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Sunday, 24 November 2013

Urinary Incontinence - The Risk factors and Causes


Urinary Incontinence, a medical, psychological, social, economic, and hygienic problem, is defined as a condition of loss of the bladder to control that can lead to mild or severe form of involuntary leakage of urine. Involuntary urine leakage or urinary incontinence is frequent among elderly women, adult women, even among adolescent women
B. Risk factors
1. Gender
If you are women, you are at increased risk of stress urinary incontinence, but men with enlarged prostate are also at higher risk of the conditions. 
2. Age
Risk of Urinary incontinence is increased with age as a result of weakening of  the muscles of the bladder and strength of urethra.
3. Smoking
In the study of  606 women whose smoking histories were known; 322 were incontinent and 284 were continent. The condition(s) causing each subject's incontinence was determined by urodynamic testing; 40% of the continent subjects had the same testing, indicated that the odds ratio for genuine stress incontinence was 2.20 for former (95% confidence interval 1.18 to 4.11) and 2.48 for current smokers (95% confidence interval 1.60 to 3.84); for motor incontinence it was 2.92 for former (95% confidence interval 1.58 to 5.39) and 1.89 (95% confidence interval 1.19 to 3.02) for current smokers(3).
4. Hysterectomy 
Hysterectomy in general, in particular vaginal hysterectomy, was associated with an increased risk for subsequent POP and SUI surgery.(4)
5. Other risk factors
In the study to study to determine the prevalence and potential risk factors associated with urinary incontinence (UI) in women and to assess its impact on quality of life (QOL), Dr. Kocaöz S, and the research team showed that the prevalence of UI was 31.9%. Logistic regression analysis indicated that the number of pregnancies (odds ratio [OR] = 0.53, 95% CI: 0.28-0.99), UI in mother (OR = 2.46, 95% CI: 1.35-4.50) and sister (OR = 0.34, 95% CI: 0.16-0.77), previous UI during pregnancy (OR = 12.22, 95% CI: 4.11-36.36) and postpartum period (OR = 11.28, 95% CI: 3.66-34.76), and body mass index (OR = 0.49, 95% CI: 0.29-0.85) were associated with a higher likelihood of incontinence (P < .05). Ninety-two of 288 women (31.9%) stated that UI has a negative impact on their QOL and only 40 of 92 (43.5%) had asked for medical help. Impairment of QOL was related with the type of UI, frequency of UI episode, and amount of leakage(5). Other researchers in the study of a total of 621 women of those initially selected in the study died before completion of this study. Face-to-face interviews with 1,521 women were completed, producing a response rate of 85.0% (1,521/1,789 women). The prevalence of daytime urinary frequency was significantly related to body mass index (p = 0.018), diabetes mellitus (p = 0.017), hypertension (p = 0.015), previous drug allergy (p = 0.003), smoking (p = 0.005), hormone therapy (p = 0.019), parity (p = 0.019), and urinary incontinence (p = 0.000). However, there was no association between urinary frequency and previous gynecologic surgery, hysterectomy, alcohol consumption, marital status, childbirth, and age of menopause(6).
6. Etc.
B. Causes 
1. Interstitial cystitis/painful bladder syndrome 
Dr. Chung MK, and scientists at the Midwest Regional Center for Chronic Pelvic Pain, indicated that Many patients with symptoms of overactive bladder with little or no pain have cystoscopic evidence of interstitial cystitis and a positive Potassium Sensitivity Test(7).
2. Prostatitis
Inflammation of prostate gland in men can cause urinary incontinence Loss of bladder control. There is a report of a case of total urinary incontinence as a late sequela of bacterial prostatitis is reported. The etiology of the incontinence and its surgical management are discussed(8)
3. Enlarged prostate or benign prostatic hyperplasia (BPH)
  Enlarged prostate can cause narrowing of the urinary track which can cause Urinary Incontinence. Urinary incontinence (UI) and benign prostatic hyperplasia (BPH) are 2 common urogenital problems in men. UI is associated with involuntary leakage of urine and lower urinary tract symptoms (LUTS) of urgency, frequency, and nocturia. Types of UI include functional, urge, stress, and overflow. Treatment for UI is based on the type of incontinence, patient-specific factors, and treatment preferences of both patients and health care providers(9).
4. Prostate cancer
In the study to review the current knowledge and treatment of incontinence and erectile dysfunction after treatment of localized prostate cancer, found that nursing care of men undergoing treatment of prostate cancer begins at the time of diagnosis and continues throughout the management of the two main adverse effects of treatment: erectile dysfunction and urinary incontinence(10).
 5. Bladder cancer 
"Women with SUI the Serbian urologist traditionally begins with cystoscopy to reduced risk of bladder tumor. There is no doubt regarding its ability to detect bladder cancer presented with characteristic symptoms or pathologic results of urinalyses" Dr. Topuzović C, and the research team at Clinical Center of Serbia said(11)
6. Cognitive disorders
Urinary incontinence is a common problem in dementia as a result of the disease interfere with nerve signals involved in bladder control. Dr. Yap P, and Tan D. at Alexandra hospital  in the study of Urinary incontinence in dementia – a practical approach, said "Almost invariably, the person with dementia will develop incontinence as the disease progresses. However, the primary reasons for incontinence are often not because of any significant pathology in the urinary system. Rather, it is due to factors outside the urinary system"(12).
7. Constipation
In the study to evaluate the frequency of urinary incontinence and urinary tract infection in children with chronic constipation and report on the resolution of these with treatment of the underlying constipation, showed that urinary symptoms were found in a significant number of children who had functional constipation and encopresis. With treatment of the constipation, most patients became clean and dry and further recurrence of urinary tract infections was prevented(13).
8. Other causes
In the assessment of the EPIC participants, 1434 identified OAB cases were matched by age, gender and country, with 1434 participants designated as controls. Cases and controls were primarily Caucasian (96.2% and 96.7%, respectively), and most (65%) were female; the mean age was 53.8 and 53.7 years, respectively, found that comorbid conditions differed significantly by case/control status, with cases reporting significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were significant differences between the cases and controls in all reported LUTS. The OAB + postmicturition + voiding group reported significantly greater symptom bother, worse HRQoL, higher rates of depression and decreased enjoyment of sexual activity, than the other subgroups(14).
 9. Etc.

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Sources
(3) http://www.ncbi.nlm.nih.gov/pubmed/1442969 
(4) http://www.ncbi.nlm.nih.gov/pubmed/21850508 
(5) http://www.ncbi.nlm.nih.gov/pubmed/22652936
(6) http://www.ncbi.nlm.nih.gov/pubmed/21056308
(7) http://www.ncbi.nlm.nih.gov/pubmed/20412643
(8) http://www.ncbi.nlm.nih.gov/pubmed/3336079 
(9) http://www.ncbi.nlm.nih.gov/pubmed/21984774
(10) http://www.ncbi.nlm.nih.gov/pubmed/22018407 
(11) http://www.ncbi.nlm.nih.gov/pubmed/22369022
(12) http://www.ncbi.nlm.nih.gov/pubmed/16642241 
(13) http://www.ncbi.nlm.nih.gov/pubmed/9240804
(14) http://www.ncbi.nlm.nih.gov/pubmed/18454794