Urinary Incontinence Symptoms, Diagnosis & Treatment

Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is a medical condition that describes the loss of bladder control. This can cause accidental urine leakage and occurs more commonly in older people, especially among women. In Singapore, the condition affects about 4.6% to 14.5% of Singaporeans, but because of the embarrassment surrounding the issue, cases are severely underreported.

Urinary incontinence can occur due to a number of reasons, such as weak pelvic floor muscles, overactive bladder muscles and nerve damage. Although often seen as a part of ageing, there are a variety of treatments that can effectively treat and/or manage urinary incontinence symptoms.

What are the types of Urinary Incontinence?

There are several types of urinary incontinence, such as:

● Stress Incontinence

Stress incontinence occurs when the urethral sphincter, the pelvic floor muscles, or both have been damaged or weakened, resulting in the inability to hold in urine especially when the pressure inside the bladder is increased. Studies have also shown that women who give birth vaginally are more likely to develop stress incontinence as a result of pelvic floor muscles being stretched and weakened.

Symptoms include urine leakage when pressure is put on the bladder, such as jumping, laughing, coughing or sneezing.

● Urge Urinary Incontinence

The most common cause of urge urinary incontinence is due to an overactive bladder. Overactive bladder syndrome occurs when someone feels a strong urge to urinate even though his or her bladder is not full. This usually occurs due to involuntary contractions of the bladder muscles even though the bladder is not completely full. Damage to the brain, nerves or spine can result in an overactive bladder.

One symptom of an overactive bladder is an overwhelming urge to urinate.

● Mixed Incontinence

Mixed incontinence is when someone has both urge and stress urinary incontinence. Mixed incontinence can also occur in men who have had prostate surgery.

● Overflow Incontinence

Overflow incontinence usually occurs when there is an obstruction preventing the normal flow of urine from the bladder. Over time, this results in the bladder becoming overfilled and hence, leakage of urine.

Overflow incontinence is usually more common in men as a result of prostate-related conditions. Nerve damage and ageing can also lead to overflow incontinence because of the bladder muscles’ inability to contract properly.

Symptoms of overflow incontinence include urine leakage due to a bladder that does not empty completely.

● Functional Incontinence

Functional incontinence occurs when the urinary tract is functioning properly, but other illnesses or disabilities are preventing you from urinating properly. This typically occurs when someone has a disability that prevents them from getting to a washroom in time.

● Nocturia

Nocturia refers to a condition where you wake up more than once each night to urinate. There are various causes of nocturia.

When to consult a doctor

You should consult a doctor if you are experiencing any symptoms of urinary incontinence, such as leakage of urine. Many of these conditions can be managed effectively with minimally invasive methods.

How is Urinary Incontinence diagnosed?

During your first visit with the urologist, they will take a comprehensive recount of your symptoms and medical history.

Urinary incontinence can be diagnosed in a number of ways, including:

● Bladder diary

Your doctor may ask you to keep a diary of your bladder habits for a few days to get a better understanding of the nature of your urinary incontinence. This can include how much fluid you drink, the types of fluid you drink, how often you would need to pass urine, the amount of urine you pass, as well as how many episodes of incontinence you have experienced.

● Physical examination

Your urologist may perform a physical examination to help them in assessing your urinary health.

● Urinalysis

In order to rule out lower urinary tract symptoms caused by urinary tract infection or stones or cancers, your urologist may order a urinalysis to screen for such conditions.

● Blood tests

A series of blood tests can be carried out to assess kidney function (renal panel) and even a PSA (prostate-specific antigen) test for prostate cancer in men.

● Residual urine test

A residual urine test may be done if your doctor suspects that you may have urinary flow obstruction or overflow incontinence. An ultrasound scan of the bladder is being done to see how much urine is left behind in the bladder after you pass urine.

● Urodynamic study (real-time video urodynamics)

Real-time video urodynamics combines the functional test of the lower urinary tract with real-time fluoroscopy to examine the structure and function of the urinary tract. This allows for the detection of structural and functional abnormalities such as incompetent bladder neck or sphincter deficiency. It also allows the doctor to discern the pressure, capacity and flow of the bladder during the filling and emptying of the bladder.

● Ultrasound

An ultrasound of the kidneys may be performed to detect any swelling of the kidneys as a result of an over-distended bladder. An ultrasound bladder can be done to detect any structural abnormalities in the bladder, including stones or growths. An ultrasound prostate can also be done for men to check for enlargement of the prostate.

● Flexible cystoscopy

This test involves the insertion of a cystoscope through the urethra to inspect the urethra, prostate and bladder.

How is Urinary Incontinence treated?

Depending on the severity of urinary incontinence, there are a variety of treatment options, from minimally invasive methods to surgical intervention.

Non or Minimally Invasive Methods

Behavioural training
Your doctor may recommend some behavioural training such as bladder training (delaying urinating when you have the urge to go in order to lengthen the duration in between toilet trips), double voiding (to empty your bladder more completely to avoid overflow incontinence), or adhering to scheduled toilet trips.
Pelvic floor muscle exercises
Pelvic floor muscles exercises or Kegel exercises help strengthen your pelvic floor muscles that control urination. This can be useful for people with stress incontinence or urge incontinence.
Medications
Anticholinergics can help calm overactive bladder muscles and may be useful for people who suffer from urge incontinence. Alpha-blockers may also be prescribed to men to help relax the bladder neck muscles and muscle fibres in the prostate, making it easier to empty the bladder.
Medical devices
Medical devices may be inserted to help women who suffer from incontinence. For example, a urethral insert, which looks like a tampon, may be inserted into the urethra before specific activities and acts like a plug to prevent any unintentional leakages.
Bladder Rehabilitation, including electrical stimulation — consists of various methods, including electrical or magnetic stimulation, to re-establish bladder functions in patients with neurogenic bladder.
Neurotoxin injections — Botulinum toxin A can be injected into the bladder muscles to reduce spasms and bladder overactivity.

Surgical Intervention

Sling procedure
A sling made of synthetic materials, such as a mesh or strips of your body’s tissue, is created under the urethra and the bladder neck. This helps to keep the urethra closed, especially when you cough or sneeze.
Bladder neck suspension
A bladder neck suspension surgery involves adding sutures in the vaginal tissue near the bladder neck and attaching them to ligaments near the pubic bone. This surgery helps to add support to the bladder neck and urethra, which reduces the risk of stress incontinence.
Prolapse surgery
This is done in women who have a pelvic organ prolapse (when one or more organs in the pelvis collapse from their normal position and slips into the vagina) and suffer from mixed incontinence. A prolapse surgery helps to lift and support the pelvic organs back into place. This procedure is typically done with a sling procedure in order to see results in incontinence.
Artificial urinary sphincter
A small fluid-filled ring is implanted around the bladder so that the urinary sphincter remains shut until there is a need to urinate. A valve (implanted beneath the skin) is then pressed to deflate the ring and allow urine to flow out of the bladder.
Injection of bulking material
Bulking material can be injected into the tissue surrounding the urethra to prevent leakage.

Treatment largely depends on the type of urinary incontinence you have and the symptoms you experience. Urinary incontinence can be cured if the underlying condition causing the symptoms can be reversed. Other forms of treatment involve long-term management.

Summary

In summary, urinary incontinence can affect one’s quality of life, causing distress and embarrassment to the patient. However, there are also a variety of treatments to effectively treat or manage urinary incontinence symptoms. It is important to communicate both your needs and desired outcomes with your urologist so that they may work with you on creating a treatment plan that best suits you.

Urinary Incontinence Symptoms, Diagnosis & Treatment