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Urinary Incontinence

Urinary incontinence is the unintentional, uncontrolled leakage of urine. There are multiple methods and treatments available to reduce or eliminate this problem, so that embarrassing situations can be avoided. 

Although women and the elderly are more likely to be affected by urinary incontinence, men and children can be affected as well. For men, urinary incontinence is usually due to prostate issues such as prostate enlargement or after surgery of the prostate, while for children, it can be due to urine infections, congenital disorders, or even psychological issues. 

What are the Types and Causes of Urinary Incontinence?

There are several types of urinary incontinence that can arise from different issues, ranging from problems of the bladder muscle functions to psychological causes. 

Urge Incontinence
Urge Incontinence is one of the major urinary incontinence types. It is caused by uncontrolled contractions of the bladder, either from irritation within the bladder (e.g urinary tract infection) or lack of bladder contraction control due to neurological disorders (e.g. stroke, spinal cord injuries, Parkinson disease). This usually causes a frequent sense of urgency to urinate, even if there might not be much to pass. Patients often have to wake up multiple times at night to go to the toilet as well.

Stress Incontinence
Stress Incontinence is another major urinary incontinence type. In this case, there is leakage of urine as a result of increased pressure within the abdomen. It can be due to coughing, sneezing, exercising or even laughing. 

Mixed Incontinence
As its name suggests, mixed incontinence is a combination of stress and urge incontinence symptoms. 

Overflow incontinence
Another term for this type of urinary incontinence is underactive bladder syndrome. It results in urine being retained in the bladder and unintentionally being released when the bladder is too full. Again, it may be due to neurological conditions, or some form of obstruction to the urine outlet (e.g enlarged prostate, tumours or cancers, pelvic organ prolapse). 

Patients usually complain that they feel a sensation of incomplete urination or dribbling of urine whenever they visit the toilet, but yet there is still leakage of urine in between toilet visits.

Functional incontinence
This form of urinary incontinence happens mostly to people who have some kind of disability, either physically or mentally (e.g dementia, severe arthritis), which prevents them from getting to a toilet in time. There is usually no actual problem with the urinary tract. 

What are the risk factors for urinary incontinence? 

Non-modifiable factors

  • Pregnancy and childbirth – can stretch and weaken pelvic floor muscles
  • Ageing and menopause – induce changes that may gradually weaken tissues of the genital-urinary tract
  • Previous pelvic or prostate surgery
  • Certain medications – can cause or contribute to urinary incontinence, for example: 
    • Water pills that increase the amount of water and salt that’s lost from the body through urination
    • Muscle relaxants
    • Narcotics
    • Allergy medicine
    • Psychiatric medications

Speak to your doctor as they may be able to help you cut out non-essential medications 

Modifiable factors

  • Obesity – places additional stress and can therefore weaken pelvic muscles as well
  • Constipation – frequent straining while having bowel movements can actually weaken pelvic floor muscles. Also, a build up of faeces in the bowels can press against your urinary system, making the individual feel the urge to urinate more frequently or conversely, hindering the normal outflow of urine
  • Dietary factors– caffeine, alcohol and spicy food are bladder irritants that can aggravate incontinence
  • Smoking – smokers tend to have a chronic cough which leads to an increase in abdominal pressure and therefore stress incontinence. In addition, the chemicals from cigarette smoking may irritate your bladder

Treatment of Urinary Incontinence

Assuming that your doctor has excluded conditions such as infections, masses, prostate issues and neurological disease which may need other specific forms of treatment, here are some of the lifestyle tips and treatment options which can improve incontinence significantly. 

1. Lifestyle Modifications

For a start, adopt a healthier lifestyle. Eating better or kicking unhealthy habits can do a lot to improve your condition.

Studies have shown that for users who have stopped smoking, men and women suffering from urinary incontinence have positive changes to their condition. 

Limiting the consumption of caffeinated beverages like coffee and tea, alcohol and carbonated drinks can help as well. 

You may also see an improvement if you avoid certain types of food which are known to be bladder irritants. This includes eating less citrus fruits such as oranges and lemons, spicy foods and even chocolate. Also, make sure you take in lots of high fibre foods to reduce constipation. 

Last but not least, engaging in a more active lifestyle with regular exercise regimes and weight loss routines can aid obese patients suffering from urinary incontinence.

2. Behavioural therapy

Bladder drills and training
Bladder drills are a set of planned timings to visit the washroom with extended periods of time interspersed between each visit. As you follow the schedule to only urinate according to the schedule, your body can get used to holding more volume in your bladder before needing to release. That way, it builds a recognisable routine to urinate and can help contribute to a more normalised bladder function. 

Bladder training is a similar process which includes progression levels to slowly build the resilience from minutes up to hours. Occasionally, some distractions and relaxation activities can be done to help with the tolerance building. 

Kegel exercises
Kegel exercises, also known as pelvic floor muscle training, help to strengthen the pelvic floor muscles and train them to hold in urine better. 

Start by identifying the correct pelvic floor muscles. The best way to do this is to try to stop your urine halfway during urination. The muscles activated for you to do that are your pelvic floor muscles.

After doing so, you can practise your Kegel exercises in any position comfortable for you.  For beginners, lie down on the floor and tighten your pelvic muscles for 3-5 seconds, then relax for another 3-5 seconds. Over a period of weeks, aim to progressively increase to hold your contractions for 6-10 seconds, followed by relaxing your muscles completely for 10 seconds. Make sure you keep breathing while you hold the contractions. Repeat 15 times for each set.

It is important to do 3 sets of Kegel Exercises daily. Your incontinence symptoms should start to improve after 6-12 weeks.

3. Medications

Depending on the form of urinary incontinence you are experiencing, there is a range of different medications that can serve to aid your symptoms. 

For instance, there are medications which can help urge incontinence by acting on the receptors of muscles responsible for urination, thereby decreasing overactivity of the bladder. They come in oral and application patches.

Vaginal oestrogen in the form of creams or pessaries may be helpful for urinary incontinence and vaginal dryness symptoms in women nearing or who have recently gone through menopause.  

4. Devices and Alternatives

There are some devices you can use to help manage your condition but like using medications, different situations would call for different solutions.

Urinary clamps are external compression contraptions for men suffering from urinary incontinence. It works by putting light pressure on the urethra from the underside of the penis to temporarily stop leakage and dribbling. 

For females, short-term use of urethral inserts can be placed within the urethra before engaging in activities like exercise to block any leakage. A pessary is a different device that helps support the urethra from its placement site inside the vagina to reduce or stop stress incontinence throughout the day. A properly fitted pessary can be a highly effective solution.

Apart from these devices, simple products such as absorbent pads or adult diapers worn externally may just be the solution, especially if symptoms are mild.

5. Surgery 

If your symptoms are severe or you would like a more long term solution, you can look to more invasive procedures to help with your urinary incontinence condition. A Urologist or Urogynaecologist can help assess your condition to provide the best treatment options or surgical procedure for you. 

As a brief overview, in women, colposuspension and urethral slings can be performed for stress incontinence, through minor incisions on the abdomen and/or vagina. 

There are also injections and nerve stimulation procedures, however they tend to be adjunct therapy to oral medications for other types of incontinence such as urge incontinence. 

Surgical procedures for insertion of slings or artificial urinary sphincter are available to males. 

Each procedure has its own risks, benefits, and chance of failure. Therefore you will need to have an in-depth discussion with an experienced specialist before coming to a decision. 

Urinary incontinence can disrupt your lifestyle if it is not dealt with. 

This article serves as a brief guide to help you understand this condition better. However, in order to know what you are doing is best for your condition, the most optimal course of action would be to find a trusted healthcare specialist to assess your condition and administer the appropriate treatment for you. 

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