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What is Bladder Leakage

Bladder leakage consists of involuntary urine loss. The affected person has an imperious and sudden need to urinate but is unable to retain urine.

Leaks can occur by sneezing, laughing, exerting some effort, or physical exercise. It is a hygienic, social and psychic problem, as it influences the daily activity of the sick and reduces their quality of life.

Incontinence is not a disease in itself, but the consequence of an alteration in the bladder filling phase that occurs in numerous diseases. It is more common among women, children (enuresis) and the elderly, affecting more than 15 percent of non-institutionalized over-65s and 35 percent of hospital income.

Prevalence

“The prevalence of urinary incontinence in Spain is 15% in women and 11.6% in men. The aging of the population is a risk factor for urinary incontinence, especially in the form of an overactive bladder,” explains Patricia Ramírez Rodríguez-Bermejo, Juan Carlos Ramírez Fernández’s Urology team belonging to the Ruber Hospital International.

Blanca Madruga, a member of the Spanish Association of Urology (AEU), comments that “we always think it is an underdiagnosed disease since today there is quite ‘shame’ when it comes to recognizing that a woman suffers from urinary incontinence. In general, men are not so modest to go to the doctor when they suffer.”

Causes

Urinary incontinence occurs when the pressure inside the bladder is higher than the pressure in the urethra.

This disorder may be due to detrusor muscle hyperactivity. The main reasons are:

Neurological problems or damage.

By an alteration of the external sphincter and pelvic floor muscles.

For the failure of the internal sphincter in the face of inappropriate relaxation or organic injury.
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Symptoms

The main symptom of urinary incontinence is the loss of urine when coughing and sneezing, physical activity or having sex.

Prevention
There are some steps that can help delay and prevent the onset of urine incontinence. Some of the tips to keep in mind are:

Follow a balanced diet, such as the Mediterranean. Avoiding overweight and obesity will reduce intra-abdominal pressure.

Reduce consumption of beverages such as coffee, soft drinks, and carbonated beverages, alcohol and citrus, among others.

Avoid spicy foods.

Increase fiber intake to prevent constipation.

Reduce your use of diuretic products and medications, so you’ll feel less like urinating.

Avoid drinking between four and two hours before bedtime.

Do not push when urinating. This will prevent the muscles of the pelvic floor from being damaged.

Do not drink before exercising.
Kegel Exercises
Kegel exercises help strengthen muscles around the urethra and pelvic floor when these muscles are weakened, urinary incontinence is more likely to occur.

These exercises consist of performing a series of contractions and relaxations that are repeated throughout the day constantly.

Types
The main types of incontinence are:

Stress urinary incontinence

In stress incontinence, urine loss occurs when you perform any movement or physical activity. Laughter, sneezing, sport, loading heavy objects or simply standing or crouching can cause urine leaks ranging from drops to a squirt.

The origin of this incontinence, which affects more than a million women, is found in the urethra. Physical exertion, even if mild, causes increased pressure in the abdomen and bladder, but is not transmitted to the urethra, triggering incontinence.

Pregnancy and age cause a loss of elasticity and tension in the pelvic floor, so the bladder and urethra fall and its continence mechanisms are only effective at rest.

This type of incontinence is not associated with the need to urinate.

Emergency urinary incontinence

It consists of the involuntary loss of urine associated with an urgent and sudden need to urinate. Therefore, there is a prior consciousness. The origin of this incontinence is found in the detrusor. Two types of emergency urinary incontinence can be distinguished:

Sensitive incontinence: It is caused by an increase in sensitive impulses from the stress/pressure receptors found in the bladder walls. An early feeling of fullness and urgency to urinate appears. It may be associated with the disease.

Motor incontinence: Urine loss is motivated by detrusor hyperactivity, i.e. a failure of motor inhibition of the urination reflex. It is mainly caused by psychic mechanisms, efforts or obstruction.

Mixed urinary incontinence

Urine loss is caused by hyperactivity of the detrusor muscle and a disorder in sphinxinal mechanisms. In this case, the incompetence of the bladder neck allows urine to enter the proximal urethra. As a result, the detrusor understands that urination has started and releases the reflection that produces its contraction.

Rebound urinary incontinence

Urine loss occurs because the bladder is distended by obstruction and inability to empty. Two causes of overflow urinary incontinence are distinguished:

Organic: In this case, the bladder is distended by an obstruction that prevents the passage of urine and is unable to empty. When the bladder can no longer be relaxed, overflow occurs. Prostate tumors and benign prostate hypertrophy are the main diseases that cause this type of incontinence.

Neurological: Neurological damage of the spinal parasympathetic nucleus or pelvic nerve causes the detrusor to be strong. It usually arises from spinal cord injuries, multiple sclerosis, or surgical interventions that affect the pelvic nerve.
Psychogenic-causing urinary incontinence
It is associated with external stimuli that affect the senses (cold or water), strong and sudden emotions (fear, anguish or pleasure) or phobias and mania.

Neurological-cause urinary incontinence

It encompasses alterations of the micdynamics that originate in the nervous system. Strokes, multiple sclerosis, Parkinson’s disease, and spinal cord injuries influence their development.

Diagnosis

The first step the specialist must take is to confirm that it is a completely unintentional and objectively demonstrable urine loss.

To establish a correct diagnosis, you must distinguish external factors and urinary tract disorders that cause incontinence, so a thorough physical examination including a perianal sensitivity examination and analytical, radiological and urodynamic studies will be required.

In addition, the practitioner should take into account personal history and concomitant diseases, such as neurological diseases, systemic pathologies with repercussions on the central nervous system and previous interventions that have affected the urinary tract (uretrotomies, transurethral resection of the prostate, etc.), the abdomen and pelvis (abdominoperineal resection of the colon or hystermineces) and the spine (decompressions). You should also control the medication taken by the patient, as some substances can trigger or aggravate incontinence.

Additional tests may be done alongside blood tests:

A simple x-ray of the abdomen: Allows diagnosing vesicular lithiasis that causes emergency urinary incontinence, especially in patients with benign prostate hypertrophy.

Intravenous urography: It is used to assess the morphology and proper functioning of the high urinary tract.

Vesicoprostate ultrasound: Diagnoses lithiasis and bladder tumors, measures the prostate and determines its obstruction.

Urodynamic studies: Evaluate the functional activity of the lower urinary tract in the bladder filling and emptying phase.

Treatments

“The pharmacological therapeutic novelties in urinary incontinence, either in isolation or in the form of drug combinations, are constant. Various surgical techniques and the use of different forms of energy promote this trend,” according to the urologist of the Ruber International Hospital.

Dietary hygiene measures

Those affected should monitor the fluids they take to prevent excessive urine formation. It is also important how they are taken; soups, stews and boiled foods provide more liquids than roasted and fried ones.

Fluids that promote urine formation include water, milk, alcohol, and infusions. Drinks should be better distributed, drinking more in the morning and gradually decreasing drinks as the day progresses. For children with enuresis, it is advisable to advance dinner time.

Pharmacological treatment

The goal of drug treatment is to make the bladder able to relax without contracting and keep the urethra closed during filling.

The most commonly used drugs are anticholinergics, substances that, by decreasing the contractile capacity of the detrusor, increase the tolerance of bladder filling and continence.

They are useful in involuntary contractions of non-neurological detrusor, mixed incontinence, and detrusor hyperreflexia. Its effectiveness is demonstrated in terms of symptom relief, but its side effects, mainly dry mouth, tachycardia, and arousal, are very severe in some patients, who must sometimes stop treatment. They are contraindicated in patients with glaucoma and cardiac arrhythmias.

Among the most common anticholinergics are oxybutynin, flavoxate, propantheline, metanthelin, and trosopium chloride.

Surgery
There are different surgical solutions, depending on the type of incontinence, bladder and urethra characteristics.

Intermittent self-probe

It consists of the introduction, through the urethra, of a tube into the bladder. It is mainly used in incontinence caused by neuronal damage or the nerves that control urination. The catheter achieves complete emptying and prevents urine leakage.

Bladder training

Patients regain bladder control by learning to resist bladder output impulse and thereby contributing to increased bladder capacity. This is achieved by exercises that develop the pelvic floor musculature.

Intravaginal electrical stimulation

Its goal is to achieve the contraction of the pelvic floor by stimulating the nerve canisteen with an intravaginal electrode.

Other data
People who may have urinary incontinence
Children (enuresis).

Women of working age.

Men with prostate problems.

Elderly.

Neurological patients: Parkinson’s patients, multiple sclerosis and spinal injury.
The psychosocial effects of incontinence often involve numerous emotional disorders, including loss of self-esteem and discontinuity in work, sexual and social activities.

Many affected refuse to leave their family environment for fear of facing embarrassing situations, limiting their usual tasks and independence.

Enuresis

Although this term refers to involuntary urine loss in general, it is currently used to define nighttime incontinence during sleep.

It is especially common in children, being more common in the female sex. The following factors influence its appearance: hereditary, anxiety, psychological alterations, brain immaturity, depth of sleep, functional and organic pathology.

In short, there are many theories about the origin of this urinary incontinence, although none is entirely conclusive.

To treat this disorder, an analysis of the social and biological traits of the child, as well as the attitude and disposition of the parents, must be carried out. Almost all cases of enuresis resolve over time and those affected do not suffer any personality alteration. His intellectual capacity is the same as that of other children.

Incontinence in the elderly

It is another of the most common and disabling disorders in the elderly. It affects more than 15 percent of non-institutionalized over-65s and 35 percent in hospitals.

The greater the physical or mental disability, the more this disorder increases. In these cases, failure to control urination is associated with many causes of incontinence: physiological changes, and neurological and central nervous system deterioration.

This population is especially affected by urinary incontinence, leading to significant limitations and even social and family isolation.

To combat this problem, drugs can be administered, surgery or palliative means that allow them to continue their daily activities and improve their quality of life.