Symptoms
Involuntary leakage of urine during activities such as coughing, sneezing, laughing, exercising, or lifting heavy objects (stress incontinence).
Urgency to urinate, followed by involuntary leakage (urge incontinence, which can coexist with USI).
Dribbling urine.
Frequent urination.
Nocturia (frequent urination at night).
Feeling of incomplete bladder emptying.
Causes
Weakening of pelvic floor muscles: Pregnancy, childbirth, obesity, chronic coughing, and straining can weaken the muscles that support the urethra.
Damage to the sphincter muscles: Surgery (e.g., prostate surgery in men), trauma, or radiation therapy to the pelvic area can damage the urethral sphincter.
Nerve damage: Conditions like diabetes, multiple sclerosis, or spinal cord injuries can damage the nerves that control the sphincter muscles.
Aging: As people age, the muscles and tissues in the pelvic area can naturally weaken.
Hormonal changes: Menopause in women can lead to decreased estrogen levels, which can weaken the urethral tissues.
Certain medications: Some medications, such as diuretics, can increase urine production and worsen incontinence.
Obesity: Excess weight can put extra pressure on the bladder and pelvic floor muscles.
Medicine Used
Alpha-adrenergic agonists: Medications like pseudoephedrine or phenylpropanolamine (although the latter is less commonly used due to side effects) can help tighten the urethral sphincter muscle.
Estrogen therapy: Topical estrogen creams or vaginal rings can help strengthen the urethral tissues in postmenopausal women.
Duloxetine: A selective serotonin and norepinephrine reuptake inhibitor (SSNRI), can be used in some countries to treat stress incontinence.
Imipramine: A tricyclic antidepressant, can sometimes be used to help with bladder control.
Botulinum Toxin (Botox) Injections: Botulinum toxin injections into the bladder muscle to treat urge incontinence.
Artificial Urinary Sphincter (AUS): If medications and behavioral therapies are not effective, an artificial urinary sphincter may be implanted surgically.
Is Communicable
Urethral sphincter incontinence is not communicable. It is a condition resulting from physical or neurological factors affecting the urinary system and is not caused by an infectious agent.
Precautions
Pelvic floor exercises (Kegel exercises): Strengthening the pelvic floor muscles can improve sphincter control.
Maintain a healthy weight: Losing weight can reduce pressure on the bladder and pelvic floor.
Avoid bladder irritants: Reduce consumption of caffeine, alcohol, and acidic foods.
Fluid management: Drink adequate fluids, but avoid excessive intake, especially before bedtime.
Proper hygiene: Maintain good hygiene to prevent skin irritation and infections.
Timed voiding: Urinate on a regular schedule to prevent bladder overfilling.
Absorbent products: Use absorbent pads or underwear for protection against leakage.
Lifestyle modifications: Quit smoking, as chronic coughing can worsen incontinence.
Consult a healthcare professional: Seek medical evaluation and treatment.
How long does an outbreak last?
Urethral sphincter incontinence is not an "outbreak" that resolves on its own. It's a chronic condition that can persist indefinitely unless treated. The duration of symptoms depends on the underlying cause, severity, and effectiveness of treatment. With appropriate management, symptoms can be significantly reduced or controlled.
How is it diagnosed?
Medical history and physical exam: The doctor will ask about symptoms, medical history, and perform a physical exam, including a pelvic exam in women.
Urinalysis: To check for infection or other abnormalities in the urine.
Postvoid residual (PVR) measurement: To measure the amount of urine left in the bladder after urination.
Bladder diary: Recording fluid intake, urination frequency, and leakage episodes.
Urodynamic testing: A series of tests to evaluate bladder function, including cystometry (measuring bladder pressure) and uroflowmetry (measuring urine flow rate).
Cystoscopy: A procedure to visualize the inside of the bladder and urethra using a thin, flexible tube with a camera.
Pad test: Weighing absorbent pads over a period of time to quantify urine leakage.
Timeline of Symptoms
The onset and progression of symptoms vary depending on the cause of USI:
Sudden onset: May occur after surgery, trauma, or a neurological event.
Gradual onset: More common in cases related to aging, weakening of pelvic floor muscles, or hormonal changes. The symptoms may initially be mild and infrequent, gradually worsening over time.
Fluctuating symptoms: Some individuals may experience periods of worse or better control, influenced by factors such as fluid intake, physical activity, or medication use.
Important Considerations
Impact on quality of life: USI can significantly affect an individual's physical, emotional, and social well-being.
Treatment is individualized: The best treatment approach depends on the specific cause and severity of the incontinence.
Combination therapy: A combination of behavioral therapies, medications, and/or surgery may be necessary.
Importance of seeking medical help: Early diagnosis and treatment can improve outcomes and prevent complications.
Ongoing management: USI often requires ongoing management and monitoring.
Support groups: Joining a support group can provide emotional support and practical advice.
Pelvic floor physical therapy: A trained physical therapist can teach and guide in the correct performance of pelvic floor exercises.