What is urination incontinence?

Urinary incontinence is the loss of bladder control, leading to the unintentional leakage of urine. It can range from occasionally leaking urine when you cough or sneeze to having a sudden and strong urge to urinate that you may not be able to control in time to reach a bathroom.

There are several types of urinary incontinence:

●     Stress Incontinence: Leakage occurs during activities that increase pressure inside the abdomen, such as coughing, sneezing, laughing, or exercising.

●     Urge Incontinence: Also known as overactive bladder, it involves a sudden, intense urge to urinate followed by involuntary loss of urine.

●     Overflow Incontinence: This happens when the bladder doesn't empty completely, leading to frequent or constant dribbling of urine.

●     Functional Incontinence: Physical or mental impairments prevent you from making it to the toilet in time.

●     Mixed Incontinence: A combination of more than one type of incontinence, often stress and urge incontinence.

Causes of urinary incontinence can include:

●     Weakening of the pelvic floor muscles

●     Neurological disorders

●     Urinary tract infections

●     Certain medications

●     Pregnancy and childbirth

●     Aging

●     Menopause

●     Prostate problems in men

How is urination incontinence diagnosed?

Diagnosing urinary incontinence typically involves several steps to determine the type, cause, and severity of the condition. Here are the common diagnostic procedures:

●     Medical History: The doctor will ask about your symptoms, including when and how often they occur, your fluid intake, and any medications you are taking. They may also inquire about your medical history, surgeries, and childbirth experiences.

●     Physical Examination: A physical exam, particularly of the abdomen and pelvic area, can help identify any physical conditions contributing to incontinence. For women, this might include a pelvic exam, and for men, a prostate exam.

●     Bladder Diary: Keeping a record of your bladder habits for several days can help provide detailed information about your symptoms. You might be asked to log when you urinate, the amount of urine, any leakage incidents, and fluid intake.

●     Urine Tests: A urinalysis or urine culture can check for infections, blood, or other abnormalities in the urine that could be causing incontinence.

●     Postvoid Residual Measurement: This test measures the amount of urine left in the bladder after urination. It can be done using ultrasound or by inserting a catheter into the bladder after you urinate.

●     Urodynamic Testing: These tests assess how well the bladder, urethra, and sphincters are storing and releasing urine. It can include measurements of bladder pressure, flow rates, and the ability of the bladder to contract properly.

●     Cystoscopy: A thin tube with a camera (cystoscope) is inserted into the bladder through the urethra to visually inspect the bladder and urethra for abnormalities.

●     Imaging Tests: Ultrasounds, X-rays, or MRI scans can help visualize the urinary tract to identify structural issues or blockages.

What are the symptoms of urination incontinence?

The symptoms of urinary incontinence vary depending on the type and severity of the condition. Common symptoms include:

●     Stress Incontinence:

○     Leakage of urine when coughing, sneezing, laughing, lifting heavy objects, or during physical activity.

●     Urge Incontinence:

○     A sudden, intense urge to urinate followed by an involuntary loss of urine.

○     Frequent urination, often including waking up multiple times at night to urinate (nocturia).

●     Overflow Incontinence:

○     Frequent or constant dribbling of urine due to a bladder that doesn't empty completely.

○     A feeling that the bladder is never fully empty.

●     Functional Incontinence:

○     Leakage occurs because a physical or mental impairment prevents you from reaching the toilet in time. This can be due to conditions like arthritis, which makes it difficult to move quickly, or dementia, which affects cognitive function.

●     Mixed Incontinence:

○     A combination of symptoms from more than one type of incontinence, often stress and urge incontinence.

Additional general symptoms that can accompany urinary incontinence include:

●     Wetting the bed during sleep (nocturnal enuresis).

●     A strong urge to urinate immediately after finishing urination.

●     Involuntary urine loss during sexual activity.

If you experience any of these symptoms, it's important to consult a healthcare provider for an accurate diagnosis and appropriate treatment plan.

What are the normal treatments of urination incontinence?

Common treatments include lifestyle changes, behavioral therapies, medications, medical devices, and sometimes surgery. Here are some typical treatment options:

Lifestyle Changes

●     Fluid Management: Regulating fluid intake to avoid overloading the bladder.

●     Dietary Changes: Avoiding bladder irritants such as caffeine, alcohol, and acidic foods.

●     Weight Management: Losing excess weight can reduce pressure on the bladder.

Behavioral Therapies

●     Pelvic Floor Exercises (Kegel Exercises): Strengthening the pelvic floor muscles can help control urination.

●     Bladder Training: Scheduling regular bathroom trips and gradually increasing the time between urination can help train the bladder to hold urine longer.

●     Double Voiding: Urinating, then waiting a few minutes and trying to urinate again, to ensure the bladder is fully emptied.

Medications

●     Anticholinergics: Used to calm an overactive bladder.

●     Mirabegron (Myrbetriq): Relaxes the bladder muscle and can increase the amount of urine the bladder can hold.

●     Alpha Blockers: Used for men with overflow incontinence due to prostate problems.

●     Topical Estrogen: Applied to the vaginal area to help strengthen the muscles and tissues around the urethra in postmenopausal women.

Medical Devices

●     Pessary: A device inserted into the vagina to support the bladder and prevent urine leakage.

●     Urethral Inserts: Disposable devices inserted into the urethra to prevent leakage during activities that cause stress incontinence.

Surgical Options

●     Bladder Neck Suspension: Helps provide support to the urethra and bladder neck.

●     Sling Procedures: A sling made of synthetic material or your own tissue is placed under the urethra to support it and prevent urine leakage.

●     Artificial Urinary Sphincter: A device implanted around the bladder neck to control urine flow.

●     Bulking Agents: Injected into the tissue around the urethra to help close the bladder opening.

Other Treatments

●     Electrical Stimulation: Mild electrical pulses stimulate the pelvic floor muscles.

●     Botox Injections: Injected into the bladder muscle to help control an overactive bladder.

●     Nerve Stimulators: Devices implanted under the skin that send electrical impulses to the nerves controlling the bladder.

The choice of treatment depends on individual circumstances, and a healthcare provider can help determine the best approach based on the specific type and cause of incontinence.

How can acupuncture help patients with urination incontinence?

Here's how acupuncture might benefit patients with urinary incontinence:

Mechanisms of Action

●     Regulation of Nervous System: Acupuncture can help modulate the autonomic nervous system, which controls bladder function. This modulation may improve bladder control and reduce overactivity.

●     Enhancement of Blood Flow: Improved blood circulation to the pelvic region can enhance muscle tone and function in the bladder and pelvic floor muscles, reducing incontinence symptoms.

●     Reduction of Inflammation: Acupuncture has anti-inflammatory effects that may help alleviate underlying conditions contributing to urinary incontinence, such as bladder inflammation.

●     Stress Reduction: Acupuncture is known to reduce stress and anxiety, which can contribute to overactive bladder symptoms. Reducing stress levels can help improve overall bladder function.

●     Muscle Relaxation: Acupuncture can help relax the muscles around the bladder and urethra, reducing spasms and improving bladder control.

Clinical Evidence

Several studies suggest that acupuncture can be an effective treatment for urinary incontinence:

●     Overactive Bladder: Research has shown that acupuncture can reduce the frequency and urgency of urination in patients with overactive bladder by regulating bladder contractions.

●     Stress Incontinence: Acupuncture can strengthen the pelvic floor muscles, potentially reducing the incidence of stress incontinence by improving muscle support for the bladder.

●     Mixed Incontinence: For patients with a combination of stress and urge incontinence, acupuncture may help manage both sets of symptoms by addressing multiple underlying factors.

Treatment Approach

●     Individualized Treatment: Acupuncturists tailor treatments to each patient's specific condition, targeting acupuncture points that correspond to the symptoms and underlying causes of urinary incontinence.

●     Frequency and Duration: Treatment typically involves multiple sessions over several weeks. The number of sessions and duration of treatment depend on the severity of the condition and the patient's response to therapy.

Conclusion

While more research is needed to fully understand the mechanisms and efficacy of acupuncture for urinary incontinence, existing studies and clinical practice suggest it can be a valuable complementary treatment. Patients considering acupuncture should consult with their healthcare provider and seek treatment from a licensed and experienced acupuncturist.