Urinary Incontinence

Urinary incontinence is defined as the involuntary passing of urine, and it is a widespread problem. There are three basic mechanisms: stress incontinence is a condition where small quantities of urine leak when there is a rise in the pressure in the abdomen, which happens during coughing or sneezing. It is more likely in patients who have suffered pelvic muscle strain or damage to during childbirth, because the weak musculature allows the bladder to bulge into the vagina. This alters the angle between the bladder neck and the urethra, which weakens the sphincter, so that small rises in pressure in the bladder are sufficient to overcome it. It also means that the bladder fails to empty completely, causing an increased likelihood of urinary tract infection. Stress incontinence can be improved by physiotherapy and pelvic floor exercises to increase muscle tone, but surgery may be required.

Urge incontinence occurs in a situation where it is not possible to override the reflex contraction of the bladder - when you got to go you got to go, and if a lavatory is not to hand there can be disaster. This is the mechanism whereby urinary tract infection and cystitis cause incontinence. In the absence of urinary tract infection urge incontinence is caused by a condition called detrusor muscle instability or irritability, which can occur in women of any age. It may be improved by bladder training exercises, which consist of increasing the time you wait before answering the call to urinate, together with drugs which reduce the tone of the bladder. Both stress and urge incontinence may occur together.

True incontinence occurs when there is an abnormal communication between the bladder and the vagina - a fistula through which urine drains continuously. This is a rare complication of Cancer of either the bladder, the vagina or the cervix, or a complication of surgery or traumatic delivery.
 
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