination leads to untimely connections or reflexes of the bladder, causing urine to leak.

What Are the Causes of Reflex Incontinence?

This type of urinary incontinence is linked to neurological problems that affect the signaling from the brain to the bladder. It is either a spinal or supraspinal reflex incontinence.

1. Spinal Incontinence - This type of urinary reflex incontinence results from the blockade of signals from the brain to the spinal cord. It affects a person's voluntary control of bladder functioning. Generally, this is due to spinal cord injury, surgical trauma, and disease. Incontinence of this kind can also be a result of side effects from radiation therapy.

2. Supraspinal Incontinence - This type is related to neurological conditions that affect the neural pathways between the brain, spinal cord, and the bladder. The diseases leading to such incontinence can be multiple sclerosis, stroke, Parkinson's disease, and Alzheimer's disease.

3. Overactive Bladder - When the bladder muscles become overactive, the bladder squeezes more often than normal, and before the bladder is full of urine.

4. Underactive Bladder - In a few individuals, the bladder muscles will not squeeze when the bladder is filled and will not empty at all. The sphincter muscles around the urethra also do not work properly in this case. They remain tight when a person with an interactive bladder is trying to empty the bladder.

What Are the Symptoms of Reflex Incontinence?

The symptoms of neurogenic bladder differ in various individuals. They also depend on the type of nervous damage the person has. Some individuals show overactive bladder, while others have underactive bladder. The symptoms are

1. Urinary Tract Infection - People with reflex incontinence as a resultant interactive or overactive bladder can get recurrent urinary tract infections. These infections are often the first symptom of neurogenic bladder.

2. Incontinence With Overactive Bladder - In an overactive bladder, which is often seen in patients with stroke, brain disease, and Parkinson’s disease, the muscles squeeze more often than normal. Sometimes, this squeezing causes urine to pass even before the person reaches the washroom. The person suffering from this may feel a sudden urge to go to the restroom; he or she may or may not leak urine after feeling this urge and sometimes may gush a large amount of urine while asleep.

3. Frequent Urination - The number of times a person urinates varies from one person to another. However, the majority of urologists suggest that using the bathroom eight to 10 times in 24 hours can be termed as frequent urination.

4. Urinary Retention - In people with an underactive bladder, the bladder muscles may not squeeze completely when they need to. The muscles around the urethra may also not work properly. They may remain constructed while emptying the bladder, and the person either dribbles out the urine or is not able to pass the urine at all.

What Is the Effect of Reflex Incontinence On Life?

The symptoms can seriously be detrimental to the quality of life. There are constant hurdles throughout the day. The person may be hesitant to go out with friends, take vacations, or even while doing everyday things. Due to fear of not being able to use washroom facilities, some people even cancel their activities. The person feels tired, depressed, and anxious.

How Is the Reflex Incontinence Bladder Problem Diagnosed?

The diagnosis of the condition is dependent on a comprehensive approach of medical history, physical examination, culture tests, and imaging diagnosis.

1. Medical History - This includes talking and asking about the symptoms such as leaking urine, frequency of urination, and time duration of symptoms. Medical history also involves underlying medical conditions such as dementia, spinal cord or brain damage injury, neurodegenerative diseases, and any recent occurrence of stroke.

2. Physical Examination - In women, the physical examination will include the abdomen, the organs of the pelvis, and the rectum. In males, the physical examination is done with the abdomen, prostate, and rectum.

3. Pad Test - This is done to know the frequency and severity of the disease. The pad is treated with a special dye and changes color when a person leaks urine.

4. Other Tests -

   1. Urine Culture - A urine sample is collected for any possible bacterial infection.

   2. Bladder Scan - This is a type of ultrasound that is performed after and before emptying the bladder.

   3. Cystoscopy - A narrow tube is inserted into the bladder to rule out any other cause due to the lesion or any mass.

   4. Urodynamic Testing - These tests are performed to check the urine stores and release of urine. It can be done either by urinating into a funnel or a catheter inserted into the bladder.

How Is Reflex Incontinence Managed?

Reflex incontinence can be managed by the following techniques -

1. Bladder Training - It is a training in which urination is delayed after an urge. It is done by holding off the urge to urinate for 10 minutes. The goal is to increase the time between urination to 2.5 to 3.5 hours.

2. Double Voiding - It refers to urinating and waiting for a few minutes and then trying again.

3. Fluid And Dietary Management - To get back control of the bladder, it is advisable to cut the consumption of caffeine and alcohol.

4. Exercises - Pelvic floor exercises and Kegel exercises help manage reflex incontinence. These are the exercises that involve contraction and relaxation of the muscles in the pelvic floor, specifically targeting the muscles that support pelvic organs such as the bladder, uterus, and rectum.

5. Medication- Common medications used to manage the conditions are anticholinergic and alpha-blockers.

Conclusion

Reflex incontinence is characterized by involuntary bladder contractions emptying without awareness or control. It often results from neurological conditions impacting the reflex arc. Diagnosis involves urodynamic testing and management exercises, medication, and catheterization. Understanding the underlying cause is very important.