How does incontinence occur?

Urinary incontinence occurs when urine is accidentally lost: it is an increasingly frequent problem, given the rapid aging of the population and mainly concerns women. In fact, this problem grows with increasing age, although it can occur at a younger age, for example in pregnancy, it is also correlated with problems of psychological or sexological origin.

Bladder functioning

The bladder is a urine storage organ that must be emptied from the first day of life onwards. Physiologically it is a very complex system that is very prone to disturbances; from the neurophysiological point of view, the behavior of urination is a hierarchically structured control ring with conscious cognitive and unconscious emotional components. Control of bladder function (release, emission, the arrest of urine) is learned in the first years of life. Unlike other mammals, humans learn in their early years to control urination (until they find a suitable place and time to perform the function in a socially acceptable way). During this period, the child experiences his power over his parents on the one hand by voluntarily holding back his excretions and on the other, he learns the sense of frustration deriving from the external compulsion of "urination on command", which could also lead to punishment. Urination in the right place and at the right time brings rewards, which support the learning of bladder and intestinal control. 

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Let's see the types of urinary incontinence 

Stress Incontinence

With this type of incontinence, urine leaks are due to the weakening of the muscles and tissues of the pelvic floor. This can happen when the pressure on the bladder increases, for example when you train, laugh, sneeze, or cough. Stress incontinence is also due to pregnancy and childbirth to pregnancy and childbirth can stretch and weaken a woman's pelvic floor muscles), overweight or obesity, taking certain medications, surgery.

Urge incontinence

This is also called an overactive bladder. With this type of incontinence, there is often an urgent need to go to the bathroom and there is often the risk of not arriving on time. The causes of overactive bladder concern problems with the bladder itself, damage to other parts of the nervous system, muscles, multiple sclerosis, Parkinson's disease, diabetes, and stroke. Other bladder problems that can give these symptoms are infections, stones, and side effects from medications. In general, women are more affected by urge incontinence than men, probably due to the shorter urethra.

Regurgitation incontinence

If you are unable to empty your bladder, you may experience regurgitation incontinence. Causes include weakened bladder muscles, conditions that block the flow of urine, such as tumors, constipation, some medications. If the bladder fails to empty, this can cause infections and other problems.

Functional incontinence

This incontinence is due to mental or physical problems, such as dementia or arthritis, which prevent you from getting to the bathroom on time.

Mixed urinary incontinence

In this case, there are two or more types of incontinence. Many women suffer from stress incontinence and urge incontinence.

 

What do you think are the causes of incontinence in an elderly woman?

In the elderly woman the causes of incontinence concern the increase of activity or the loss of contractility of the detrusor muscle, with a reduction of the flow of urine, the degeneration of the muscle cells of the bladder wall, the collagen deposits in the interstitial spaces, the atrophy of the superficial and intermediate layers of the epithelium of the urethral mucous membranes (irritation, loss of compliance), the greatest elimination of fluids during the night. (Elbendawi A., 1993, Hendrix S L, Cochrane B B, Nygaard I E. et al., 2005, Kirkland J L, Lye M, Levy D W., et al., 1983).

Pregnancy

The problem can occur during pregnancy: it affects between 30 and 60% of all pregnant women; the phenomenon regresses in more than half of women after childbirth.
 

Life quality

Regardless of gender, incontinent people can be said to have a significantly lower quality of life, higher depression scores, and lower sleep quality than continent people.

Psychological causes of incontinence

Since 1980 various authors have tried to identify the psychological causes of incontinence, based on psychometric tests. In particular, we mention:

• Norton et al. (1990) found no obvious psychosomatic difference between women with urge incontinence and women with other forms of incontinence.
• Berglund et al. (1994) believe that there are higher values ​​for symptoms of physical and mental anxiety and distrust for women with urge incontinence.
• Freeman et al. (1985), Macaulay et al. (1991), Lamm et al. (1986), Chiara et al. (1998) highlighted higher values ​​for anxiety and depression in patients with urge incontinence.

It has also been highlighted that women with urge and stress incontinence experience more frequent anxiety problems than women with stress incontinence and this is reflected in a sense of personal insecurity and fear of disease.

 

Psychological influences on the functionality of the pelvic floor

From a psychophysical point of view, the urogenital tract is an organ of desire, production, and reproduction. This can lead to psychological influences on the functionality of the pelvic floor, which consist of three effects in particular:

• Involuntary release of urine, for example during a state of fear or anger
•  Retention to the bitter end, until a suitable place for the function, has been found
• The reduction of muscle tone, such as during a prostration state.

Other psychosomatic problems of bladder function are expressed in the painful bladder, overactive bladder, and recurrent urinary tract infections.
 

• The syndrome bladder pain (BPS) is defined as a chronic pelvic pain that seems to be linked to the bladder. In addition, there is either a persistent urge to urinate or an increase in the frequency of urination.
• The overactive bladder occurs when the smooth muscle that surrounds the bladder (detrusor muscle) is contracted in a spastic and uncontrolled. These involuntary contractions cause an increase in intra-bladder pressure and, on the clinical level, an urgent need to urinate felt by the patient (urination urgency).
   

The natural treatment of  urinary incontinence 

Treatment for urinary incontinence depends on the type of incontinence, the severity of the problem, the underlying cause, and which measures the best suit the patient's lifestyle. In addition, some therapeutic approaches are optimal for men, while others are more suitable for women. The goal of any urinary incontinence treatment is to improve the patient's quality of life. In most cases, the first line of treatment is conservative or minimally invasive. Medicines may be needed depending on the cause of incontinence. If the symptoms are more severe and all other treatments are not effective, a surgical approach may be recommended. Therapeutic success depends, first of all, on the correct diagnosis. In most cases.

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