Urinary incontinence is the involuntary leakage of urine. It is a common condition that can affect the physical, psychological and social wellbeing of those affected , as well as their families and caregivers.
There is involuntary leakage of urine on effort or exertion e.g. sneezing or coughing. It is usually caused by an incompetent sphincter and weak pelvic outlet from previous trauma, previous pregnancies, or increased abdominal pressure such as constipation, obesity and chronic cough.
There is involuntary leakage of urine accompanied by, or immediately preceded by, the urgent need to empty your bladder. This is due to the involuntary and inappropriate contractions of the muscles in the wall of the bladder. The cause is usually unknown but may also be caused by local irritation from urinary tract infection, bladder stones or bladder tumour. Other uncommon causes include stroke, Parkinson’s disease, multiple sclerosis, dementia or spinal cord injury.
Overactive bladder syndrome (OAB)
There is urgency that occurs with or without urge incontinence. It often involves daytime frequency and the need to wake up at night to urinate. It is a diagnosis of exclusion – when no identifiable cause is found. Mixed incontinence There is involuntary leakage of urine associated with both urgency and exertion – mixed features of stress and urge incontinence.
This is usually due to chronic bladder outflow obstruction – when the bladder is very full but unable to empty. It may be more common in diabetic or stroke patients. It also occurs commonly after deliveries or pelvic surgeries. It can affect kidney function if left untreated. Therefore, early assessment and intervention are required.
Pelvic floor exercises should be
taught and practised by women
The diagnosis is usually made after your doctor has taken a complete history and performed a thorough physical examination. Basic and further investigations will be planned depending on the initial assessment.
History taking involves asking you questions about your symptoms, details about your previous pregnancies, medical and surgical history and medications. Your doctor may also enquire about sexual history and how your condition may have affected your daily activities and quality of life. You may also be asked to complete a bladder diary for up to three days, including both working days and days off.
Abdominal and pelvic examination
will be performed to assess for any
possible tumours, co-existing pelvic
organ prolapse, strength of pelvic floor
muscle contraction or signs of vaginal
atrophy. An erect stress test – where
the patient will be asked to stand on an
incontinence sheet and cough about 10
times, to assess for any urinary leakage,
is usually performed. If necessary,
a neurological examination may also
Further tests will be ordered after the
doctor’s initial assessment.
Most commonly, a urine dipstick test to
look for blood, glucose, protein, white
blood cells and nitrites will be done.
Urine cultures to exclude urinary tract
infection may also be part of the initial
Post-void residual urine volume
should be measured in women who
have symptoms suggesting voiding
dysfunction or recurrent urinary tract
infections. This may be performed using
a bladder scan or catheterisation.
For some people, urodynamics studies,
a complex assessment of changes
in bladder activity during filling and
emptying, may be required to confirm
the diagnosis and decide on treatment
options, especially if surgery for urinary
incontinence is considered.
In general, lifestyle modifications such as weight control in obese patients and reduction of caffeine intake may help to reduce symptoms of stress, urge or mixed urinary incontinence.
Surgical options Surgery is the mainstay of treatment for stress incontinence when conservative management has failed. Your childbearing wishes also have to be considered before surgery. The following surgical procedures have high success rates of up to 80 to 90 percent but also have risks including but not limited to bladder, vaginal wall and bowel injuries, urinary retention and infection. They should only be undertaken by a trained and accredited surgeon.
Other options such as vaginal devices, collagen injections and artificial urinary sphincter are not recommended as first-or secondline treatment strategies.
These treatment modalities may
only be considered for those who
have failed the above medical
3. Mixed incontinence
Treatment should be directed
towards the predominant symptom,
but may involve a combination of
4. Overflow incontinence
Ladies, do not suffer in silence. Please
seek medical help early to improve
your quality of life.
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