Any woman who leaks urine suffers from urinary incontinence, which is failure of the bladder holding mechanism. There are many causes to incontinence, but stress urinary incontinence is the most common type of urinary incontinence, affecting half of all women with urinary leakage.
Stress urinary incontinence (SUI) occurs when a stressful event increases the intra-abdominal pressure suddenly and provokes the urine to leak. Severe coughing bouts, sneezing, strong laughter, physical exercises and abrupt straining are such moments.
Common Types of Incontinence
This is the most common kind of urinary incontinence, especially among women who have given birth or gone through the menopause. In this case “stress” refers to physical pressure, rather than mental stress. When the bladder and muscles involved in urinary control are placed under sudden extra pressure, the person may urinate involuntarily.
The following actions may trigger stress incontinence:
- A sudden cough
- Heavy lifting
Urge incontinence (effort incontinence)
Also known as reflex incontinence or “overactive bladder,” this is the second most common type of urinary incontinence. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes an urge to urinate that cannot be stopped.
When the urge to urinate comes, the person has a very short time before the urine is released, regardless of what they try to do. The urge to urinate may be caused by:
• A sudden change in position
• The sound of running water (for some people)
• Sexual intercourse (especially during orgasm)
Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.
This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. An enlarged prostate gland can obstruct the bladder. The bladder cannot hold as much urine as the body is making and/or the bladder cannot empty completely, causing small amounts of urinary leakage. Often, patients will need to urinate frequently, and they may experience “dribbling” or a constant dripping of urine from the urethra.
Prevalence of SUI
Many women suffer stress urinary incontinence. About 10% of young women and 30% of older women experience it, with an overall prevalence of 40% among all women. The commonest cause would be pregnancy and childbirth. 70% of post-delivery women experience some degree of urinary leak in the first six months. Women accept the inconvenience as part of delivery. Studies documented spontaneous improvement or symptom resolution after women participated in Kegel pelvic floor retraining.
Causes of SUI
Two unique characteristics of advancing pregnancy include the increased laxity of tissue attributed to hormones like relaxin and progesterone, and the downward pressure on the pelvic floor by increasing bulk of the uterus and fetus. On their own, these factors would have altered the sphincter control at the urethra, predisposing it to leak during stress activity.
Far more injury is inflicted on the pelvic floor during the passage of the baby through the birth canal. The longer the labour and the harder the pushing will stretch and tear the ligament and muscle support of the urethra and bladder. Besides, as the baby negotiates down the vagina, the pelvic nerves are inadvertently injured.
Only one in seven women who complain of stress urinary leak ever seek medical help, which is explained by the embarrassment, lack of information on treatment methods, fear of surgical treatment and unable to afford treatment.
Treatment for urinary incontinence will depend on several factors, such as the type of incontinence, the patient’s age, general health, and their mental state. It is vitally important that before any treatment is prescribed, the type of incontinence is appropriately diagnosed.
Different urinary incontinence type requires separate treatment strategy. Doctors may recommend that the patient keep a voiding diary in order to monitor the frequency and volume of urination. Laboratory tests such as urinalysis, serum creatinine, and PostVoid Residual Urine may also be ordered. In severe urinary incontinence, surgery is the definitive treatment. For example, sling procedures are done in severe stress incontinence.
Bladder training and pelvic floor exercises (called kegels) are just two natural treatments for overactive bladder. Research suggests that these non-drug remedies can be very effective for many women, and they have almost no side effects.
Bladder training is the most common OAB treatment that doesn’t involve medication. It helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at fixed times of the day – this is called scheduled voiding. You learn to control the urge to go by waiting for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.
Kegel exercises. Just as you exercise to strengthen your arms, abs, and other parts of your body, you can exercise to strengthen the muscles that control urination. During these exercises, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. Start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10.
The latest non-surgical and non-drug treatment for stress urinary incontinence and overactive bladder involves the application of laser energy to the part of the vagina that overlay the urethra and bladder (e.g. Mona Lisa Touch). Many studies in the last five years demonstrated how laser induces the collagen and glyco-protein build up in the vaginal skin, leading to a revitalised the blood supply and possibly the improved nerve function of these supporting layers of the bladder. Improvement in bladder symptoms in many has spurred further research to optimise vaginal laser therapy in managing women with mild to moderate bladder weakness.
Dr James Lee
Dr James Lee earned his medical degree at the NUS. After a career in family medicine, he advanced his training in obstetrics & gynaecology in the United Kingdom. He gained wide experience in the specialty. He obtained the MRCOG in 2001. In 2004, he underwent subspecialty training in urogynecology and pelvic reconstructive surgery at the St George’s Hospital Medical School, London. He excels in managing women who suffer from lower urinary tract and pelvic floor disorders. Besides urodynamic evaluation of the urogenital tract, pelvic reconstructive & vaginal surgery, his other interests include laparoscopic surgery, male & female sexual dysfunction. Dr Lee is a member of International Urogynecology Association, International Continence Society, and International Society of Sexual Medicine. He was the past president of the Society for the Study of Andrology & Sexology, Singapore (SSASS) and continues to be an active executive committee member.
1988 M.B.B.S (SINGAPORE) THE NATIONAL UNIVERSITY OF SINGAPORE
2001 MRCOG (UK) ROYAL COLLEGE OF OBSTETRICIANS & GYNAECOLOGISTS
2008 GRADUATE DIPLOMA IN ACUPUNCTURE (SINGAPORE)
2010 Apr Private practice: Providing general O&G service, with a strong sub-specialty focus on Urogynecology, Pelvic Floor Medicine and Surgery. Accredited in Parkway Group of Hospitals (Mt Elizabeth, Gleneagles, Parkway East), Thomson Medical Centre and Mount Alvernia Hospital.
2010 Mar Consultant, Dept of O&G, NUH
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Source: Prime Magazine Aug - Sep 2017 Issue. Reproduced with permission.
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