What is urinary incontinence?
By definition, urinary incontinence is the involuntary leakage of urine, a very common problem that affects women twice as often as men. Although it is more common in older women, it’s not part of aging. Indeed, women of all ages are at risk for urinary incontinence, from athletes, women in child-bearing age, to women experiencing menopause and older.
How does urinary incontinence affects an individual?
A spectrum of complications associated with urinary incontinence; urinary tract infections, skin rashes and skin infection as a result of a continuously wet skin, and an impact on quality of life; can limit your social activities, or travelling needing to look out for toilets en-route, the inconvenience of pads, also work becomes more stressful because you’re frequently away from your desk or from meetings. Incontinence may affect your sleep thus you become tired and irritable. It also affects your personal life and even sexual relationship as you avoid intimacy because of the possible embarrassment from urine leakage.
Why do I leak urine on coughing?
This results in an increase pressure on the bladder forcing urine out. Usually the pelvic floor muscle supports the bladder and urethra (water passage) and prevents involuntary urine leakage. These muscles can be weakened by childbirth, obesity, menopause or an inherited tissue weakness. This is known as ‘genuine stress incontinence’.
Why do I need to rush to the toilet and get caught short (urgency incontinence)? Normally, the bladder muscle should contract only when you pass urine. Sometimes, the bladder muscle contracts before it is full and when you would rather not go to the toilet. If you don’t reach the toilet on time, you might leak. The urge to pass urine may be overwhelming and so you go to the toilet more often. If you don’t make it to the toilet on time, incontinence may occur. This condition is known as OAB “Over-Active Bladder” syndrome.
Are there risk factors for urinary incontinence?
1. Childbirth, menopause and obesity are the commonest risk factors of stress urinary incontinence due to weakening of the pelvic floor support.
2. Neurological disease such as stroke, multiple sclerosis and spinal injuries are risk factors for OAB, although majority have no apparent cause (idiopathic).
What treatments are available?
You need to see your doctor first, who may refer you to an urologist for more specialised treatment
1. Weight loss
2. Pelvic floor exercises (with or without biofeedback): as long as you do them regularly long-term, they will help both stress and urge incontinence.
1. For OAB syndrome; anticholinergic drugs are mainstay medical therapy, e.g. Solifenacin, Fesotoredine, Oxybutynin usually help with urgency. Main side effects are dry mouth and constipation.
2. For stress urinary incontinence, Duloxetine is a new drug; it does not cure but can help in some cases. The main side effect is nausea.
3. Botulinum toxin (“Botox”) injection into bladder, currently off-license indication for refractory OAB
1. Placing a synthetic tape or a tissue sling underneath the urethra to support it
2. Urethral bulking agent injection
3. Fixing the bladder in a higher position with stitches at an operation (Burch colposuspension)
Of the above, most women prefer the synthetic tape, also known as TVTO (Tension-free Vaginal Tape – Obturator):
A tape or hammock can be placed under the urethra to provide additional support. This reduces urine leakage episodes so you enjoy a better quality of life as a result. You have to come in to hospital for up to 24 hours and normal activities can be resumed after a month or so.
- Urinary Tract Infection
- Interstitial Cystitis
- Pelvic Pain Syndrome
- Bladder Cancer