What is urinary incontinence?
Loss of bladder control is urinary incontinence. Severity ranges from occasionally leaking urine while straining, coughing or sneezing to having a frequent sudden urge to urinate. Urinary incontinence can affect daily activities and quality of life. Therefore, it requires appropriate treatment. Neurological disorders that cause loss of bladder control cause a condition called neurogenic bladder. The cause may be in the brain, spinal cord or nerves supplying the bladder. Treatment involves medical management and lifestyle changes.
What neurological disorders cause loss of bladder control?
The causes of neurologic urinary incontinence include
What are the symptoms of neurological damage to the bladder?
People with this condition may have the following symptoms
- Frequent urination although the quantity is less
- Problems with starting to urinate or emptying the bladder
- Loss of bladder control
- Problems knowing if the bladder is full
- Repeated urinary tract infections
How is urinary incontinence treated?
Treatment options for urinary incontinence depend on the type of incontinence, severity and underlying cause. A combination of medical treatments, exercises and lifestyle modifications may be needed to manage urinary continence associated with neurogenic bladder.
Treatment options include
- Behavioral techniques
- Fluid and diet management: This means reducing or avoiding alcohol, caffeine or acidic foods and decreasing fluid consumption.
- Bladder training: This means training the bladder to delay urination after having the urge to urinate. Patients could start by trying to hold off going to the bathroom for 10 minutes every time there’s an urge to urinate and gradually lengthening the time between going to the bathroom.
- Double voiding: This means urinating and then waiting to urinate again after a few minutes.
- Bladder diary: Keeping a bladder diary may help you to record some things that make your symptoms worse.
- Pelvic floor muscle exercises: The pelvic floor muscles support the bladder. Strengthening the pelvic floor muscles by doing exercises recommended by the doctor can help manage urinary incontinence. These are also called Kegel exercises. The first step is to imagine that you're trying to stop urinary flow and then contract or tighten the muscles you would use to do that. Hold the position for two to 10 seconds and then relax for two to 10 seconds. This should be performed at least three times a day for a few minutes each time.
- Electrical stimulation: Electrodes (rods that can conduct small shocks) can be temporarily inserted into the rectum or vagina to stimulate and strengthen the pelvic floor muscles.
- Alpha blockers: They help treat overflow and urge incontinence. They relax the bladder muscles, making it easier to empty the bladder. Examples include Flomax (tamsulosin) and Cardura (doxazosin).
- Anticholinergics: These help to control an overactive bladder and help in treating urge incontinence. Examples include Ditropan XL (oxybutynin) and Sanctura (trospium).
- Mirabegron: This is used to relax the bladder muscles, hence increasing bladder capacity.
- Botulinum toxin (Botox®) injections: These may be used to help patients who have an overactive bladder due to a brain or spinal cord disease or injury. These may need to be repeated every three months.
- Sacral neuromodulation: This technique is used for patients with an overactive bladder when drugs or lifestyle changes do not work. The sacral nerves carry signals between your spine and bladder. Manipulation of these signals can improve overactive bladder symptoms. The surgeon places a thin wire close to the sacral nerves. Then, the wire is connected to a small, battery-operated device placed under your skin. It delivers electrical impulses of harmless intensity to the bladder to stop the “bad” signals that can cause an overactive bladder.
- Catheterization of the bladder: If nothing else works, the bladder may be catheterized for a short or long period of time. A tube is inserted inside the bladder through the urinary opening. This helps drain the bladder. The urine is collected in a bag that is attached to the tube.
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