Urinary Incontinence

Urinary incontinence, the involuntary leakage of urine, is a widespread issue that affects approximately one in three individuals over the age of 60. Although more commonly observed in women, men are also susceptible, especially following prostatic surgery.

This condition can severely impact an individual’s quality of life, influencing their physical, psychological, and social well-being.

Common symptoms of urinary incontinence

• Urgency Incontinence: Characterised by a sudden, intense urge to urinate followed by an involuntary loss of urine. Commonly, individuals may need to urinate frequently, rush to the bathroom, and wake up multiple times at night to urinate.
• Stress Urinary Incontinence: Occurs when physical movements or activities like coughing, sneezing, bending, lifting, or exercising put pressure on the bladder, causing urine leakage.

Severe symptoms or complications

Persistent or severe urinary incontinence can lead to various complications, including:

• Skin Irritation: Persistent dampness can irritate the skin, leading to rashes, infections, and wounds.
• Urinary tract infections (UTIs): Retained urine can become a breeding ground for bacteria, increasing the risk of recurrent UTIs.
• Psychological Impact: Chronic incontinence can lead to embarrassment, anxiety, and depression, significantly affecting one’s quality of life and leading to social isolation.

What causes urinary incontinence?

The underlying causes of urinary incontinence vary and often involve issues related to the bladder’s ability to store and release urine:

• Overactive Bladder: Typically results in urgency incontinence due to involuntary bladder contractions during the bladder filling phase, despite not being full.
• Weak Pelvic Floor/Urinary Sphincter: The muscles and tissues supporting the bladder and urethra weaken, commonly resulting in stress incontinence.
• Mixed Urinary Incontinence: A combination of symptoms from both stress and urgency incontinence, indicating issues with both bladder control and pelvic support.

How urinary incontinence is diagnosed

A number of diagnostic tests may be employed to determine the type and cause of urinary incontinence. The most common include:

Ultrasound Scan KUB

This non-invasive test evaluates the anatomy of the bladder and kidneys, checking for abnormalities and how well the bladder empties.

Urodynamics

This assesses the functionality of the urinary system. It measures pressure in the bladder and flow rates as the bladder fills and empties, providing insight into the bladder’s capacity and any functional abnormalities.

Treatments for urinary incontinence

Treatment options vary based on the type and severity of incontinence and may include:

Conservative Management

Includes lifestyle changes such as fluid and diet management to avoid irritants like caffeine and alcohol.

Bladder Retraining

Bladder retraining is behavioural training that includes exercises that help overcome the urge to urinate and therefore increase the intervals between emptying the bladder.

Pelvic Floor Exercises (PFMT)

The aim of these is to strengthen the pelvic floor muscles. This can be learnt under the formal guidance of a dedicated physiotherapist.

Medication

Anti-cholinergic drugs can calm an overactive bladder, effective in about 60% of cases.

Intravesical Botox Injections

A minimally invasive procedure where Botox is injected into the bladder wall to reduce symptoms, requiring repetition every 6-9 months.

How to prevent urinary incontinence in the future

Preventative measures focus on strengthening pelvic floor muscles and managing lifestyle factors:

• Regular Exercise: Engaging in pelvic floor exercises strengthens the muscles and improves bladder control.
• Weight Management: Maintaining a healthy weight reduces pressure on the bladder and pelvic floor muscles.
• Appropriate Fluid Intake: Regulating fluid intake helps manage bladder capacity and reduces the urgency and frequency of urination.