Urinary Incontinence Symptoms

Inability to hold urine despite voluntary effort or leakage of urine before you reach the toilet is clinically defined as urinary incontinence. The severity of symptoms vary significantly, depending upon the cause, severity and associated symptoms.Urinary incontinence is more common in females. According to a new study (1), about 30 to 51% females reported at least one episode of UI in the past 1 year. The prevalence in adult nulligravida (who never became pregnant) females is about 12.5% (2).

Classic Symptoms of Urinary Incontinence

Urinary incontinence is a recognized urinary condition that compromises the quality of life by interfering with social, professional and personal interactions. The symptoms of urinary incontinence are dependent on the clinical variety of incontinence; most frequently reported types are:

1. Stress Incontinence

The urinary sphincters serves as ‘one-way valve’ that are under the strict voluntary control in normal healthy adults. However, in some individuals the valves are less competent at holding the urine in situations of stress (mostly physical). For example, any activity that increases the intra-abdominal pressure significantly (and abruptly) can worsen this type of incontinence; such as:

• Forceful Sneezing
• Strenuous exercise (especially weight lifting)
• Laughing
• Coughing

This type of urinary incontinence is more common in individuals who are at extremes of age (very young or very old). The primary pathophysiology is weakness of muscles and lack of neuro-urinary regulation due to:

• History of recent or old pelvic surgery
• Obstetric complications (like multiple childbirths, history of pelvic trauma, obstructed labor, prolonged labor, instrumental delivery etc.) can increase the risk of damage to delicate tissues of the pelvis and present as urinary incontinence immediately (or later in life).
• Sudden weight gain or weight loss (especially in the setting of pregnancy due to pressure of expanding uterus that can significant affect the competency of sphincters.

2. Overflow Incontinence

It is characterized by persistent or frequent urinary leakage due to incomplete voiding of bladder. Certain drugs can worsen this type of incontinence; for example muscle relaxants, sedatives, anti-psychotics, anti-hypertensive drugs etc. Other common causes of overflow incontinence are:

• Urinary tract obstruction due to urethral stones (that offers difficulty in the passage of urine followed by incontinence
• Prostate hypertrophy or malignancy (severity of incontinence increases in most cases after the treatment of cancer)
• Radiotherapy of pelvic region

3. Urge Incontinence

Urge incontinence refers to an intense urge to micturate due to hypersensitivity of the bladder. Often times the urge to micturate is followed by involuntary dribbling of urine. This type of incontinence worsens if the person is suffering from an acute urinary tract infection or constipation. Other associated symptoms are:

• Increase frequency of urination
• Nocturnal enuresis
• Burning micturition (or dysuria)
• Passage of cloudy and foul-smelling urine

Aggravating factors include, consumption of bladder irritants (like alcoholic drinks, caffeinated beverages etc.), aerated or carbonated drinks, artificial sweeteners, toxic doses of vitamin C or Vitamin B -complex etc.

4. Functional Incontinence

Any functional illness (extra-urinary) that affects your capacity to reach the toilet in time is referred to as functional incontinence. This includes:

• Advanced arthritis
• Mental illnesses
• Degenerative brain conditions (stroke, Alzheimer’s disease, Parkinson’s disease)

5. Mixed Incontinence

If one or more of the clinical types of urinary incontinence co-exists, the condition is referred to as mixed incontinence.

Some Risk Factors That May Lead to Urinary Incontinence

Certain physiological factors like advanced aging can lead to laxity of bladder muscles and can increase the risk of urinary incontinence significantly in individuals. Other relevant risk factors include:

• Menopause (due to loss of protective influence of estrogen)
• Prolapse of uterus, rectum or urinary bladder
• History of pelvic procedure (like hysterectomy, blunt trauma or any other surgery) that may affect the strength/ stability of pelvic floor muscles
• Chronic health issues or metabolic disorders like diabetes

Identifying and Managing Urinary Incontinence

Urinary incontinence is not only an embarrassing condition but can also increase the risk of several complications over time in poorly managed cases. A few frequently reported ones are:

• Recurrent attacks of urinary tract infection:
• Skin sores, infections or rashes (if dribbling is persistent and surrounding skin is wet most of the time)
• Depression
• Inability to maintain social and personal relationships

It is highly recommended to speak to your primary healthcare professional to learn more about the cause and management protocols of urinary incontinence symptoms to live a healthy and functional lifestyle.References:

1. Buckley, B. S., & Lapitan, M. C. M. (2010). Prevalence of urinary incontinence in men, women, and children—current evidence: findings of the Fourth International Consultation on Incontinence. Urology, 76(2), 265-270.
2. O'Halloran, T., Bell, R. J., Robinson, P. J., & Davis, S. R. (2012). Urinary Incontinence in Young Nulligravid WomenA Cross-sectional Analysis. Annals of internal medicine, 157(2), 87-93.
3. Gyhagen, M., Bullarbo, M., Nielsen, T. F., & Milsom, I. (2013). The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 120(2), 144-151.
4. Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older americans. Vital & health statistics. Series 3, Analytical and epidemiological studies/ [US Dept. of Health and Human Services, Public Health Service, National Center for Health Statistics], (36), 1-33.

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