Urinary Incontinence

What Is Urinary Incontinence?

Urinary incontinence is the uncontrollable leakage of urine. It is more common in the elderly, especially among women. Urinary incontinence is not a natural process of ageing.

How Does Your Bladder Empty Urine?

The lower urinary tract consists of the urinary bladder and the bladder outlet. In a healthy person, the bladder stores urine and voids at the person's convenience. During the storage phase, the bladder relaxes and the bladder outlet contracts. No urine leaks out. However, when the bladder and / or the bladder outlet are not functioning normally, urine may leak.

Types Of Urinary Incontinence

There are four types of urinary incontinence:

1. Leakage of urine when you cough, sneeze, laugh or lift something heavy (stress incontinence).
2. Leakage of urine before you can reach a toilet (urge incontinence).
3. Inability to stop urine from constantly dribbling out; you may sense a full bladder but you have difficulty emptying it completely (overflow incontinence).
4. A false connection between the bladder or the ureter to the vagina (fistula).

You can prevent urinary incontinence by adopting the following good habits:

• Drink 6-8 glasses of water daily unless your doctor has instructed otherwise.
• Limit your intake of alcohol and caffeinated drinks.
• Take a balanced diet that includes all food groups and keep within a healthy weight range.
• Include enough fluid and fibre in your diet and exercise regularly to prevent constipation that can lead to poor bladder control.
• Practise good bladder habits by regularly emptying your bladder. Holding back for too long when a bladder is full, or persistently emptying it when it is not, can both cause abnormal bladder function.
• Do pelvic floor exercises regularly to strengthen the muscles supporting the outlet of the bladder.
• Avoid precipitating factors such as obesity, chronic cough, sneezing and heavy lifting etc.

Sometimes, conditions such as urinary tract infection, vaginal inflammation, constipation, restricted physical movements (e.g. stroke, Parkinson's diseases and arthritis) and side-effects from certain medicines can cause or worsen urinary incontinence. These situations are only temporary and can be cured when these causes are treated.However, if urinary incontinence is still present after these temporary causes have been treated, it could be due to the bladder's inability to store or empty urine properly or a urethral malfunction.

Below are some common factors that cause urinary incontinence:

• Weak pelvic floor muscles supporting the bladder outlet. Multiple childbirths, menopause, obesity and the lack of pelvic floor exercises can weaken the muscles.
• Nerve disorders like stroke and dementia causing a loss of bladder control. When the bladder muscles are too active, urine leaks. However, in 90% of the women with overactive bladder, no cause can be found.
• Incomplete emptying of the bladder causes urinary retention and overflow.

What Can Be Done?

Urinary incontinence can be readily treated, improved or cured with behavioural methods, medication or surgery. Management will depend on the types of urinary incontinence.

Behavioural methods are simple and effective ways to control your bladder. You can train your bladder to control the urge for overactive bladder; you can pass urine at certain set times for overflow incontinence, and you can train your pelvic floor muscles for stress incontinence.

Medicines are used to treat urinary infection, vaginal inflammation or to reduce overactivity of bladder muscles. In menopausal women, urinary frequency and urgency can be relieved by local oestrogens.

Surgery is commonly used for female stress urinary incontinence. It is offered after you have failed conservative treatment or you have severe stress urinary incontinence. Your doctor will recommend the appropriate type of surgery. Surgery is also recommended for conditions that cause voiding difficulties such as enlarged and retroverted uterus in women, or pelvic organ prolapse.

Where To Seek Help?

Consult your family doctor or visit a urogynaecologist or urologist if you suffer from urinary incontinence.