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Urinary Incontinence

Posted on 27 January 2021


Urinary incontinence is common and undertreated.

It is estimated that up to 50% of women will have some urinary incontinence.

The General Longitudinal Overactive Bladder Evaluation – UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age.  Prevalence of UI was estimated by using the bladder health survey (BHS). Out of 7000 women- 47% responded and of them 41% suffered from urinary incontinence (1366). Only 25% of women with urinary incontinence seek help (339).

Patients may be reluctant to seek assistance due to embarrassment, lack of knowledge about treatment options and fear of surgery.

 Impact on health

  1. Quality of life– Urinary incontinence is associated with depression and anxiety, work impairment, and social isolation
  2. Sexual dysfunction– Incontinence during sexual activity (coital incontinence), which may affect up to one-third of all incontinent individuals, and fear of incontinence during sexual activity both contribute to incontinence-related sexual dysfunction
  3. Morbidity– skin irritation and perineal infection. In older women, increased risk of falls.

Risk factors

  1. Age – Both the prevalence and severity of urinary incontinence increase with age. 3% of adult women under age 35, 38% for women over age 60.
  2. Obesity– Obesity is a strong risk factor for incontinence. Obese women have a nearly threefold increased odds of urinary incontinence compared with non-obese women. Weight reduction is associated with improvement and resolution of urinary incontinence, particularly stress urinary incontinence (SUI)
  3. Parity– Increasing parity is a risk factor for urinary incontinence and pelvic organ prolapse
  4. Mode of delivery– Compared with women who have had a caesarean section, women who have had a vaginal delivery are at higher risk for stress urinary incontinence. However, caesarean delivery does not protect women from urinary incontinence
  5. Family history– The risk of urinary incontinence, particularly urge incontinence, may be higher in patients with a family history
  6. Others
    1. Smoking.
    2. Stress urinary incontinence has been associated with participation in high-impact activities.
    3. Other risk factors for urge incontinence include recurrent urinary tract infections (UTIs), and bladder symptoms in childhood, including childhood enuresis

Classification

Stress incontinence — Individuals with stress incontinence have involuntary leakage of urine that occurs with increases in intraabdominal pressure (e.g., with exertion, sneezing, coughing, laughing) in the absence of a bladder contraction

Urge incontinence — Women with urge incontinence experience the urge to void immediately preceding or accompanied by involuntary leakage of urine. The amount of leakage ranges from a few drops to completely soaked undergarments. More common in older women.

Overflow incontinence — Overflow incontinence typically presents with continuous urinary leakage or dribbling in the setting of incomplete bladder emptying

Mixed incontinence – Contributing factors

  • In post-menopausal women, low estrogen levels contribute to urinary incontinence
  • Rare conditions, such as fistula and diverticula
  • Neurological conditions, such as stroke, Parkinson’s disease, diabetic neuropathy
  • Bladder cancer

Evaluation

Usually, diagnosis can be made based on history taking and examination.

  • Some medications can contribute to urinary incontinence
  • Alcohol and caffeine intake have been associated with lower urinary tract symptoms
  • Caffeine intake exacerbates urinary incontinence due to its stimulant and diuretic effects
  • Impact on quality of life —The impact of the patient’s incontinence on her quality of life can be assessed informally by asking a few targeted questions or by using a validated questionnaire
  • Urine test- to check for blood/ abnormal cells and/or infection
  • Initial evaluation does not require invasive testing, such as urodynamic studies

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