Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having sudden, unpredictable episodes of strong urinary urgency. Sometimes, the urgency may be so strong you don't get to a toilet in time.

Causes:

Urinary incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innervation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause inadequate urinary storage or control.

Acute and temporary incontinence are commonly caused by the following:

• Childbirth
• Limited mobility
• Medication side effect
• Urinary tract infection

Chronic incontinence is commonly caused by these factors:

• Birth defects
• Bladder muscle weakness
• Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)
• Brain or spinal cord injury
• Nerve disorders
• Pelvic floor muscle weakness
• Vaginal prolapse

 Types
- Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on the bladder. It is the most common type of bladder control problem in women. In women, physical changes resulting from pregnancy, childbirth, and menopause often contribute to stress incontinence. Stress incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause, similarly because of lowered estrogen levels. In female high-level athletes, effort incontinence occurs in all sports involving abrupt repeated increases in intra-abdominal pressure that may exceed perineal floor resistance

- Urge incontinence happens when you have a strong need to urinate but can't reach the toilet in time. This can happen even when your bladder is holding only a small amount of urine. Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running (as when washing dishes or hearing someone else taking a shower).

- Functional incontinence occurs when a person recognizes the need to urinate, but cannot physically make it to the bathroom in time due to limited mobility. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity, unwillingness to toilet because of depression, anxiety or anger, or being in a situation in which it is impossible to reach a toilet.

- Overflow incontinence: Sometimes people find that they cannot stop their bladders from constantly dribbling, or continuing to dribble for some time after they have passed urine. Overflow incontinence is rare in women, although sometimes it is caused by fibroid or ovarian tumors. Early symptoms include a hesitant or slow stream of urine during voluntary urination.

- Mixed incontinence is a combination of different types of bladder control problems, usually stress and urge incontinence. These problems often occur together in older women.

Diagnosis

On the basis of detailed case- history, physical examination and certain tests we can diagnose the type of Urinary incontinence. A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

Other tests include:

• Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
• Urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes.

Urinary incontinence in women

Bladder symptoms affect women of all ages. However, bladder problems are most prevalent among older women. Up to 35% of the total population over the age of 60 years is estimated to be incontinent, with women twice as likely as men to experience incontinence. One in three women over the age of 60 years area estimated to have bladder control problems.

Bladder control problems have been found to be associated with higher incidence of many other health problems such as obesity and diabetes. Difficulty with bladder control results in higher rates of depression and limited activity levels.

Treatment

Treatment depends on the type of problem you have and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures prescribed by your doctor, or surgery.

Weight loss

A study published in The New England Journal of Medicine on January 29, 2009, demonstrated that weight loss in overweight women reduced stress incontinence. The study included women with a Body Mass Index (BMI) over 25 and at least 10 episodes of urinary incontinence per week. The results demonstrated that with exercise and restricted diet they had a 70% or greater reduction in overall incontinence episodes.

Most bladder control problems can be improved or cured. Treatment for stress incontinence includes:

• Doing Kegel exercises (consist of contracting and relaxing the muscles which form part of the pelvic floor) to strengthen the pelvic floor muscles. It is one of the best ways to improve stress incontinence.
• Using a removable device called a pessary (which is placed inside the vagina). It can help reduce stress incontinence by putting pressure on the urethra.
• Medicines can be used but these may have side effects.
• Surgery to support the bladder or move it back to a normal position.

For urge incontinence, the doctor may suggest behaviour changes to fix the problem. For example, bladder training can help increase how long one can wait before urinating. Medicines can also be used to treat this. The doctor may also suggest things you can do at home, such as going to the bathroom at set times and completely emptying your bladder when you urinate. It may also help to cut back on caffeine drinks, such as coffee, tea, or sodas.

Prevention
Strengthening the pelvic muscles with Kegel exercises may lower the risk for incontinence. If you smoke, quitting may help as it may make you cough less, which may help with incontinence.

Homeopathic Therapeutics

Homeopathic medicines along with lifestyle modifications such as regular pelvic exercises, weight reduction can effectively relieve the patient from this distress. Some of the commonly used medicines are:

Causticum: When the bladder weakness can be attributed to paralytic condition. physical actions such as the act of coughing, ordinary acts such as laughing, moderate actions like walking, actions like sneezing, becoming excited or being physically strained can all bring about bouts of incontinence. The condition of the patient tends to rapidly worsen towards the hours of the evening, in the hours of the morning, around 3 to 4 a.m., and in weather that is dry and cold, or when the person is physically stooping down to do something. The condition of the patient tends to improve if some warmth is experienced as a result of the weather or because of the use of warm clothing.

Equisetum: This form of urinary incontinence can also affect people with weak bladders; it also tends to affect the elderly, and is the form of incontinence that is present in many old women. The person affected with this form of urinary incontinence tends to be awakened several times in the nighttime because of an urgent need to urinate.

Pulsatilla: In urinary incontinence in which the symptoms of the condition can include problems such as involuntary urination during the first stage of sleep at night, sudden urination can also occur when the person is sneezing, coughing, laughing, and in the periods during which chills or colds affect the person. The patient may find it very hard to suppress an urge to urinate, and in most instances feels its necessary to concentrate very hard in order to hold it in. The urine actually dribbles out even when the person is sitting or walking about. This form of incontinence in young girls brings out a sudden and inconvenient desire to urinate, thus adding to the discomfort of the person. Psychologically the patient can become very gentle and mild, and can display weepy moods. The person does not feel thirsty at all.

Sepia: Extremely weakened bladder and sudden urination. Commonly in patients with uterine displacement or those suffering a prolapse. This form of urinary incontinence also includes incontinence triggered by stress and physical movements like coughing, laughing or sneezing

Ferrum phosphoricum: Incontinence of urine, if from weakness of the sphincter muscle.

Secale cor: Enuresis in old people mostly due to paralysis of bladder.

Zincum met: When nerve weakness results in involuntary urination.

In the present Issue of Homeopathic Horizon Ezine we present to the profession a concise work on Urologic Disorders and its management with Homeopathy. We have tried to encompass as many articles on the subject as we can. We gratefully invite comments and feed backs from all of you.

Wishing you a Happy Reading!!!