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Urinary Incontinence

  • What is urinary incontinence?

    Urinary incontinence is the inability to control the release of urine from the bladder. As we get older, the pelvic floor muscles become weaker, thereby causing poor bladder control. This is a common problem and can develop at any age.

    Common types of urinary incontinence include:

    • Overflow incontinence – Small amounts of urine leakage throughout the day
    • Stress incontinence – Small amounts of urine leakage when coughing, laughing, sneezing or exercising
    • Urge incontinence – A frequent and urgent need to urinate
  • Common causes of urinary incontinence include:

    • In both sexes – bladder cancer, bladder stones, neurological disorders or ageing
    • In men – prostatitis (swelling of prostate gland), enlarged prostate or prostate cancer
    • In women – pregnancy and childbirth, hysterectomy (surgical removal of the womb), menopause or interstitial cystitis (painful bladder syndrome)

    Temporary causes of urinary incontinence include alcohol, excessive fluid intake, caffeine, medications, urinary tract infection (UTI) and constipation.

  • The symptoms range from occasionally leaking urine when you cough or sneeze to having an urge to urinate that is so sudden and strong that you have to rush to a toilet in time.

  • Treatment depends on the type, severity and cause of urinary incontinence. Acute urinary incontinence caused by infections, kidney stones or medication side effects often goes away when the original problem is treated. Other treatments include:

    • Conservative management:
      1. Biofeedback, in which electronic sensors record nerve impulses and muscle contractions. Monitoring these impulses while doing exercises according to your doctor's instruction can improve bladder control
      2. Electrical stimulation to strengthen muscles in stress or urge incontinence
      3. Simple Kegel exercises to strengthen the pelvic floor and sphincter muscles
    • Continence devices to help reposition and stabilise the bladder and urethra:
      1. Bulking substances like collagen or artificial substances provide support to the urethra to reduce stress incontinence
      2. Pessary (a semi-rigid removable ring) is placed in the vagina to reposition the urethra and reduce stress incontinence leakage
    • Medication:
      1. Hormone replacement therapy to restore normal bladder function
      2. To inhibit an overactive bladder’s activity by stabilising muscle contractions
      3. To relax muscles and allow more complete bladder emptying
    • Surgical treatment:
      1. Catheterisation (insertion of a thin tube into the bladder) for women whose bladder fails to empty completely because of loss of muscle tone, prior surgery or spinal injury. The catheter is inserted into the urethra and allowed to drain into a bag attached to the leg
      2. Placement of a pubo-vaginal sling (‘a hammock’) beneath the bladder to provide support
      3. Placement of an artificial sphincter (a ring that encircles the urethra) that can be manually inflated to close around the urethra and prevent urine leakage
      4. Sutures (stitches) to stabilise the bladder by attaching it to nearby muscle, tissue or bone

    A combination of these therapies may be needed and treatment is tailored to meet your individual needs.

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