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MANAGEMENT
OF URINARY INCONTINENCE
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Involuntary
leak of urine (incontinence) is a growing concern among the
aging people and its effects on socio-economic condition of
any population are innumerable. Though with increasing age,
high risk for incontinence is noted, even at 20 years people
present with incontinence, said Dr Pearllyn Quek Leng Choo,
Associate Consultant, Department of Urology, Changi General
Hospital in her talk on “Management of Urinary Incontinence”.
Thirty to 40% of women in their 60-80 years is likely to encounter
this problem. In Singapore, 11.8% of women are known to have
incontinence but only 22.2% of them are seeking medical help.
Many patients think that it is a consequence of aging, which
is a big reason for not seeking medical help in our community.
Besides this, symptom may not be so severe, embarrassment,
expensive, not possible to treat or treatment is not available
are some of the misconceptions of non-treatment seekers. Good
bladder control, tight pelvic floor muscles and competent
sphincter mechanism (effective open and closure) are needed
for good urinary system, which is controlled by brain, Dr
Quek said.
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Incontinence
is of different types viz., stress, urge, and overflow, total and
temporary incontinence. Stress incontinence, which is due to increased
intra-abdominal pressure, is the most common type of incontinence
occurring in 49%. In this case urine will leak when coughing, laughing,
sneezing and straining. Pelvic floor muscle strengthening, electrical
stimulation, medications and surgical methods can easily treat this
condition. Urge incontinence noted to occur in 40%, is due to an
overactive bladder. People with this condition will be peeing more
than 8 times a day, 2 or more times at night, wanting to pass urine
after every drink and bed-wetting. At times, urge incontinence is
associated with other conditions like urinary tract infection, bladder
outlet obstruction and stress urinary incontinence. Thus, before
embarking on the treatment for urge incontinence, proper evaluation
is necessary to derive full benefits from the treatment. Bladder
training and medications are some of the easiest treatment options
available now. Overflow incontinence, the incomplete emptying bladder,
is predominantly due to either weak bladder muscles or blockage
at the urethra. Catheters or medications or surgery can simply overcome
this problem. Total incontinence would probably occur in patients
with prior surgery, pelvic trauma, nerve damage, sphincter insufficiency
or damage and abnormal tract, for effective treatment for this problem
surgery is the best option, said Dr Quek.
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