Incontinence of Urine

Incontinence of Urine

1. Definition
   Incontinence of urine means the involuntary loss of urine. It is a symptom that may indicate an underlying disease of the urinary tract or nervous system.

2. Causes / Etiology
   ‑ Neurological disorders – spinal cord injury, multiple sclerosis, Parkinson’s disease.
   ‑ Urinary tract infection – irritation of bladder wall.
   ‑ Weak pelvic floor muscles – especially after childbirth or menopause.
   ‑ Prostatic enlargement or surgery in men.
   ‑ Certain drugs – diuretics, sedatives, anticholinergics.
   ‑ Constipation – pressure on bladder.

3. Types or Classification
   Stress incontinence – urine leaks when coughing, sneezing or lifting.
   Urge incontinence – sudden strong urge to void followed by leakage.
   Overflow incontinence – continuous dribbling because bladder is over‑distended.
   Functional incontinence – patient cannot reach toilet in time due to physical or mental limitation.
   Mixed incontinence – features of both stress and urge types.

4. Pathology (step‑wise)
   step 1 → bladder fills and stretch receptors send signals to the spinal cord.
   step 2 → brain receives the signal and decides when it is appropriate to void.
   step 3 → descending impulses relax the urethral sphincter and contract detrusor muscle for emptying.
   step 4 → if any of these neural or muscular steps are disrupted, urine escapes unintentionally, producing the various clinical types described above.

5. Clinical Features
   General – patient reports involuntary leakage, may feel embarrassed, may avoid social activities.
   Specific –
    Stress type: leakage during coughing, laughing, lifting.
    Urge type: sudden urgency, may be unable to hold even a few seconds.
    Overflow type: constant dribbling, feeling of incomplete emptying, sometimes a palpable full bladder.
    Functional type: leakage related to inability to get to toilet (e.g., arthritis, dementia).

6. Complications
   Acute – skin irritation, dermatitis, urinary tract infection.
   Chronic – recurrent infections, renal impairment from chronic retention, social isolation, depression, reduced quality of life.

7. Diagnosis / Investigations
   Routine – urine analysis (to detect infection, glucose, blood), urine culture if infection suspected.
   Special – uroflowmetry (measures flow rate), post‑void residual volume by ultrasound, cystometry (urodynamic study of bladder pressures), cystoscopy (visual inspection of bladder and urethra), pelvic ultrasound (to assess prostate size or pelvic organ prolapse).

8. Management
   General – bladder training (timed voiding), pelvic floor muscle exercises (Kegel), weight control, smoking cessation, avoid bladder irritants (caffeine, alcohol, spicy food).
   Modern treatment – antimuscarinic drugs (e.g., oxybutynin) for urge type, β‑3 agonists (mirabegron), topical estrogen in post‑menopausal women, sling surgery or colposuspension for stress type, catheterisation for severe overflow.
   Dietary advice – drink adequate fluid (about 1.5–2 L/day) but avoid excess caffeine/alcohol, maintain regular bowel habits with fiber‑rich diet to reduce constipation.

9. Homeopathic Therapeutics (selected remedies)

Sepia
‑ emotional indifference, feeling of heaviness.
‑ leakage on coughing, sneezing or exertion.
‑ weak pelvic floor, worse after standing.
‑ improves with rest and warmth.
‑ aversion to cold drinks.
‑ tendency to feel “cold” in lower abdomen.

Lycopodium
‑ urge to urinate with dribbling.
‑ pelvic muscles feel weak, especially after meals.
‑ symptoms worsen in cold weather.
‑ relief with warmth, especially hot drinks.
‑ anxiety about public toilets.
‑ constipation with hard stools.

Causticum
‑ stress incontinence, urine loss on effort.
‑ marked weakness of sphincter muscles.
‑ burning sensation in urethra.
‑ symptoms aggravate by cold exposure.
‑ better in warm, dry environment.
‑ tendency to develop ulcerations in genital area.

Natrum Muriaticum
‑ urge incontinence with sudden, sharp need.
‑ emotional upset, especially grief or disappointment.
‑ symptoms worsen after emotional stress.
‑ relief after rest in a quiet place.
‑ craving for salty foods.
‑ tendency to retain urine leading to overflow.

Pulsatilla
‑ urge incontinence with frequent, small amounts.
‑ emotional lability, weepy, seeks consolation.
‑ symptoms improve in open air, fresh air.
‑ worse in warm, stuffy rooms.
‑ aversion to rich, fatty foods.
‑ desire for gentle, soothing touch.