Incontinence in the Setting of Morbid Obesity
Obesity is one of the major risk factors for both bladder and fecal incontinence. Obese women are susceptible to both forms of incontinence. Fat in the abdominal region, both subcutaneous and visceral fat, puts pressure on the bladder. A person with normal weight having a weak bladder can cope with and control incontinence. However, the extra weight exacerbates the situation and makes it that much more difficult to manage episodes of incontinence.
The severity of incontinence increases with an increase in BMI. Also, age is a factor. A young obese individual may have strong enough sphincter muscles to voluntarily regulate the process of excretion. Muscles weaken as we age and an elderly obese person is more liable to face incontinence.
There is also a co-relation between diabetes and incontinence. Given that obese individuals are often diabetic, their risk of becoming incontinent increases. It is known that diabetic women taking insulin are at greater risk than those diabetics not dependent on insulin.
It is important to know that just as weight gain can worsen existing symptoms of incontinence, weight loss can reverse the situation and lead to improvements. Thus, obesity is a modifiable risk factor for incontinence and patients should make sincere attempts to lose weight so that they can better manage and control only incontinence but also diabetes, hypertension, and arthritis.
In fact, research shows that obese patients that underwent gastric bypass surgery showed a significant drop in incidents of stress incontinence.
What is Incontinence?
Incontinence is defined as involuntary urination or defecation. Involuntary leakage of urine is the more common type of incontinence amongst the two.
Urinary incontinence is categorized into
- Stress Incontinence – This is the most common form and often present in women. Can happen when an activity such as laughing, coughing, sneezing, etc puts pressure on already weak sphincter and pelvic muscles. The muscles can become weak from injury, medicines, or surgery. Women with multiple pregnancies and natural childbirths are susceptible to the condition. In fact, being female is considered a risk factor. Age, obesity, and smoking are other risk factors.
- Urge Incontinence – This is characterized by the subject not having enough time between getting an urge to urinate and being able to do so in a toilet. A sudden contraction of the bladder leads to involuntary leakage of urine. The bladder contractions may occur irrespective of the amount of urine in the bladder. This can sometimes make it difficult to recognize the signs of a filled bladder that needs emptying. Cancer of the bladder, bladder inflammation, stroke, and multiple sclerosis are some of the causes of urge incontinence.
Diagnosis and Examination
Individuals suffering from incontinence are usually treated by urologists, in the case of women urogynecologists and obstetricians are also consulted. The medical practitioner may try to find out if there is a pattern to the occurrences. The patient may be asked to maintain a journal to note down the frequency of voiding, times, and volume of urine. The doctor may look for signs of straining to micturate, discomfort during urination, etc. The doctor may check for any residue of urine in the bladder after urination in order to determine elasticity of bladder muscles. Cystoscopy or bladder and urethra inspection is carried out. A urine test may be done to check for underlying causes and infection. A blood test can be carried out for similar reasons. The doctor may also check for causes related to the nervous system.
Treatment
Treatment depends upon the severity of the symptoms and the duration of the condition. Patients are usually asked to give up tobacco, alcohol, and caffeinated drinks. Treatment consists of lifestyle changes, surgery, medicine, and exercises to strengthen the pelvic floor muscle.
Behavioral changes include losing weight if the subject is obese, regularizing bowel movements to reduce pressure on the bladder due to constipation, and avoiding activities that can cause stress incontinence.
Pelvic floor muscle training or Kegel exercises are taught in order to strengthen the urethral sphincter. Biofeedback may be taught, it helps the practitioner gain control over certain involuntary responses by the body.
Medicines are a preferred mode of treatment for mild cases of stress incontinence. Alpha-adrenergic agonist drugs strengthen the sphincter whereas anti-muscarinic drugs can stop unwanted bladder contractions. Post-menopausal women may be administered estrogen to improve blood supply to the urethra. Surgery is usually the last option and performed only after the true cause of incontinence has been determined with certainty.
Fecal Incontinence
The inability to exercise control over bowel movement and involuntarily pass stool is known as fecal incontinence. The condition is more common in women and the elderly. Common causes include constipation, muscle damage, nerve damage, and diarrhea.
Diagnostic procedures include an MRI scan of the anal sphincter, anal manometry, and ultrasonography. The tests are performed to check for the tightness, sensitivity, proper functioning, structure, and nerve damage related to the rectum.
Treatment procedure for fecal incontinence depends upon the cause and extent of the condition. Changes in diet, medicines, bowel training, and surgery are the different courses of treatment available.
Dietary changes include consumption of high-fiber food to add bulk to the stool and avoiding items such as tea and chocolate that can lead to the relaxation of the anal sphincter muscles. Other foodstuff to be avoided includes cured meat, spicy preparations, alcoholic beverages, fruits with laxative properties, and confectionery containing sweeteners such as sorbitol and mannitol.
The subject is encouraged to take small meals and stay hydrated so that the stool remains soft and bulked up.
Biofeedback and Kegel exercises are used to train and strengthen the muscles of the pelvic floor. People that experience bowel incontinence because of constipation are advised to try and establish a regular pattern for bowel movement.
Finally, if the condition has been caused due to injury then surgery may be required to repair the anal sphincter.
