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Urinary Incontinence

Introduction

Urinary incontinence is defined as involuntary loss of control of urine. It is more common in women. Up to 30% of Malaysian women had urinary incontinence. Types and causes of incontinence :

  1. Urge incontinence – most commonly due to bladder muscle ( Detrusor) instability . There is involuntary and overactive bladder muscle contraction. This produces excessive bladder pressure that causes urine to leak out.
  2. Stress incontinence (during coughing and straining) – usually occurs as a result of weakened pelvic floor muscle after childbirth or menopause (reduced hormonal level). It can also occur in men after prostate surgery.
  3. Retention and overflow – Inability to empty the bladder adequately. It may be caused by outflow obstruction in the urinary tract, diabetes or injury to nerve supplying the bladder.
  4. Outflow obstruction – It occurs almost always in men due to enlarged prostate or narrowing of urethra (urinary passage in penis).
  5. Functional – Due to inability to reach and use the toilet on time. This is usually associated with poor physical mobility, confusion, communication problems or depression.
  6. Neurogenic (damage to nerves or brain example: Stroke, tumour ; bladder irritation eg. due to stone or tumour).
  7. Mixed (combined urge and stress incontinence).

Symptoms

Bladder muscle ( Detrusor) instability May present with;

  • Urgency : Immediate need to pass urine as soon as the sensation of urination develops
  • Frequency : Voiding of urine frequently

Stress incontinence

  • May present with leakage of urine with physical (straining) activities example: Coughing, laughing, sneezing and lifting.

Retention and overflow

  • Difficulty in passing out urine.

Outflow obstruction

  • Patient may have continuous dribbling of urine.

Neurogenic

  • It may present as urgency, frequency, bladder retention and overflow.

Complications

Physical

  • Infection – skin, urinary tract
  • Skin rash

Psychological

  • Depression and anxiety
  • Stress to the carers

Social

  • Social isolation
  • Financial strain

Treatment

Non drug treatment

  • Behavioral modification : Bladder retraining aims to suppress the urge to pass urine by lengthening the time period between voiding episodes. This may lead to an increase in bladder capacity and fewer incontinent episodes.
  • Patients with stress incontinence can be improved by strengthening the pelvic floor muscles through doing pelvic floor exercises and electrical stimulation.

Drug treatment

  • Medicines are available from your doctor to treat these conditions.
  • There are medications used to treat urinary incontinence caused by bladder instability.

Treatment will be required for underlying urinary tract infection, constipation, diabetes, prostatic enlargement. Avoid caffeine. Appropriate amount of fluids intake to avoid dehydration(constipation). However excessive fluid intake may worsen the incontinence. Ensure regular bowel habits. Provision of adequate toileting facilities and continence aids eg diapers, bed pans, commode (mobile toilet). Ensure personal hygiene ie bathing and laundry.

Some patients may require intermittent catheterization or indwelling catheter to prevent persistent retention and / or pressure sores (if non healing). However catheterization may increase risk of urinary tract infection.

Surgery

Surgery maybe needed in more severe stress incontinence which ranges from minimally invasive procedure to major reconstructive surgery.

Prevention

  • Maintain healthy weight
  • Practice pelvic floor muscle exercise during pregnancy and after delivery
  • Avoid blood irritants ? example: caffeine , alcohol
  • Eat more fibers to prevent constipation

Rehabilitation

Multidisciplinary team assessment and advice example by doctors, nurses, occupational therapies, physiotherapist would be helpful.

Last Review : 26 April 2012
Writer : Dr. Joseph Ngeh
: Dr. Mohd Daud Che Yusof
: Dr. R. Sukumar a/l Rajaretnam
Reviewed : Dr. Mohd Daud Che Yusof