Plug that leak
Urinary incontinence affects both men and women and it can be at times very embarrassing. Know what it is all about and what your options are when you have it.
BY: Dr Chin Chong Min
Urinary incontinence is the uncontrolled leakage of urine from the bladder. It affects all age groups, but is more common in older people as they age. It is estimated that one out of 10 people above the age of 65 years have urinary incontinence and women are afflicted more than men. The incontinence can range from leaking a small amount of urine, such as when coughing or laughing, to a large leak due to strong urgency.
Many people are too embarrassed to admit they have urinary incontinence or seek treatment. Those who bear with their incontinence risk getting skin rashes, sores and urinary tract infections. It also affects their social life as they dare not go out with friends and family because of inconvenience of looking for a toilet and embarrassment if they wet their pants or skirt. Urinary incontinence can be treated in majority of cases, but you need to see a doctor for an assessment.
Is urinary incontinence just part of growing older?
No, but changes with age can reduce how much urine your bladder can hold. Ageing can make your urine stream weaker due to weak bladder muscle or cause you to feel the urge to urinate more often due to an unstable bladder. This does not mean that nothing can be done. With treatment, incontinence can be controlled or cured.
What causes incontinence?
Urinary incontinence can be caused by many different mechanisms, from weak pelvic muscles to diseases like diabetes. Here’s a list of common causes:
• Enlarged prostate gland.
• Weakened pelvic muscles after childbirth.
• Urinary tract infection.
• Diseases such as diabetes, stroke and Parkinson’s.
• Following spine injury, pelvic or prostate surgery.
Are there different types of incontinence?
There are five types of urinary incontinence:
1) Stress incontinence – Stress incontinence occurs when as a result of sudden increase in the pressure in the abdomen, such as coughing, laughing, lifting objects or during physical exercise. Stress incontinence commonly results from weak pelvic muscles, for example by childbirth, obesity or surgery on the womb. As such, stress incontinence is most commonly seen in women.
2) Urge incontinence – This type of leak is due to a sudden and strong urge arising from the bladder, often before one can reach the toilet. The warning can be as short as a few seconds to minutes. Urge incontinence is more common in the elderly and is due to an overactive or “over-sensitive” bladder.
3) Overflow incontinence – This type of incontinence is due to an overfilled bladder. This often occurs in men as a result of bladder blockage caused by an enlarged prostate gland or tumour. There is often a prior history of difficulty emptying the bladder, eg. straining to urinate. Diabetes or certain medicines may also cause this type of incontinence.
4) Functional incontinence – Functional incontinence occurs when a person has trouble getting to the bathroom in time because of limitation in their mobility, eg. arthritis or other diseases that affect the limbs or joints.
5) Mixed incontinence – This usually refers to someone having both stress as well as urge incontinence. This is one of the most difficult to treat and may even require specialised investigation called urodynamics to sort out.
How do you know if you have urinary incontinence?
There are a few questions that are used to assess if you might have urinary incontinence:
• Do you leak urine when you cough, sneeze, laugh or during physical exertion?
• Are you unable to hold your bladder when you get the urge to pee and leak even before reaching the toilet?
• Do you wet yourself on the bed overnight without knowing?
If any of the answers are “yes”, you likely have urinary incontinence.
How is urinary incontinence treated?
Treatment depends on what is causing of the problem and the type of incontinence. Sometimes, the incontinence is due to a transient problem, eg. bladder infection, constipation, medication. The incontinence will go away once the medical problem is solved.
Kegel exercises can help in mild stress incontinence through strengthening the pelvic muscles. Although designed for women, the Kegel exercises can also be practised by men. It may take three to six months to see improvement. Physiotherapy can be supplemented for those who are unable to do these exercises.
• Squeeze or tighten the pelvic floor muscle, located between the anus and the pubis.
• Hold for a count of 10. Relax for a count of 10.
• Repeat this 10 to 20 times, 3 times a day.
Medicine can help in some types of urinary incontinence. For example, oestrogen cream applied to the vagina can be helpful for some women who have mild stress incontinence. Several prescription medicines are available to treat urge incontinence. For men, prescription medicine is available to shrink the prostate and improve flow of urine.
Surgery is indicated in cases that do not respond to conservative measures, especially for stress incontinence in women. The most popular minimally-invasive technique is the insertion of a tape to re-support the bladder. There are many brands available but the most established with the longest follow-up period is the tension-free vaginal tape (TVT) with a success rate of more than 90 percent. In men suffering from overflow incontinence due to an enlarged prostate, endoscopic surgery can be done to scrape away the obstructing prostate gland (called TURP). It is usually performed if medication fails to resolve the bladder blockage. In cases of refractory urge incontinence, botox can be injected into the bladder muscle to paralyse it. There is also another form of prostate surgery called TUNA or transurethral needle ablation of the prostate. Though there are many surgical ways to treat an enlarged prostate, the gold standard is still TURP.
Are there preventive measure against urinary incontinence?
Here are some ways:
• Pelvic floor exercises to strengthen the muscles that hold up the bladder.
• Reduce weight if you are obese.
• Avoid caffeine, alcohol and sweet drinks if you notice that these drinks give you a strong urge to pee soon after consuming them.
• There are no “preventive” foods.
Dr Chin Chong Min is a consultant urologist at Chin Chong Min Urology & Robotic Surgery Centre at Mt Elizabeth Medical Centre.
(PHOTO CREDIT: Toilet, nicootje, stock.xchng; wc, merala, stock.xchng)