What is Urinary Reflex Incontinence

Reflex incontinence is a condition of urinary urgency due to some causes. With the increasing population, the problem associated with the bladder continues to grow. Urinary and reflex incontinence are diseases of the urinary bladder concerned with the subject of urology, the branch of medicine that deals with the urinary tract system study. This article summarizes the knowledge of reflex incontinence, its causes, and treatment.

Keywords:  overactive bladder, OAB, symptoms, causes, treatment, sphincter muscles

1) Introduction:

Reflex Incontinence is also known as overactive bladder. It is a condition like an urge incontinence in which you have a sudden muscle spasm that causes a strong urge to urinate. It usually results in leakage of urine before reaching the toilet.

Sudden bladder spasms also cause reflex incontinence, resulting in a large amount of urine leakage. The urinary sphincters cannot control the passage of water from the bladder. The percentage of people suffering from this disorder varies from 9.9-36.1%. It affects the health as well as work productivity of one’s life.

2) Symptoms:

• Frequency: Going to the washroom every hour.
• Urgency: Constant urge to urinate.
• Nocturia: nighttime-frequency.
• Urge incontinence leads to leakage of urine.

3) Causes and risk factors:

Reflex incontinence is caused by malfunctioning of the bladder muscle, known as the detrusor muscle.

Even if the bladder is not filled, this muscle starts contracting, indicating the body to urinate.

Some common causes are given below:

• Weak pelvic muscles: pregnancy or childbirth can weaken your pelvic muscles, which causes involuntary movement of muscles.
• Nerve damage: the signal receives by the sphincter muscles to empty the bladder sends on wrong time due to some trauma or some other diseases, which includes:
• Pelvic or back surgery.
• Herniated disc.
• Radiation.
• Parkinson’s disease.
• Multiple sclerosis.
• Stroke.
• Medication, Alcohol, or caffeine: these all things cause dullness in the function of nerves.Which results in the wrong time indication to urinate.

• Infection: an infection known as urinary tract irritates the muscles and leads the bladder to contract without caution.
• Overweight: it places extra pressure on muscles.
• Estrogen deficiency after menopause: menopause is a condition that occurs in females in which, after a certain age, their menstrual cycle stops due to hormonal change. This causes leakage of urine.

4. Treatment:

OAB is a common and treatable disorder. Treatment of OAB comprises fluid management, behavior modification, drug therapy, neuromodulation, and, rarely, surgery.

• Behavioral changes that can make to help OAB

Maintain a record: write fluid intake, the number of times one pees, and the number of times urine leakage occurs. Write why it happened like due to:

• Coughing
• Sneezing
• Laughing
• Unable to find washroom on time.

• Make a diet chart: remove or lowers the consumption of food or drink that weakens the bladder system—for example, tea, coffee, alcohol, spicy and acidic foods, etc.
• Take care of bowel consistency: Constipation can pressure the bladder and affect bladder function. By taking healthy bowel habits, you may be able to avoid constipation.
• Maintain weight scale: Excessive weight places pressure on your bladder, which causes bladder control problems.
• Prevent smoking: smoking irritates the bladder muscle.
• Start bladder retraining and control the urge to urinate: It teaches how to handle the feeling of urgency to urinate by voiding intervals. The purpose of bladder retraining is to maintain the ability to control urinary urges.

5. Medication:

The first doctor suggests behavioral techniques before switching to medication to treat OAB. Don’t take any medicines without asking the doctor. Some common medications are given below:

• Anticholinergic medications

These medications control muscle spasms in the bladder:

• Oxybutynin (Ditropan®), oxybutynin XL (Ditropan XL®), oxybutynin TDDS (Oxytrol®).
• Tolterodine (Detrol®).
• Solifenacin (Vesicare®).
• Fesoterodine (Toviaz®).
• Darifenacin (Enablex®).
• Trospium (Sanctura XR®).
• Oxybutynin Gel (Gelnique®).
• Beta-3 adrenergic medication
• Mirabegron (Myrbetriq).

• Nerve Stimulation:

Nerve stimulation is a treatment that is used when no conservative treatments, i.e., behavioral therapies (diet modifications, biofeedback, bladder retraining, pelvic muscle exercises) and medications. Have worked or have not been tolerated. There are different kinds of nerve stimulation treatments. 

These can include:

• Sacral nerve stimulation
• Percutaneous tibial nerve stimulation
• Botox injections into the bladder muscle: