Urinary incontinence is the inability to control urination.

Types:
There are five types urinary continence:

Stress incontinence, urge incontinence, overflow incontinence, mixed incontinence and functional or environmental incontinence.

1.Stress incontinence:
It is the most common type of urinary incontinence and happens when a person leaks urine when they cough, sneeze, exercise or do anything that puts pressure on the bladder.

2.Urge incontinence:
This occurs when the bladder muscles are too active.
People with urge incontinence lose urine as soon as they feel a strong desire to go to the bathroom.

3.Overflow incontinence:
This is the feeling of never completely emptying the bladder.

4.Mixed incontinence:
It is the combination of stress and urge incontinence.

5.Functional or environmental incontinence:
This occurs when people cannot get to the toilet or get a bedpan when they need it.
The urinary system may work well, but physical or psychological disabilities prevent normal toilet usage.

Causes and risk factors:
Urinary incontinence can be caused by temporary problems, such as urinary tract infection, vaginal infection or irritation, constipation, obesity, smoking, frequent high-impact aerobics or effects of medicine.
Incontinence can also be caused by other permanent conditions, such as:
Aging (bladder holds less and urine stream may be weaker)
Weakness of muscles that hold the bladder in place
Weakness of bladder itself
Weakness of the urethral sphincter muscles
Weakness of the pelvic muscles due to pregnancy, followed by a long, difficult vaginal birth
Overactive bladder muscles
Blocked urethra (caused by prostate enlargement in men)
Hormone imbalance in women
Neurological disorders
Prolapsed uterus
Structural abnormalities in the urethra
Immobility
Diabetes
High calcium levels in the blood

Women are far more prone to the urinary incontinence problems than men for several reasons. For one thing, childbirth exerts a heavy toll on the bladder and the sphincter muscle that controls the urethra (the canal that carries urine from the bladder out of your body). Additionally, the loss of female hormones after menopause leads to a thinning and weakening of the urethral lining that is supposed to keep the bladder closed except during urination.

Diagnosis:
Enquiry about medical history as well as urinary habits.
A vaginal and rectal examination.
The vaginal exam can reveal anatomic causes, such as a dropped bladder (cystocele), a prolapsed uterus or structural abnormalities in the urethra.
A rectal exam is necessary to assess the sphincter tone and possible fecal backup.
laboratory and diagnostic tests:
The laboratory tests include blood and urine samples.
The diagnostic tests may include a cystoscopic examination, post-void residual (PVR) measurement, stress test and urodynamic testing.
The cystoscopic examination is a procedure in which a small tube with a telescope attached, is inserted into the bladder so the doctor can look for any abnormalities in the bladder and lower urinary tract.
PVR measurement measures how much urine is left in the bladder after urinating by placing a small soft tube into the bladder.
A stress test looks for urine loss when stress is put on the bladder muscles.
Urodynamic testing involves inserting a small tube into the bladder and examining the bladder and urethral sphincter function.

Treatment:
Stress incontinence can be treated in one or more of the following ways:
1. Behavioral Techniques
Behavioral treatments include pelvic muscle rehabilitation, retraining the bladder, weight loss and dietary changes, such as alleviating caffeine-based and carbonated beverages, citrus foods and juices, chocolate, highly spicy foods and alcohol.

Pelvic muscle rehabilitation includes pelvic muscle exercises, biofeedback therapy, vaginal weight training and pelvic floor electrical stimulation. These techniques are recommended to strengthen the muscles around the vagina and urethra.
Vaginal weight training uses a weighted vaginal cone inserted by a woman into the vagina twice daily and worn for 15 minutes.

Bladder training to “hold on” for increasing amounts of time and to void at regular, scheduled intervals. This technique teaches patients to resist the urge to void and gradually expands the intervals between voiding.
Weight loss Losing extra pounds, especially in the abdomen, can relieve pressure on the bladder and pelvic floor muscles.

2. Medication
Stress incontinence can also be treated with medications that increase the contractility of the sphincters at the bladder neck.

If a woman is past menopause and incontinence is due to the thinning or drying of urethral walls, a vaginal estrogen cream is recommended.

Collagen implants are also an option that some physicians use to treat stress incontinence

3. Surgery
Surgery can be 90 percent successful in women with severe stress incontinence.
The vaginal sling operation creates a hammock under the urethra to give support.
More complicated surgical procedures include implantation of an artificial sphincter (a cuff which can be inflated to squeeze the urethra, impeding urine flow) or laparoscopic bladder neck suspension.
In this procedure, three incisions are made in the abdomen and sutures are used to reposition the bladder neck.

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