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Urinary Incontinence

There are various forms of urinary incontinence. In true incontinence the bladder cannot retain urine, and there is a slight but continuous flow from a virtually empty bladder. Malfunction of the sphincter muscles which normally control the escape of urine can cause incontinence, perhaps as a result of nervous disease or injury to the muscles or nerves of the spinal cord (as in spina bifida). Another cause may be lesions in the urinary tract. In cases of tonic incontinence the bladder is emptied at normal intervals, but the desire to pass urine occurs urgently and the patient is unable to control it. This form of incontinence may be due to a shrunken or contracted bladder, or to inflammation of the prostate gland, the urethra or the bladder. It can often be treated once the cause has been found.

Stress incontinence occurs where emptying the bladder is directly stimulated by such things as coughing, sneezing, sudden exercise or movement, or any sudden contraction of the diaphragm resulting in increased abdominal pressure: once started it cannot be controlled. In these cases the sphincter muscles are usually either very weak or damaged, or there may be a disease of the nervous system. It is most common in women, particularly immediately after child­birth when there may be a weakened muscle in the floor of the pelvis.

Other causes of incontinence include tumours and enlargement of the prostate gland in the male. This can often be cured by removal of the prostate. Occasionally, a woman's urethra is damaged during childbirth, due to stretching of the vagina which lies very close to the outlet of the urethra, causing temporary incontinence. Incontinence occurring during sleep is known as enuresis and it is most common among children and adolescents. It is quite normal up to the age of five. Among older children it is often due to psychological problems or else to infection.

Treatment

Treatment of stress incontinence is to improve the function and condition of the sphincters by exercises in which the pelvic floor muscles are tightened. If the incontinence is caused by an underlying disorder, treatment of the disorder itself will usually solve the problem.

There are appliances and other aids that can be worn in cases of incontinence, either before or during treatment, or permanently where treatment is not possible for some reason. Several types of portable urinal are available for daytime use. For males, these take the form of a funnel connected to a bag, and fitting on to the penis with a sheath. The whole appliance is worn on a belt around the abdomen. During sleep the sheath and funnel are connected to a bottle by a long tube to prevent any urine spilling while the patient tosses and turns. A plastic dribbling bag may be useful where incontinence is only slight. Unfortunately, there are fewer satisfactory appliances available for women; one type takes the form of a wide funnel fitting over the entire vulva and draining into a bag. The best treatment for a woman may be a surgical operation to make a urinary diversion, which means creating a new system for expelling the urine by using another outlet. Where the incontinence is only mild, special padded pants may be all that is needed to counteract the problem.

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