สาเหตุ วิธีการรักษาอาการกลั้นปัสสาวะไม่อยู่ ปัสสาวะเล็ด - Leakage, Causes and Treatment for Urinary incontinence

Urinary incontinence

Urinary incontinence is the unintentional release of urine and is classifiable into various types. The approach to treating urinary incontinence considers its severity, type, and underlying cause.

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Urinary incontinence

Urinary incontinence is the unintentional release of urine and is classifiable into various types. The approach to treating urinary incontinence considers its severity, type, and underlying cause. Additionally, addressing urinary incontinence may involve the application of combined treatment techniques.

What is urinary incontinence?

Individuals with urinary incontinence leak urine unintentionally due to weakened muscles or nerve problems. They often leak urine eight times a day or more and several times at night.

Urinary incontinence can be categorized into several types, as follows.

  • Stress incontinence is due to sudden increased pressure on the bladder caused by coughing, laughing, or physical activity.
  • Urge (urgency) incontinence is associated with the symptom of a sudden urge to pass urine with the inability to withhold the urine.
  • Mixed incontinence has a mixture of stress incontinence and urge incontinence symptoms. Over 30-50 percent of women with urge incontinence also have stress incontinence.
  • Overflow incontinence is due to the inability to empty the bladder despite the need to void due to urethral obstruction, causing pressure build-up sufficiently to overcome the obstruction and result in unintentional urine leaks.

What causes urinary incontinence?

Causes of urinary incontinence vary, from everyday activities to underlying health conditions and physical problems. A detailed diagnosis from a specialist may specify the causes of your incontinence.

Temporary urinary incontinence

Causes of temporary urinary incontinence mostly are foods and beverages, medications, constipation, and urinary tract infections.

  • Foods, beverages, and medications that may cause urinary incontinence include:
    • Alcohol
    • Artificial sweeteners
    • Caffeine
    •  Carbonated drinks and sparkling water
    • Chocolate
    • Chili peppers
    • Large doses of vitamin C
    • Certain medications for heart disease and blood pressure, muscle relaxants, and sedatives
  • Certain health conditions may give rise to urinary incontinence, for example:
    • Urinary tract infection: Infection in the urinary tract can lead to irritation. As a result, you have urinary urgency or even incontinence. 
    • Constipation: Since the rectum shares some of the nerves with the bladder, constipation can lead to overactivity of the bladder and urinary frequency.  

Persistent urinary incontinence

Persistent urinary incontinence is due to underlying health conditions and other factors, such as:

  • Pregnancy: Stress incontinence can develop in pregnant women due to hormonal changes and the increased weight of the fetus.
  • Childbirth: Weakened pelvic floor muscles resulting from vaginal delivery can lead to poor bladder control. As a result, the pelvic floor may prolapse. The bladder, small intestine, and uterus may subsequently protrude into the vagina, which can lead to incontinence.
  • Aging: As you age, the bladder capacity decreases, and involuntary contraction of the bladder occurs more frequently.
  • Menopause: After menopause, the body makes less estrogen. The lining of the bladder and urethra can become less healthy as a result, leading to deterioration of the lining. Incontinence can occur due to this deterioration.
  • Prostate problems: Benign prostatic hyperplasia or enlarged prostate gland can be the culprit of incontinence in older male adults. In addition, untreated prostate cancer can be associated with stress and urge incontinence. 
  • Obstruction: Blockage in the urinary tract can lead to the inability to pass urine, causing overflow incontinence. Stones in the bladder can also cause urinary incontinence due to bladder irritation.
  • Neurological disorders: Stroke, multiple sclerosis, Parkinson's disease, a spinal injury, or brain tumor can block nerve signaling involved in bladder control. Urinary incontinence can ensue as a result.

Other factors that may lead to an increased risk of having urinary incontinence.

  • Diabetes.
  • Hysterectomy or other pelvic surgery.
  • Smoking.
  • Radiation therapy to the pelvis.

What are the symptoms of urinary incontinence?

What are the symptoms of urinary incontinence?

The primary symptom of urinary incontinence is any uncontrollable urine leakage from the bladder, regardless of volume, from small leakage to complete bladder emptying. Your urine may leak when you laugh, sneeze, exercise, or cough. Other symptoms that may accompany urinary incontinence include:

  • Urinate frequently (over eight times a day).
  • Wake up more than once at night to pass urine (nocturia).
  • Unable to resist an urge to urinate.
  • Wet bed at night.

What complications are associated with urinary incontinence?

Chronic urinary incontinence can lead to the following complications:

  • Rashes, skin infections, and sores due to constantly wet skin
  • Increased risk of repeated infections of the urinary tract

How is urinary incontinence diagnosed?

Physical exams, including a pelvic or a prostate exam, may be performed for an accurate diagnosis. Tests for urinary incontinence include an abdominal ultrasound, cystoscopy to inspect the urinary tract, urinalysis, and urodynamic testing like a postvoid residual urine test.

How is urinary incontinence treated?

Treatment modality for urinary incontinence will be considered based on the severity of incontinence, the type, and the underlying cause. Sometimes, the treatment may require a combined modality approach. The doctor will deal with underlying health conditions first to ease incontinence and usually will recommend noninvasive or less invasive treatments as a starter. Later, consider surgical procedures or other options if the former techniques are of no avail.

วิธีรักษาภาวะกลั้นปัสสาวะไม่อยู่ - How is urinary incontinence treated?

How to treat urinary retention?

Behavioral treatment

  • Bladder training: This training helps you delay urination after an urge to urinate occurs. At the beginning, you should hold your urine for 10 minutes. The goal is to urinate only every 2.5 to 3.5 hours.
  • Double voiding: This technique guides you to urinate twice, in succession, to avoid overflow incontinence.
  • Scheduled toileting: This training requires you to urinate at fixed intervals, every two to four hours, to avoid bladder overfilling.
  • Fluid and diet management: This technique is beneficial for regaining bladder control by reducing the consumption of liquid, alcohol, caffeine, or acidic foods. Losing weight and regular exercise can help alleviate urinary incontinence as well.

Pelvic floor muscle exercises

Pelvic floor muscle exercises help strengthen the muscles that control urination. These exercises, also known as Kegel exercises, can help relieve stress and urgency incontinence.

To start Kegel exercises, follow the following steps:

  • Squeeze or tighten your pelvic floor muscles as if trying not to urine, and hold for five seconds. Then, relax the muscles for another five seconds (if you find it too difficult to follow, you can start by holding for two and relaxing for three seconds).
  • Repeat the previous step until you can squeeze your muscles for 10 seconds.
  • Ten repetitions equal to one set. Repeat the exercise three sets a day.

Biofeedback can help you be aware of how well you squeeze your muscles or whether you contract the right ones.

Medications

Common medications for urinary incontinence include:

  • Alpha-blockers: These medications help relax muscles in the neck of the bladder in men with urinary or overflow incontinence, facilitating the emptying of the bladder.
  • Anticholinergics: These medications can treat the overactivity of the bladder and urge incontinence.
  • Mirabegron: This medication helps relax the bladder muscles, increase the amount of urine one can urinate, and treat urge incontinence.
  • Topical estrogen: Topical estrogen may help restore tissues in the urethra and vaginal areas. Topical estrogen is available in creams, patches, and rings.

Medical devices

Devices that can treat urinary incontinence in women include:

  • Pessary: A pessary is a device inserted into the vagina to provide structural support for the urethra.

Surgery

Various surgical procedures are available to treat urinary incontinence if other treatments are ineffective. Types of surgery for urinary incontinence include:

  • Artificial urinary sphincter: A device is implanted around the bladder neck to close the urinary sphincter until there is an urge to urinate. Once the urge occurs, press a valve implanted under your skin to deflate the device, allowing the outflow of bladder urine.
  • Bladder neck suspension: This technique provides urethra and bladder neck support.
  • Sling procedures: This procedure involves creating a sling using synthetic material or strips of the body's tissue. The sling helps treat stress incontinence by compressing the urethra during sneezing or coughing.
  • Prolapse surgery: A combination of a sling procedure and prolapse surgery may be required to treat pelvic organ prolapse and mixed incontinence in women.

Absorbent pads and catheters

If medical treatments cannot solve your incontinence, you can try products, such as catheters and pads, which alleviate the discomfort and inconvenience due to urinary leakage.

ควรพบแพทย์หากมีอาการกลั้นปัสสาวะไม่อยู่ - urinary incontinence when to see a doctor?

When to see a doctor?

If incontinence occurs frequently, negatively affecting your life, you should seek medical advice or attention. Urinary incontinence may limit your activities or social interactions and elevate the risk of falls in seniors when rushing to the toilet.

How can I prevent urinary incontinence?

The following steps can help prevent urinary incontinence:

  • Avoid beverages that can cause overactivity or irritate the bladder, e.g., caffeinated or carbonated drinks.
  • Do pelvic floor exercises regularly.
  • Lose weight or maintain a healthy weight.
  • Quit smoking.
  • Try to prevent constipation.
  • Urinate regularly to prevent overfilling.

Urine leakage may cause skin irritation. For prevention, take additional care of the skin by:

  • Cleaning yourself with a washcloth.
  • Refraining from douching frequently.
  • Protecting your skin with petroleum jelly.

Follow these steps to make your toilet more conveniently accessible, which is beneficial if you have urinary incontinence.

  • Illuminating the passageways to the toilet.
  • Remove anything you can trip over, such as a rug or furniture, from the passageways.

Preparing for your appointment

It would be beneficial to do these steps before your appointment:

  • Be aware of pre-appointment restrictions.
  • Write down how frequently you urinate a day, your symptoms, and other conditions accompanying urinary incontinence.
  • Make a list of all your medications, supplements, and vitamins.

Doctors commonly ask the following questions:

  • When did the symptoms begin developing?
  • Do your symptoms come and go or occur continuously?
  • What seems to improve or worsen your symptoms?
  • How often do you have the urge to urinate?
  • Do you have trouble emptying your bladder?
  • How frequently do you drink alcohol and caffeinated beverages?

FAQ

  • Can urinary incontinence be left untreated?
    Urinary incontinence can become worse without treatment or behavioral changes. An urge to urinate may occur more frequently if you gain weight or stick with the same dietary habits.

A Note from MedPark's Doctor

The risk of urinary leakage increases with age. If you have urinary incontinence, proper treatment can improve the condition and help you regain the ability to control your bladder for a better quality of life.

Article by

Published: 29 Feb 2024

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