By Dr James Ng Jun Jiet, Consultant Obstetrician & Gynaecologist,
Uro-gynaecologist, Hospital Seri Botani
Urinary incontinence is the involuntary loss of bladder control, a common and often embarrassing condition that is prevalent in women. While it can range in severity, it is not an inevitable part of aging and can often be managed or even eliminated with proper treatment. The treatment will depend on the type of urinary incontinence.
Common Types of Urinary Incontinence
- Stress Incontinence: This is the most common type in women. It happens when physical pressure on the bladder causes urine to leak. This can be triggered by actions like coughing, sneezing, laughing, exercising, or lifting heavy objects. It’s often caused by weakened pelvic floor muscles and/or a damaged urethral sphincter.
- Urge Incontinence: Also known as an “overactive bladder,” this type involves a sudden, intense urge to urinate that is difficult to control, leading to involuntary urine leakage before you can get to the toilet. This is caused by the detrusor muscles in the bladder walls contracting too often.
- Mixed Incontinence: This is a combination of both stress and urge incontinence symptoms.
- Overflow Incontinence: Occurs when the bladder doesn’t empty completely, leading to frequent or constant leakage of a small amount of urine. This is more common in men but can affect women due to obstructions like pelvic organ prolapse or issues with the detrusor muscle not fully contracting.
Causes of Urinary Incontinence in Women
Urinary incontinence can be caused by temporary issues or long-term conditions.
Temporary Causes:
- Urinary Tract Infections (UTIs): A UTI can irritate the bladder and cause temporary incontinence.
- Constipation: Hard, compacted stool can put pressure on the nerves of the bladder, leading to leakage.
- Certain Foods and Drinks: Alcohol, caffeine, carbonated drinks, artificial sweeteners, spicy foods, and acidic foods can act as diuretics and/or irritate the bladder.
- Medications: Some antidepressants, diuretics (water pills), and sedatives can contribute to incontinence.
Long-term or Chronic Causes:
- Pregnancy and Childbirth: The physical stress of pregnancy, especially a vaginal delivery, can weaken the pelvic floor muscles and damage the nerves that control the bladder.
- Menopause: The drop in estrogen levels after menopause can lead to a thinning and weakening of the tissues in the bladder and urethra.
- Age: As you get older, the bladder muscle’s capacity to store urine decreases, and involuntary bladder contractions become more frequent.
- Obesity: Excess weight puts added pressure on the bladder and pelvic floor muscles.
- Neurological Conditions: Diseases such as multiple sclerosis (MS), Parkinson’s disease, or a stroke can disrupt the nerve signals between the brain and the bladder.
- Chronic Health Conditions: Diabetes and pelvic floor disorders can contribute to incontinence.
- Family History: There may be a genetic link to developing the condition.
Treatment Options
A healthcare provider can help determine the best course of treatment. The approach often starts with conservative methods and can progress to more invasive options if needed.
1. Lifestyle and Behavioral Changes
- Pelvic Floor Muscle Exercises (Kegels): Strengthening your pelvic floor muscles is a first-line treatment for all types of incontinence. These exercises help tone the muscles that support the bladder. A physical therapist can provide guidance to ensure you are doing them correctly.
- Bladder Training: For urge incontinence, this involves learning techniques to increase the time between bathroom visits.
- Dietary Adjustments: Reducing or avoiding bladder-irritating foods and drinks, such as caffeine and alcohol, can help.
- Fluid Intake: While it may seem counterintuitive, drinking a healthy amount of water is important. Limiting fluids too much can make incontinence worse by reducing bladder capacity and causing concentrated urine to irritate the bladder.
- Weight Management: Losing excess weight can significantly reduce pressure on the bladder.
- Quitting Smoking: Chronic coughing from smoking can strain the pelvic floor muscles.
- Timed Voiding: Establishing a regular schedule for urination, rather than waiting for the urge, can help retrain your bladder.
2. Medical Devices
- Vaginal Pessaries: These are flexible silicone rings inserted into the vagina to provide support to the urethra and bladder, helping to prevent leakage, particularly with stress incontinence.
- Urethral Inserts: A small, tampon-like device that can be inserted into the urethra to act as a plug during physical activity and removed before urination.
3. Medications
- Anticholinergics: These drugs can calm an overactive bladder and are used to treat urge incontinence.
- Mirabegron: This medication relaxes the bladder muscle, increasing its capacity to hold urine.
- Topical Estrogen: For women in menopause, low-dose vaginal estrogen can help restore the health of tissues in the urethra and vagina.
- Duloxetine: An antidepressant that can help improve bladder control.
4. Interventional and Surgical Procedures
- Nerve Stimulation: Sacral nerve stimulators are implanted devices that send painless electrical pulses to the nerves controlling the bladder, helping to manage urge incontinence.
- Bulking Agent Injections: A synthetic material is injected around the urethra to help it close more effectively.
- Botox Injections: Injections of Botox into the bladder muscle can help reduce involuntary contractions for those with an overactive bladder.
- Sling Procedures: This is a common surgical procedure for stress incontinence. A “sling” made of synthetic material or the body’s own tissue is placed to support the urethra and bladder neck, keeping it closed during activities that increase abdominal pressure.
It’s important to remember that urinary incontinence is a common medical condition, not a personal failure. Many people are embarrassed to discuss it, but seeking help from a healthcare professional is the first step toward finding a solution and improving your quality of life. Dr James Ng is here to help.
