Incontinence products
Urinary incontinence is an involuntary leaking of urine, which can occur when any of the normal functions of the bladder are disrupted. There are three major categories of urinary incontinence, which are classified according to etiology: stress incontinence (SI), also referred to as genuine stress incontinence; detrusor instability (DI), also referred to as urge incontinence (UI); and overflow incontinence. Stress incontinence refers to involuntary loss of urine during coughing, laughing, sneezing, jogging or other physical activity that causes a sufficient increase in intra-abdominal pressure. Urge incontinence refers to the involuntary loss of urine due to unwanted bladder contraction that may be associated with an uncontrollable desire to urinate. "Mixed incontinence" refers to a combination of both urge and stress incontinence. The most common type of urge incontinence (UI) in elderly individuals is detrusor instability (DI) or urge incontinence. DI is urinary leakage due to spontaneous and uninhibited detrusor contractions occurring before the bladder is completely full. Accompanying these contractions is an extremely strong need to urinate (urgency) and in some case complaints of frequency or nocturia. Another term often used is overactive bladder, which includes a cluster of symptoms; urgency, frequency, nocturia and in some cases detrusor instability. Persistent urinary incontinence can result from spastic or hyperactive bladder smooth muscle such as detrusor originating incontinence. In certain instances such incontinence is caused by loss of control resulting from spinal injury, parkinsonism, multiple sclerosis or recurrent bladder infection to name a few. Overflow incontinence is the involuntary loss of urine associated with an over-distended bladder. This condition results in frequent to constant dribbling of urine in the absence of detrusor contractions. Symptoms may resemble those seen in stress incontinence or detrusor instability. In men, overflow incontinence may be due to an outlet obstruction, hypocontracted detrusor muscle, or a neurological disorder such as a spinal cord injury or multiple sclerosis. Although rarely seen in women, overflow incontinence is most commonly due to prior genitourinary surgery or pelvic organ prolapse. Individuals with overflow incontinence will typically retain large amounts of urine within the bladder after voiding. In this case, the ability to store urine is intact but bladder emptying is impaired. Urinary incontinence arises in both men and women with varying degrees of severity, and from different causes. In men, the condition most frequently occurs as a result of prostatectomies which result in mechanical damage to the urethral sphincter. In women, the condition typically arises after pregnancy when musculoskeletal damage has occurred as a result of inelastic stretching of the structures which support the genitourinary tract. Specifically, pregnancy can result in inelastic stretching of the pelvic floor, the external sphincter, and the tissue structures which support the bladder and bladder neck region. Treatment of urinary incontinence can take a variety of forms. Most simply, the patient can wear absorptive devices or clothing, which is often sufficient for minor leakage events. Diapers and other absorbent constructions are the most popular remedy because they are easily obtained, and can address acute UI symptoms quickly. However, while affording reasonably effective control of urine leakage and providing mobility to the patient, absorbents also have very serious drawbacks. Alternatively or additionally, patients may undertake exercises intended to strengthen the muscles in the pelvic region, or may attempt a behavior modification intended to reduce the incidence of urinary leakage. Incontinence is typically treated by catheterization, use of absorbent products, and for males, devices attached to the exterior surface of the penis to collect urine discharge. In men, an alternative to the indwelling catheter or absorbent device is an external collecting device that is fitted over the male genitalia, like a condom. This may include an absorbent material or can be connected by a tube to a drainage bag that is typically held onto the thigh by leg straps. In a non-ambulatory situation, bedside drainage bags can be used. Treatment of incontinence may involve surgery or administration of any of various pharmacological agents, e.g., a anticholinergic such as oxybutynin, atropine, propantheline, terodiline, dicyclomine and others, a sympathomimetic such as ephedrine, pseudoephedrine, phenylpropanolamine and others, a tricyclic antidepressant such as amitriptyline, imipramine, doxepin and others, an estrogen or a direct acting antispasmodic such as flavoxate. In addition to treating incontinence, such pharmacological agents may cause other powerful physiologic responses such as excitability , and dry mouth, drowsiness, dizziness or hallucinations. A variety of surgical procedure options are currently available to treat incontinence. Depending on age, medical condition, and personal preference, surgical procedures can be used to completely restore continence. One type of procedure, found to be an especially successful treatment option for Stress Urinary Incontinence in both men and women, is a sling procedure. A sling procedure is a surgical method involving the placement of a sling to stabilize or support the bladder neck or urethra. There are a variety of different sling procedures.
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