A) Types -

• Stress incontinence–

  Also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles to prevent the passage of urine, especially during activities that increase intra-abdominal pressure, such as coughing, sneezing, or bearing down.

• Urge incontinence–

  Involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.

• Overflow incontinence–

  Sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine. It is as if their bladders were constantly overflowing, hence the general name overflow incontinence.

• Mixed incontinence-

  Not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.

• Structural incontinence-

  Not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.

• Functional incontinence-

  Not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.

• Nocturnal enuresis-

  Not uncommon in the elderly female population and can sometimes be complicated by urinary retention, which makes it a treatment challenge requiring staged multimodal treatment.

• Transient incontinence-

  Temporary version of incontinence. It can be triggered by medications, adrenal insufficiency, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.

• Giggle incontinence-

  An involuntary response to laughter. It usually affects children.

• Post-void dribbling-

  The phenomenon where urine remaining in the urethra after voiding the bladder slowly leaks out after urination

B) Checkups –

At Genesis fertility careful evaluation of the pattern of voiding and urine leakage is done so as to find the exact type of incontinence .Careful history taking is done to find other important points like straining and discomfort, use of drugs, recent surgery, and illness. The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

C) Other tests :

• 1. Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
• 2. Urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes.
• 3. Blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
• 4. Ultrasound – sound waves are used to visualize the kidneys, ureters, bladder, and urethra
• 5. Cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder
• 6. Urodynamics – various techniques measure pressure in the bladder and the flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

D) Treatment- Exercises & Surgical correction

a) Exercises –

One of the most common treatment recommendations includes exercising the muscles of the pelvis. Kegel exercises may strengthen a portion of the affected area. The pelvic floor is actually a group of muscles and connective tissues running side-to-side and front to back along the bony ridges of the pelvis. Kegel exercises to strengthen or retain pelvic floor muscles and sphincter muscles can reduce stress leakage. The patient should do at least 24 daily contractions for at least 6 weeks. Increasingly there is evidence of the effectiveness of pelvic floor muscle exercise to improve bladder control. For example, urinary incontinence following childbirth can be improved by performing those pelvic floor muscle exercises

B) Surgery –

• 1. Slings -The procedure of choice for stress urinary incontinence in females is what is called a sling procedure. A sling usually consists of a synthetic mesh material which is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra.
• 2. The tension-free transvaginal tape(TVT) - The tension-free transvaginal tape(TVT) sling procedure treats urinary stress incontinence by positioning a polypropylene mesh tape underneath the urethra. The 20-minute outpatient procedure involves two miniature incisions and has an 86-95% cure rate. Complications, such as bladder perforation, can occur in the retropubic space if the procedure is not done correctly. This minimally invasive procedure is a common treatment for stress urinary incontinence.
• 3. The transobturator tape (TOT) - The transobturator tape (TOT) sling procedure aims to eliminate stress urinary incontinence by providing support under the urethra. This minimally-invasive procedure eliminates retropubic needle passage and involves inserting a mesh tape under the urethra through three small incisions in the groin area. With the cure rate of more than 90 % this procedure is rated as the safest
• 4. The mini-sling - The mini-sling procedure also known as TVT-Secure. The reported short term cure rates of the TVT-Secure ranged from 67% to 83%.
• 5. Bladder repositioning - Most stress incontinence in women results from the bladder displacing down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position. This not only holds up the bladder but also compresses the bottom if the bladder and the top of the urethra, further preventing leakage.