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Urinary incontinence

Definition
  • Urinary incontinence: Involuntary loss of urine.
Types
  • Stress incontinence: Loss of urine during physical exertion such as coughing, sneezing, or exercise.
  • Urge incontinence (Overactive bladder): Sudden, intense urge to urinate followed by involuntary loss of urine.
  • Mixed incontinence: Combination of stress and urge incontinence.
  • Overflow incontinence: Inability to empty the bladder completely, leading to dribbling.
  • Functional incontinence: Physical or mental barriers preventing reaching the toilet in time.
Epidemiology
  • More common in females, especially post-menopausal women.
  • Prevalence increases with age.
Causes
  • Stress incontinence: Weakened pelvic floor muscles, often due to childbirth or surgery.
  • Urge incontinence: Bladder muscle (detrusor) overactivity, idiopathic or due to conditions like UTIs, bladder stones, or neurologic disorders.
  • Overflow: Blockage or obstruction of the bladder, weak bladder muscle.
Investigations
  • History and examination: To determine type of incontinence.
  • Urine dipstick: Rule out infection or hematuria.
  • Bladder diary: Record timings and amounts of urine leakage.
  • Urodynamic testing: Assesses bladder and sphincter function.
  • Cystoscopy: To view inside of bladder.
Management
  • Lifestyle interventions: Weight loss, fluid management, avoiding irritants like caffeine.
  • Pelvic floor exercises (Kegel exercises): Especially for stress incontinence.
  • Medications: Anticholinergics, Mirabegron for urge incontinence.
  • Surgical treatments: For stress incontinence ā€“ tape procedures, colposuspension; For overflow incontinence ā€“ catheterisation.
Complications
  • Impact on quality of life.
  • Skin problems due to moisture.
  • Urinary tract infections.

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