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    Incontinence of The Urine, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Incontinence of The Urine, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Incontinence of The Urine, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Ebook243 pages4 hours

    Incontinence of The Urine, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

    By Kenneth Kee

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    About this ebook

    Urinary incontinence is a symptom and indicates the uncontrollable leakage of urine.
    This can produce a lot of discomfort to patients having this disorder or symptom.
    Elderly women are more susceptible to it than men.
    With a longer life span many elderly patients can be observed being brought to the family doctor clinic wearing adult diapers.
    Elderly patients are likely to believe that the only way to prevent embarrassment is to wear absorbent menses pads or padded undergarments like adult diapers.
    However the skin wetness may result in rashes, sores, or infections.
    Most people with urinary incontinence are women mainly because childbirth weakens the pelvic floor muscles.
    Old age in turn such as the menopause produce both weakness and other age related disorders which can affect the period of time the patient can wait once the patient feels the urge to go
    Alcoholism and an enlarged prostate can both produce it as well, but childbirth related muscle weakness remains the most frequent cause.
    Causes:
    With aging, the bladders are not capable of holding as much urine and the sphincter muscles may weaken reducing the body’s ability to stop the urination.
    In women the reduction in estrogen after menopause causes the lining of the urethra to be thinner so that it might not close properly permitting urine to leak out.
    Childbearing can also raise the danger of forming urinary incontinence.
    With age or after vaginal delivery, the pelvic muscles are never as strong as the way they were before birth, particularly after multiple deliveries.
    Everyone tend more likely to become incontinent with age because of both the deterioration of the organs and brain
    Women have the greater disorder because of childbirth, the menopause and also having a shorter outlet
    Other causes:
    Diabetes, neurological diseases, and nerve injury
    In men and women, urinary incontinence can be due to neurological disorders such as multiple sclerosis, spinal cord injury, and Parkinson’s disease.
    Pelvic surgery or prostate surgery
    Enlarged prostate in men
    Pelvic organ such as uterus prolapse in women
    Urinary Incontinence is a medical symptom which may be temporary or permanent
    Urinary incontinence may be categorized into 4 main types:
    Stress
    Urge
    Overflow
    Functional
    Mixed
    A full history and physical examination will be able to help the doctor to diagnose urinary incontinence, type and possible causes of the incontinence.
    Urinalysis
    Post-void Residual Measurement
    Ultrasound
    Urodynamic Testing
    Pad tests
    Void diary
    Cystoscopy
    Treatment:
    A. Lifestyle changes.
    Scheduled Toileting
    Double Voiding
    Bladder Training
    Reducing Fluid
    Kegel exercises
    Vaginal cone therapy
    Biofeedback
    Electrical stimulation
    B. Treating the cause of the incontinence
    Medicines
    antidepressant
    anticholinergic
    Oxybutynin
    Nighttime voiding and incontinence
    Desmopressin (DDAVP)
    Pessaries
    C. Surgery
    Removal of Enlarged Prostate
    Bladder repositioning
    Bladder neck suspension
    Periurethral bulking therapy
    Mid-urethral slings
    Artificial urinary sphincter
    Retropubic suspension
    The transobturator male sling
    Transobturator vaginal tape
    Sacral nerve modulation
    Injection of neurotoxins such as botulinum toxin
    D. Catheterization
    Indwelling urethral catheters
    Suprapubic catheter
    Intermittent Catheterization
    Medicated and silver-coated catheters
    Other Methods:
    Absorbent Pads
    Intra-vesical pharmacotherapy
    Accupuncture
    New Methods:
    Potassium channel openers
    Prostaglandins
    Estrogens
    Urethral injection of a combined patient-derived adipose stem cells (ASCs) and collagen

    TABLE OF CONTENT
    Introduction
    Chapter 1 Incontinence of Urine
    Chapter 2 Causes
    Chapter 3 Symptoms
    Chapter 4 Diagnosis

    LanguageEnglish
    PublisherKenneth Kee
    Release dateSep 9, 2017
    ISBN9781370683307
    Incontinence of The Urine, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Author

    Kenneth Kee

    Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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      Book preview

      Incontinence of The Urine, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee

      Incontinence of

      The Urine,

      A

      Simple

      Guide

      To

      The Condition,

      Diagnosis,

      Treatment

      And

      Related Conditions

      By

      Dr Kenneth Kee

      M.B.,B.S. (Singapore)

      Ph.D (Healthcare Administration)

      Copyright Kenneth Kee 2017 Smashwords Edition

      Published by Kenneth Kee at Smashwords.com

      Dedication

      This book is dedicated

      To my wife Dorothy

      And my children

      Carolyn, Grace

      And Kelvin

      This book describes Incontinence of Urine, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

      (What The patient Need to Treat Incontinence of Urine)

      This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If the patient would like to share this book with another person, please purchase an additional copy for each reader.

      If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

      Thank you for respecting the hard work of this author.

      Introduction

      I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

      My purpose in writing these simple guides was for the health education of my patients.

      Health Education was also my dissertation for my Ph.D (Healthcare Administration).

      I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

      This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

      From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.

      Some people have complained that the simple guides are too simple.

      For their information they are made simple in order to educate the patients.

      The later books go into more details of medical disorders.

      The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

      Since 2013, I have tried to improve my spelling and writing.

      As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

      Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

      I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

      I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

      I apologize if these repetitions are irritating to some readers.

      Chapter 1

      Urinary Incontinence

      What is Urinary Incontinence?

      Urinary incontinence is a symptom and indicates the uncontrollable leakage of urine.

      This can produce a lot of discomfort to patients having this disorder or symptom.

      Elderly women are more susceptible to it than men.

      With a longer life span many elderly patients can be observed being brought to the family doctor clinic wearing adult diapers.

      Elderly patients are likely to believe that the only way to prevent embarrassment is to wear absorbent menses pads or padded undergarments like adult diapers.

      However the skin wetness may result in rashes, sores, or infections.

      Most people with urinary incontinence are women mainly because childbirth weakens the pelvic floor muscles.

      Old age in turn such as the menopause produce both weakness and other age related disorders which can affect the period of time the patient can wait once the patient feels the urge to go

      Alcoholism and an enlarged prostate can both produce it as well, but childbirth related muscle weakness remains the most frequent cause.

      What are the causes of Urinary Incontinence?

      Causes:

      There are many causes for urinary incontinence:

      With aging, their bladders are not capable of holding as much urine and the sphincter muscles may weaken reducing the body’s ability to stop the urination.

      In women the reduction in estrogen after menopause causes the lining of the urethra to be thinner so that it might not close properly permitting urine to leak out.

      Childbearing can also raise the danger of forming urinary incontinence.

      In women, the pelvic floor has the support of the vaginal wall.

      With age or after vaginal delivery, the pelvic muscles are never as strong as the way they were before birth, particularly after multiple deliveries.

      It is important to understand that urinary incontinence is not a normal effect of aging or childbearing and that it can often be treated.

      Mental retardation would only produce incontinence if serious: it could delay toilet training.

      The combination of childbirth, the results of menopause and aging of the organs directly and indirectly controlling urination indicate that women over 50 most often suffer from secondary (i.e. after learning to control it) incontinence of some degree.

      Most women can be treated so it is not a large problem, but she may have to try different methods before some small amount of success is found.

      Everyone tend more likely to become incontinent with age because of both the deterioration of the organs and brain involve urination anatomically and the mental and physical response to the urge.

      But, with the present physical differences, women have the greater disorder because of childbirth, the menopause and also having a shorter outlet so it happens earlier and more often overall.

      Besides aging and childbirth, there are still many other possible causes of urinary incontinence:

      1. Diabetes, neurological diseases, and nerve injury

      2. In men and women, urinary incontinence can be due to neurological disorders such as multiple sclerosis, spinal cord injury, and Parkinson’s disease.

      3. Other disorders are conditions that affect the nerve pathways of the body such as a herniated disc that presses on the nerves or a stroke with weakness of pelvic muscles.

      4. Pelvic surgery or prostate surgery

      5. Enlarged prostate in men

      6. Pelvic organ such as uterus prolapse in women

      Urinary Incontinence is a medical symptom which may be temporary or permanent.

      1. Lifestyle factors

      Smoking and obesity can both raise the risk of developing incontinence.

      In some women, urine may leak out during high-impact exercise, such as running.

      Diet:

      Too much tea, coffee or carbonated drinks can cause irritation to the bladder and cause or add to incontinence.

      Coffee and other drinks containing caffeine can be a special disorder as caffeine is a diuretic, i.e. it raises the urge to pass urine.

      2. Excessive alcohol.

      Alcohol is also a diuretic that can induce urination.

      Because it also has depressant effect on the brain, it may affect the person’s judgment transiently, hence leading to accidental urinary incontinence.

      3. Medicines

      Diuretic pills, heart medicines and antidepressants can produce or add to urinary incontinence.

      The causes of temporary urinary incontinence are certain medicines, such as sleeping pills, diuretics, antidepressants and even antihistamines.

      4. The presence of Urinary Tract Infection (UTI) may cause enough irritation to the bladder to stimulate urinary incontinence.

      5. Constipation produces impaction of the stools in the rectum causing pressure on the urethra.

      This stimulates the nerves to the bladder leading to urinary incontinence.

      Permanent urinary incontinence

      In both sexes there are many disorders which can induce or add to chronic or persistent urinary incontinence:

      Men:

      1. Enlarged prostate

      BPH or benign prostate hypertrophy is linked with aging and can cause obstruction of the urethra and block urinary flow leading to urge or overflow urinary incontinence.

      2. Prostate Cancer

      Prostate cancer can produce urinary incontinence if not treated.

      The incontinence in prostate cancer patients may also be a side effect of treatment, e.g. surgery, radiation therapy.

      3. Prostatitis

      Inflammation of the prostate gland occasionary can produce constriction of the urinary flow and incontinence.

      Women:

      1. Prolapsed uterus,

      2. Enlarged uterus due to fibroids,

      3. Ovarian cysts or tumors.

      Due to their weight tumors or enlarged uterus or ovaries can pull on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening

      Aging

      With age there is a decline in the bladder capacity to keep urine.

      Surgery

      Any surgeries involving organs such as the ovary, uterus, prostate, rectum can produce inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.

      Urinary tract obstruction

      Any enlarged tumors along the urinary tract can block the normal flow of urine and produce incontinence.

      Bladder stones can cause the same blockage and incontinence.

      Neurological disorders

      Stroke, Parkinson’s disease, tumors in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can involve the nerves to the bladder and weakening of the bladder opening muscles.

      What are the types of Urinary Incontinence?

      Urinary incontinence may be categorized into 4 main types:

      It is possible however to have more than one form of urinary incontinence

      1. Stress incontinence

      Stress incontinence is the most frequent type as produced by a weakening of the pelvic floor and mainly involves women after childbirth.

      Leakage of urine happens because of weakness of the pelvic floor muscles.

      When there is pressure applied on the bladder (e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy), the muscles at the opening of the bladder will be under stress and opens to permit leaking of urine.

      Stress urinary incontinence has to do with higher abdominal pressure.

      This is also called activity-related incontinence.

      It can happen when there is sudden pressure from a cough, sneeze, laugh, or exercise.

      Recently one of my elderly female patients had to wear a menses pad because of her chronic cough.

      Each time she coughs, the urine automatically leaks out.

      2. Urge incontinence

      Urge incontinence is more frequent in old age where the capability to hold the urine after the urge is felt is gone to some degree.

      There is a sudden uncontrollable leakage of urine while feeling the urge to urinate.

      Known as overactive bladder, urge incontinence is featured by the need to go to the bathroom often and a sudden and serious urge to urinate followed by an uncontrollable leakage of urine.

      People often do not reach the bathroom.

      3. Overflow incontinence

      Overflow incontinence is the least frequent, where the bladder becomes full and begins leaking.

      There is a consistent dribbling of urine even after completing urination.

      There is a failure to entirely empty the bladder.

      Termed chronic urinary retention, overflow incontinence happens when urine is retained in the bladder.

      Patients who have overflow incontinence may not feel the need to urinate and do not empty their bladders totally.

      Urine flow may be weak.

      When the patient is completed, the patient may still feel that he or she needs to urinate.

      The pressure of too much urine in the bladder often induces urine to dribble out between trips to the bathroom.

      4. Functional incontinence

      There is physical or mental impairment leading to the failure to recognize the need to urinate.

      As a result the person is not able to get to the toilet in time and pass out the urine.

      These are people who go through dementia, Parkinson or are incapacitated by poor physical movement.

      Mixed incontinence.

      In many cases, people have more than one form of incontinence.

      It is possible to have stress incontinence and urge incontinence, mainly in women.

      Other forms of urinary incontinence are enuresis (bed wetting) which is frequent in children,

      Transient incontinence is temporary and occasionally induced by medicines

      What are

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