Urinary incontinence

Trainee : Urinary incontinence is an involuntary leakage of urine, as patients don’t have control over their urinary sphincter. But can you explain it to me ?

Doctor : Well, urinary incontinence generally includes the stress incontinence during pregnancy and child birth, menopause, hysterectomy, age and obesity. There’s also the urge incontinence due to cystitis or some neurological conditions like multiple sclerosis, stroke and Parkinson’s, as well as an enlarged prostate in men; but also the overflow incontinence, which happens when there’s an obstruction to the bladder, when there’s a tumor or urinary stones.

Trainee : So, it’s not only due to surgical procedures ?

Doctor : No, there’s the functional incontinence due to mobility issues, the total incontinence, that’s when the bladder cannot hold urine, and the mixed one.

Trainee : I’m a little bit lost…

Doctor : You’ll get used to it. I should also add that though urinary incontinence happens mostly in women, men also suffer from urge and overflow incontinence, mainly due to an enlarged prostate that can cause the bladder to drop and the urethra to become irritated.

Trainee : Can incontinence be anatomical ?

Doctor : Sure. Total incontinence can be due to a birth defect, but also from factors like a spinal cord injury that impairs the nerve signals between the brain and the bladder, or else a fistula, that’s when a tube or a channel develops between the bladder and a nearby area, usually the vagina.

Trainee : Are there any other causes to incontinence ?

Doctor : Yes. Use of medication like diuretics, antihypertensive drugs, sleeping pills, sedatives and muscle relaxants; urinary tract infections and also alcohol consumption. The usual factors are obesity, smoking, gender, old age, some diseases and conditions, and of course prostate disorders in men.

Trainee : How can we diagnose it ?

Doctor : Diagnosis varies from physical exams, blood tests, urinalysis to pelvic ultrasound, urodynamic testing, cystograms and cystoscopies, among other exams of course.

Trainee : And are there any complications related to the inability to retain urine ?

Doctor : These usually include skin problems (irritations, rash and infections), and for women, prolapse, that is part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. This is usually caused by weakened pelvic muscles.

Trainee : Are there any specific treatments that would work well ?

Doctor : Besides surgery (mainly sling procedures, colposuspension and insertion of artificial sphincter), we take into account the patient’s age, general health and mental state, and propose treatments that range from pelvic and sphincter muscle strengthening exercises to use of medications like topical estrogens, anticholinergics, or even antidepressants. For women, we might think of urethral inserts, radiofrequency therapy and sacral nerve stimulation.

Common phrases

Urinary incontinence is an involuntary leakage of urine, as patients don’t have control over their urinary sphincter.

→ L’incontinence urinaire est une fuite involontaire d’urine car les patients ne contrôlent plus leur sphincter.

Stress incontinence happens during pregnancy and birth, menopause, hysterectomy, age and obesity.

→ L’incontinence urinaire d’effort survient durant la grossesse et la naissance, la ménopause, l’hystérectomie, avec l’âge et l’obésité.

Urge incontinence comes from cystitis or an enlarged prostate.

→ Une cystite ou une hypertrophie prostatique peut être à l’origine d’une incontinence impérieuse.

It can be treated by surgery, mainly sling procedures, colposuspension and insertion of artificial sphincter.

→ La chirurgie peut être une réponse à l’incontinence urinaire, principalement la suspension par bandelette, la colposuspension et l’insertion d’un sphincter artificiel.

For treatments, we take into account the patient’s age, general health and mental state.

→ Le traitement prend en compte l’âge du patient ainsi que son état physique et mental.