Urinary Incontinence

Urinary incontinence is the uncontrollable leakage of urine. If it is frequent or severe enough, it can become a social and hygiene problem.

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Urinary incontinence (UI) is not an automatic process of ageing; it is a medical condition, which results from a number of temporary or permanent causes. It is more prevalent among women than men, owing to the difference in their anatomies, and its occurrence increases with age. 

Both women and men can become incontinent from stroke or nerve injury, abnormal structural defects of the urinary tracts, multiple sclerosis, and problems associated with ageing. Also, a higher incidence of bladder control problems is associated with health conditions such as obesity  and diabetes .

Types of Urinary Incontinence 

UI can be categorised into four main types, but, it is possible to suffer from more than one type:
Stress incontinence — leakage of urine when there is pressure exerted on the bladder, e.g. from laughing, sneezing, coughing, exercising, heavy lifting and during pregnancy; this is the most common cause of urinary incontinence among women
Urge incontinence — an uncontrollable urge to urinate, resulting in leaking urine before reaching the toilet
Overflow incontinence — the inability to empty the bladder completely, resulting in constant dribbling of urine
Functional incontinence — the inability to get to the toilet in time, owing to physical or mental impairment such as dementia or severe arthritis

Urinary Incontinence Causes

Urinary incontinence may be temporary or persistent and may result from one or more factors. Causes of temporary incontinence include:
Drinking too much tea, coffee or carbonated drinks — these can irritate the bladder and cause or contribute to incontinence; coffee and other drinks contain caffeine which is a diuretic, i.e. it increases the urge to pass urine
Excessive alcohol — alcohol, like caffeine, is also a diuretic
Certain medications, such as diuretic pills, heart medications, cold medications and antidepressants — these can cause or contribute to incontinence
Urinary tract infection — a fairly common condition; the infection may cause sufficient irritation to the bladder to cause incontinence
Constipation — this may result in stool impaction in the rectum (the stools getting stuck), which can cause irritation to the bladder, contributing to incontinence

The following factors can lead to or contribute to chronic or persistent urinary incontinence:

Ageing 

As you age, the bladder has a reduced capacity to store urine. Prostate problems are associated with ageing in men and an enlarged prostate gland can obstruct the urethra and block urinary flow, resulting in urge or overflow incontinence.

Prostate Cancer 

Untreated prostate cancer can cause incontinence, but more often, the incontinence in prostate cancer is a side effect of surgery or radiation therapy used to treat the cancer.

Prostatitis

Prostatitis is an inflammation of the prostate gland that in rare cases can result in constriction of the urinary flow and incontinence. 

Surgery Involving the Organs Near the Bladder

Surgery involving the organs near the bladder runs the risk of inadvertent damage to muscles or nerves in the urinary tract, which can result in incontinence.

Urinary Tract Obstruction 

Tumours anywhere along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.

Neurological Conditions 

Neurological conditions such as stroke, Parkinson’s disease, tumours in the brain or spinal cord and injury to the nerves in the pelvis or spinal cord can all damage bladder nerves.

Urinary Incontinence Signs and Symptoms 

The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be rare and limited. Some other symptoms of UI include:
Urgency — a strong desire to urinate, whether or not the bladder is full, often occurring together with pelvic discomfort or pressure
Frequency — urinating more than once in a two-hour period or more than seven times a day
Nocturia — the need to get up and urinate at least twice during hours of sleep
Dysuria — painful urination
Enuresis — bed-wetting or urinating while sleeping

Urinary Incontinence Treatment 

Many people with chronic urinary incontinence, especially the elderly, believe that wearing absorbent pads or undergarments is their only option. Over time, however, use of these products may lead to rashes, sores or infections. 

Treatment involves addressing the cause of incontinence and making certain lifestyle changes. These include:

Timed Voiding

Timed voiding (urinating) involves charting your urination and leakage patterns for several days to help you discover which times of day you normally need to empty your bladder. 

Changing Fluid Intake 

You may need to increase or reduce your fluid intake, or change the timing of fluid intake to gain more control over the bladder.

Bladder Training 

This involves training your bladder on how to control the urge to void.

Pelvic Floor Exercises 

This is often used in women when the incontinence is mild or they do not wish to go for an operation. 

Medication

Your doctor may prescribe drugs, for example, to treat urinary tract infections or inhibit contractions of an overactive bladder.

Surgery

Your doctor may recommend surgery to alleviate incontinence if other treatments are unsuccessful.

Catheterisation 

Your doctor may recommend that you use a catheter (a tube that collects urine and leads it to a drainage bag).

Overcoming Stress or Urge Incontinence 

Here are some things you can do to help with stress or urge incontinence:

  • Give your pelvic muscles a workout. Kegel exercises strengthen the muscles that control urination.
  • Bladder training. Teach your bladder to behave, by gradually increasing the time between loo visits.
  • Be mindful of what you eat and drink. Some foods such as coffee, tea, colas, alcohol, chocolate and acidic fruit juices may affect how often you have to find a loo.
  • Drink plenty of water to flush out excess amounts of acid and bacteria. This sounds counter-intuitive but the water will keep your bladder free of irritants.
  • Stop smoking. Smoking can cause chronic cough, which in turn can damage your pelvic floor muscles.
  • Check your medications with your doctor as some may lead to incontinence.
  • Stay healthy. Incontinence has been linked to obesity, diabetes, high blood pressure and stroke.

In the meantime, you may want to use absorbent pads to manage any unwelcome leaks. 

Occasionally, medical intervention may be required. Your doctor might recommend biofeedback (inserting a probe to monitor when your muscles are squeezing correctly); pessaries for women (inserts which reposition the urethra to help reduce leakage); or electrical stimulation of the bladder nerves.

Commit to Kegels 

Kegel exercises for your pelvic floor muscles are the front-line defence against incontinence. At the minimum, do the exercises three times a day, five minutes each time. They are not a cure, but often, dramatic improvements are seen within weeks or months of regular exercise.

  1. Sit, stand or lie with your knees slightly apart.
  2. Slowly squeeze your pelvic floor muscles, hard, and hold that squeeze for five seconds. Rest five seconds. Repeat five times.
  3. Do five quick tight squeezes in succession: Squeeze, relax, squeeze, relax…

Remember to breathe, and make sure you aren’t contracting your abdominal muscles when carrying out these drills.

Learn more about how to manage urinary incontinence from Changi General Hospital's guide to urinary incontinence and management

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