What is Urinary Incontinence?
Urinary incontinence is the inability to control the bladder or prevent urine from leaking. Fortunately, this common and embarrassing problem is treatable. Often, urinary incontinence is a result of the weakening of the pelvic floor muscle.
What is the pelvic floor muscle?
The pelvic floor muscle is shaped like a hammock at the bottom of our pelvic bone. Its functions include:
- Supporting organs such as the bladder, bowel, rectum and uterus (for women)
- Supporting the core muscle system
- Contracting and relaxing the muscle that enables the passing of urine and bowel
What weakens the pelvic floor muscle?
- In Women
Commonly, the pelvic floor muscle is stretched and weakened during pregnancy by the weight of the baby. This affects the tone of the urethral sphincter, the muscle which controls the retention and release of urine from the bladder. Multiple pregnancies can further weaken this muscle.
- In Men
Patients with prostate cancer or benign prostatic hyperplasia (a non-cancerous enlargement of the prostate) may undergo surgery to remove the gland. The operation may subject them to the risk of damage in the genital nerve or urethra, which in turn can weaken this muscle.
Other Causes of Urinary Incontinence
- Prolapse of the pelvic organs: a condition where the bladder, uterus or rectum drops into the vagina
- Spinal nerve or cord injury: as a result of injury or degeneration in the spine
- Benign prostatic hyperplasia: an enlarged prostate, which compresses on the urethral sphincter, limits the bladder’s ability to empty completely. As a result, the bladder fills up faster causing frequent or urgent need to urinate.
- Stroke
Types of Urinary Incontinence
- Stress urinary incontinence
- Urge urinary incontinence (Overactive bladder)
- Mixed urinary incontinence (A combination of 1 & 2)
1. Stress Urinary Incontinence
Stress urinary incontinence occurs when there is physical exertion that increases the intra-abdominal pressure and stresses the pelvic floor muscles. It is the most common type of incontinence. Urine leakage can be triggered by:
- Coughing
- Sneezing
- Heavy lifting
- Bearing down due to constipation
How can Stress Urinary Incontinence be treated?
A digital examination via the rectum or vagina can be used to assess the strength of the pelvic floor muscle. There are non-surgical and surgical treatment options for this condition.
Non-Surgical Treatments for Stress Urinary Incontinence
- Pelvic Floor Muscle Training or Kegel Exercise
This is carried out by a physiotherapist as the first line of treatment. Electrical stimulation and biofeedback are often used while doing Kegel exercise to enhance the effectiveness of this strengthening exercise.
- Pessary
A pessary is a removable device that is inserted into the vagina to support the pelvic organs. This is effective for mild prolapse, which eases the pressure on the pelvic floor muscle.
- Fibre intake
Constipation may aggravate urinary incontinence. Eating more high-fibre foods and drinking lots of fluids will help to soften stools.
- Lifestyle
Regular exercise helps to improve a person’s mobility and fitness, especially in the elderly. This may enable them to reach the toilet before wetting themselves. Moving around regularly will also help with bowel movement and reduce constipation.
- Urosheath
Urosheath is a latex or silicone tubing placed over the penis to help facilitate the drainage of urine. It is not a treatment to improve urinary incontinence but an alternative to incontinence pad.
Surgical Treatments for Stress Urinary Incontinence
- Tension Free Vaginal Tape
A minimally invasive surgery that is performed by a Urologist to provide support to the bladder neck in women. This may be considered when all non-surgical options have failed.
- Male Sling
A surgery that relocates the urethra in order to maintain appropriate tension over the urethra and avoid recurrent leakages and urine retention.
- Artificial urinary sphincter
An implant that is surgically placed around the urethra to treat more severe cases of male stress urinary incontinence. It compresses on the urethra and restricts the flow of urine out of the bladder.
2. Urge Urinary Incontinence (Overactive Bladder)
The condition, also known as an overactive bladder, happens when the bladder contracts involuntarily, causing urine to leak through the urethral sphincter, which holds the bladder closed. It may be caused by infection, neurologic disorder or diabetes.
Signs and symptoms:
- Uncontrollable urge to urinate
- Frequent urination
- Nocturia: more than two toilet visits every night
The urge can be triggered by the sound of water dripping or flowing, or when seeing the toilet.
How can Urge Urinary Incontinence or Overactive Bladder be treated?
It is usually diagnosed with a urodynamic test which checks how well the bladder and urethral sphincter store and release urine. It can be treated in the following ways:
- Pelvic floor muscle training (see treatment for Stress Urinary Incontinence)
- Bladder training to delay urination upon feeling the urge. The duration is gradually stretched to reach urination every two to four hours.
- Abstaining from caffeinated food and drinks such as coffee, tea, carbonated drinks and chocolate which can increase the urge and frequency of urination
- Medication such as Vesicare and Enablex can help to reduce the urge to urinate by relaxing the bladder muscles.
3. Mixed Urinary Incontinence
Generally, patients will need absorbent pads and adult diapers to avoid urine accidents, skin irritation and to block odour. Urinary incontinence can hamper daily activities and may pose some physical, social and emotional challenges for the sufferers. Other consequences include the likelihood of one slipping into depression, isolation and low self-esteem.
However, for most patients, simple lifestyle changes or medical treatment can stop the discomfort or embarrassment.
You need not feel disheartened or suffer in silence. Urinary incontinence is a common problem, and there is a range of treatment options. Your doctor and physiotherapist can develop a suitable treatment plan based on your diagnosis. Seeking early treatment can help you lead a more active and fulfilling life.
Ms Vernetta Wong
Physiotherapist, PhysioAdvance
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Ms Vernetta Wong is a musculoskeletal physiotherapist and lymphoedema therapist at Physio Advance, a member of Healthway Medical Group.
