KEEPING A LID ON URINARY INCONTINENCE
Dr Chin Chong Min

Urinary incontinence is common in older people, affecting at least one out of 10 people age 65 or older. It can be an embarrassing situation and if left untreated, can cause rashes and skin infections, as well as anxiety and depression. Find out how to deal with it.

Suffering from urinary incontinence can be a very embarrassing experience. However, coming to terms with it and understanding it fully can put a stop to your shame and let you get on to enjoying life again.

Urinary incontinence ranging from a mild leakage to uncontrollable and embarrassing wetting is the inability to hold your urine. Even though both men and women suffer form urinary incontinence, women suffer form urinary incontinence, women experience this two times more than men and this is because of pregnancy, childbirth, menopause and the structure of the female urinary tract. Furthermore, urinary incontinence is common in older people, affecting at least one out of 10 people age 65 or older, according to the National Institute of Aging, US.

However, urinary incontinence is not a natural part of aging, according to the Agency for Health Care Policy and Research (AHCIPR) in the US, and if left untreated, can cause rashes and skin infections, as well as anxiety and depression.

Causes of urinary incontinence

Many causes of urinary incontinence are temporary. These include urinary tract infection, vaginal infection, constipation and side effects of certain medications. Other causes, according to the Health A to Z website, include too much caffeine and bladder-stimulating foods and beverages such as milk or milk products, sugar, chocolate, tomatoes, spices, citrus juice and fruits, and carbonated beverages.

Urinary incontinence can also be caused by medical conditions such as weakness of the pelvic muscles, weakness of the bladder itself, weakness of the urethral sphincter muscles (the group of muscles that tightens to hold urine in and loosens to let it out), overactive bladder, blocked urethra from prostate enlargement in men, prostate enlargement in men, hormone deficiency in women, neurological disorders, restricted mobility, stroke, multiple sclerosis and dementia state.

Types of urinary incontinence

There are many type of urinary incontinence. However, the most common ones are:

Stress incontinence
Urine leakage occurs when there is increased abdominal pressure during activities such as sneezing, laughing, coughing, lifting and running. This form of incontinence, according to the National Institute of Diabetes and Digestive and kidney Diseases (NIDDK), US, is most common among women.

Urge incontinence
Urine leakage associated with an overpowering urge to urinate. With this form of urinary incontinence, you may leak urine when you drink even a small amount of liquid or when you hear running water. You find that you also need to go to the bathroom very often.

Overflow incontinence
The bladder is always full so that small amounts of urine leak from it. You may feel that you never seem to completely empty your bladder, or you feel you have to empty your bladder but cannot. This form is seen mostly in men with enlarged prostate glands, diabetics and seniors.

Functional incontinence
This occurs in people with normal bladder control but who are unable to reach a toilet due to a physically limiting disorder such as severe arthritis.

Mixed incontinence
This is a combination of stress and urge incontinence, and as many as 50 per cent of women with stress incontinence report both of these symptoms.

Once you mention to your doctor about this problem, he will then try to find the cause. He will discuss your medical history, and you may be asked to keep a record of your usual urinary habits. He will also perform a physical examination, urine tests and/or other tests to help determine the exact cause of the problem. These additional tests may include cystoscopy (looks at abnormalities in bladder and urethra) and urodynamics (determines bladder and urethral sphincter function).

Treating urinary incontinence
Urinary incontinence can be treated in one or more of these ways:

Behavioural techniques
These teach you ways to control your own bladder an sphincter muscles. There are two types – bladder training and pelvic floor exercises. You also may be asked to drink less water depending on your bladder problems. Bladder training, which is used for urge incontinence, teaches you how to control the urge to urinate and to gradually increase the intervals between voiding.

Pelvic muscle rehabilitation
These include the Kegel exercises which are used for stress incontinence. These exercises help to strengthen weak muscles that originally support the bladder. Other alternative treatments include: biofeedback and pelvic floor electrical stimulaton.

Medication
This is used to treat urinary infection, replace hormones, stop abnormal bladder muscle contractions, or tighten spincter muscles, according to AHCPR. These may include: antibiotics, hormone replacement therapy and prescription drugs for bladder or sphincter control.

Surgery
This is needed when other treatments have failed. Surgery can be used for women with severe stress incontinence. There is now available a minimally-invasive procedure that uses a tape called a TVT (tension-free vaginal tape) that can restore the bladder back to its original support position. In the case of an enlarged prostate, endoscopic surgery called TURP (transurethral resection of the prostate) has replace open surger to effectively remove the bladder blockage.

In cases of a small, contracted bladder, surgery can be done to enlarge it to enable it to hold more urine. The type of surgery will depend on the type and cause of your urinary incontinence.

Other measures
There are some other products that can be used to manage urinary incontinence and these include pads and catheters. However, they should only be used to supplement other treatments or when all treatments have failed, warned AHCPR. Catheters are used when a person cannot urinate. It is a tube that is placed in the bladder to drain urine into a bag outside of the body. The catheter can be left inside the bladder, or preferably, be put in and taken out of the bladder at regular hours to empty it.

Urinary incontinence is treatable and you can get help for it. In addition to seeing your doctor, the Society of Continence (Singapore) has trained nurses and counselors to provide free advice. You can reach at 787-0337.