Urinary Incontinence Disease

DESCRIPTION

Urinary incontinence is the involuntary loss of urine from the bladder. It can occur while asleep or awake. The amount of urine lost can vary greatly. The condition comes to medical attention when it is perceived to be a social and/or health problem by the patient or family.

System(s) affected: Renal/Urologic
Genetics: Unknown
Incidence/Prevalence in USA:
- 11–55% in community-dwelling elderly (over age 65)
- 13 million in U.S.
- Up to 50% in nursing home populations
Predominant age: Geriatric populations. Increases with age.
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Involuntary loss of urine
Urinary urgency

CAUSES

Pelvic floor muscle weakness
Post TURP
Urethral sphincter weakness
Bladder irritation (cystitis, tumors, stones, diverticula)
Detrusor motor/sensory instability (stroke, dementia, parkinsonism)
Anatomic obstruction (prostate, stricture, cystocele)
Neurogenic bladder (diabetes, spinal cord injury, multiple sclerosis)
Loss of central nervous system control (severe dementia)
Fecal impaction
Drugs (cyclophosphamide, caffeine, beta blockers, cholinergic agents, alcohol, alpha agonist)

RISK FACTORS

Increasing age
Female sex/estrogen deficiency
Prostatic hypertrophy (males)
Multiparity (females)
Dementia
Diabetes
Spinal cord injury
Multiple sclerosis
General debilitated condition
Stroke

LABORATORY

Urinalysis - generally normal. May show glycosuria (diabetes), proteinuria (glomerular disease), white blood cells (infection), red blood cells (tumor), or bacteria (infection).
Urine culture - will be positive in urinary tract infection

Drugs that may alter lab results:

Diuretics (low urine specific gravity)
Antibiotics (negative urine culture)

Disorders that may alter lab results: Not applicable. Disorders producing abnormal lab results generally contribute to the problem of incontinence.

PATHOLOGICAL FINDINGS

Relate to the primary cause of incontinence
Urinary sphincter incompetence
Prostatic hypertrophy
Neurogenic bladder
Bladder tumors
Urinary tract infection
Fecal impaction

SPECIAL TESTS

Voiding cystourethrogram - may show bladder and/or urethral pathology
Cystometrograms - may show abnormal sphincter pressure or bladder physiology
Post-voiding residual measurement - may show increased residual urine (normally less than 50 cc)

IMAGING

Renal ultrasound - may show renal pathology
IVP - may show renal pathology

DIAGNOSTIC PROCEDURES

The diagnosis is generally made by history
Physical examination of men should include palpation of abdomen (for distended bladder), digital rectal exam (for prostatic hypertrophy), and neurological exam
Physical exam of women should include palpation of abdomen (for distended bladder), vaginal speculum and bimanual pelvic exam (for genitourinary pathology), and neurologic exam
Both men and women should be examined for fecal impaction
It is sometimes helpful to ask the patient to reproduce the activities (e.g., coughing, sneezing, laughing) which result in loss of urine
Office cystometry - using a catheter and 60 cc Asepto syringe (without plunger)

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

All primary conditions relating to urinary incontinence should be identified and treated specifically (e.g., urinary tract infection, bladder tumors, prostatic hypertrophy, diabetes)
Good perineal hygiene
Pelvic floor (Kegel) exercises
Biofeedback/behavioral training
Intermittent catheterization (selected patients)
Impress Soft Patch (Uro Med Corp.) or Fem Assist
Incontinence pads
Indwelling catheterization (selected patients)
Condom catheters (male patients)
Treatment for fecal impaction
Electrical stimulation (selected patients)
Vaginal cones
Bladder neck prosthesis

SURGICAL MEASURES

Some patients with overflow incontinence secondary to prostatic hypertrophy may benefit from transurethral resection of the prostate (TURP)
Some patients with stress incontinence may benefit from bladder suspension procedures
Some patients with poor urethral tone may benefit from periurethral collagen injections or sphincter implants

ACTIVITY

Full activities should be encouraged

DIET

No special diet
In situations where access to bathroom facilities is limited, may want to avoid high-volume fluid intake and reduce intake of caffeine- or alcohol-containing beverages

PATIENT EDUCATION

Should be directed at the general problem, as well as any underlying diseases
Should include instructions regarding good general nutrition and exercise practices
Rational toileting schedule, based on the patient's pattern of incontinence
Easy access to toilet facilities
Pelvic floor (Kegel) exercises
Bladder training – timed voiding, increasing slowly to 3 hours
Examples of specific instructions can be found in Clinics in Geriatric Medicine, November 1986, pages 841–855

PREVENTION/AVOIDANCE

Instruct women in routine use of Kegel exercises after birth of children
Regular pelvic examination of female patients to detect pelvic pathology
Regular rectal examination in male patients to detect early prostatic pathology and provide treatment for hypertrophy

POSSIBLE COMPLICATIONS

Urinary tract infection
Hydronephrosis (with atonic bladder or outlet obstruction)
Renal failure (with obstructive hydronephrosis)
Adverse drug reactions

EXPECTED COURSE AND PROGNOSIS

Prognosis is generally good. Most patients can achieve an increase in bladder control with appropriate medical management
Some feel that sphincter incompetence is best treated surgically

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: This problem is most commonly seen in the aging population
Others: N/A

PREGNANCY

Stress incontinence can occur during pregnancy

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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