Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine from the urethra. It could happen at all ages and both sexes.

The common types of incontinence are the following:

Overflow

This happens when the bladder is full and there is overflow of urine. It usually happens in patient with bladder outlet obstruction or neurogenic bladder and the bladder cannot contract to pass out all urine. There is accumulation of urine in the bladder resulting in urine leak out intermittently.

Stress

Stress incontinence occurred in patient with weakness of the external sphincter that results in leaking of urine aggravated by straining like sneezing or coughing. The damage of the external sphincter can be due to birth injury in ladies  or post-surgery in male like TURP or open prostatectomy in older males. It could be range from mild to severe that may wet more than 1 pad a day.

 

Urge

Urgency is happened to patient who rush to the toilet when there is a feeling of urine in the bladder. The volume of urine may not be much but cause a lot of lifestyle disturbance especially restriction of outdoor activities.

Combinations of above

Incontinence may also happen with combinations of the above. The commonest is the stress with urge incontinence due to weakness of the pelvic floor with overactive bladder, it happens commonly in women more than 40 yrs old with urinary tract infection and weak pelvic floor.

 

Treatment

Incontinence causes a lot of social embarrassment and the patients usually do not like to socialize. Whenever they need to go out, two conditions must be there:

·       toilet;

·       pampers

  1. Treat the underlying conditions like in overflow incontinence is to treat the bladder outlet obstruction or neurogenic bladder. As in the stress incontinence is to strengthen the pelvic floor by exercise and in urge incontinence is to treat the associated causes like BOO, stroke or Parkinson’s disease

  2. Manage any potential life-threatening conditions, in the overflow bladder is to reduce the excessively distended bladder so as to reduce the pressure in the urinary tract in order to diminish the stress to the kidneys

  3. Reduce the wetness – either the biofeedback, exercise or medication will reduce the incontinence by stress and urge

  4. Surgery - includes

    • Injection of Bulking material

    • Tap or sling to suspend the descend of the urethra or bladder neck.

    • Artificial continence sphincter  – this is usually for male patient after prostate surgery

 

 

Disclaimer: This is not a guide to self-diagnose. We encourage to seek urologist advice further.

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