29.DEC.2020 5 MIN READ | 5 MIN READ

Affecting both men, and women, urinary incontinence can be easily managed with the right diagnosis and treatment!

Urinary incontinence is the involuntary leaking of urine that typically happens when a person sneezes, coughs or even laughs vigorously. It can also happen when you feel a strong and sudden urge to urinate but can’t make it to the bathroom in time.

Contrary to belief, urinary incontinence doesn’t only happen when you get older. Although it can happen more often as we get older, there are many other possible causes for urinary incontinence which can be managed once it’s been accurately diagnosed by a urologist.

In most cases, urinary incontinence commonly happens when control over the urinary sphincter is lost or weakened, and is typically more common among women.

Types of urinary incontinence

A lot of people have experience the occasional urine leak, but some may leak small and moderate amounts more frequently, depending on their condition and type of incontinence.

The few types of urinary incontinence include:

Stress incontinence

This is where urine leaks after pressure is exerted on the bladder from coughing, sneezing, laughing, exercising or heavy lifting.

Urge incontinence

This is usually a troubling and disturbing symptom that starts to control your daily routines. This is a sudden, intense urge to urinate that is followed by involuntarily urinating. Frequent urination can happen during the night which can disturb a sufferer’s sleep. Common causes include infection, neurologic disorder or diabetes.

Overflow incontinence

This is the frequent, or constant, dribbling of urine because the bladder doesn’t empty completely and the bladder is constantly over flooded beyond its capacity to store the excess urine, thereby leading to urine ‘overflowing’.

Functional incontinence

This happens when a physical or mental impairment prevents a person from getting to the bathroom in time. For example, arthritis which can interfere with a person unbuttoning their pants.

Mixed incontinence

This is a combination of more than one type of urinary incontinence.

What causes urinary incontinence?

Urinary incontinence causes
Urinary incontinence is actually a symptom and not a disease which can be caused by a person’s daily habits, medical conditions or physical issues.

Temporary urinary incontinence could be caused by certain food, drinks and medications which may act as diuretics which stimulate the bladder and increase the volume of urine. These include alcohol, caffeine, carbonated drinks, artificial sweeteners, spicy, sugary or acidic food, heart and blood pressure medications, sedatives and muscle relaxants, or high doses of vitamin C.

Urinary incontinence can also be caused by urinary tract infections which irritate the bladder, and make you feel like urinating urgently. This may be a cause of some leakage.

Constipation is another cause where hard and compacted stools in your rectum stimulate the nerves in the area and result in increased urinary frequency.

Recurrent urinary incontinence can be caused by physical problems or changes such as pregnancy, where hormonal changes and weight of the foetus can cause stress incontinence. Childbirth via vaginal delivery may weaken the pelvic floor muscles, which are important for bladder control.

Ageing is another cause of urinary incontinence. When the bladder muscles age, it can decrease the urine storage capacity of the bladder and involuntary bladder contractions increase as a person ages. After menopause, women produce less oestrogen which plays a part in keeping the lining of the bladder and urethra healthy. The deterioration of the tissues could worsen incontinence.

A hysterectomy (the surgical removal of a woman’s uterus) could damage pelvic floor muscles which could lead to incontinence.

An enlarged prostate, or benign prostatic hyperplasia, could cause incontinence. Untreated prostate cancer could be associated with stress or urge incontinence. This could also happen as a side effect from prostate cancer treatment.

Obstructions, such as a tumour in the urinary tract, could block the normal flow of urine and cause overflow incontinence. Urinary stones may also cause urine leakage.

Neurological disorders such as multiple sclerosis, Parkinson’s disease, stroke, brain tumour or a spinal injury could affect the nerve signals related to bladder control. A problem there, could also cause urinary incontinence.

An overactive bladder can also develop in patients with poor urination habits, such as holding in urine for too long, are more common in certain occupations due to the lack of toilet access. When severe, it can lead to urge incontinence and affects both genders.

Can urinary incontinence cause complications?

Other than discomfort and embarrassment, urinary incontinence can have other complications, both physically and mentally. These may include rashes, skin infections or sores due to constantly damp skin.

There’s also the increased risk of repeated urinary tract infections. Urinary incontinence can also impact social, work, and interpersonal relationships, especially when the sufferer limits outings or social interactions because of embarrassment. As for the elderly, there’s an increased risk for falls where they rush to the bathroom.

What are the treatment options for urinary incontinence?

Kegel exercises for urinary incontinence
Treatment will differ depending on the type of incontinence, age, level of health and mental state of the patient.

For stress incontinence, Kegel exercises could help strengthen your pelvic floor muscles which help control urination. To control the urge to urinate, you can also train your bladder by delaying urination, controlling your urination by starting, stopping, and then going to urinate again (called double voiding), and having a bathroom schedule, such as going to urinate every 2 hours or so.

Medication such as anticholinergics or beta-agonists may also be prescribed to calm overactive bladders. Topical oestrogen could also strengthen the tissues in the urethra and vaginal areas to alleviate symptoms.

Medical devices for women include urethral inserts (inserted before any activity and taken out when you want to urinate), pessary (a ring inserted in the vagina which holds up the bladder and prevent leakage), Botox injected into the tissue around the urethra, and sacral nerve stimulators (implanted under the skin and connects the spinal cord to the bladder, emits an electrical pulse and stimulates the nerve improving bladder control).

Surgical options include the sling procedure (mesh inserted under the neck of the bladder to support the urethra), colposuspension (lifting the bladder neck and relieve stress incontinence) and implanting an artificial sphincter (inserted to control the flow of urine from the bladder into the urethra).

What should you do?

Urinary incontinence is a manageable condition as long as you receive an accurate diagnosis and treatment plan. Additionally, more people experience it than you think so take charge of bladder by seeing a urologist if you experience incontinence at any age.

 

Article reviewed by Dr Colin Teo, urologist at Gleneagles Hospital

References

(April 2019) Urinary incontinence. Retrieved on 1 November 2020 from https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

(December 2017) Urinary incontinence: What you need to know. Retrieved on 1 November 2020 from https://www.medicalnewstoday.com/articles/165408.

29.DEC.2020
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Teo Chang Peng Colin
Urologist
Gleneagles Hospital

Dr Colin Teo is a urologist practising at Gleneagles Hospital, Singapore.