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Incontinence
 
 

Understanding Incontinence

Incontinence is the uncontrolled leakage of urine from the bladder. There are many types of incontinence and before treatment can be advised, one must be clear which type of incontinence is affecting the patient and its underlying cause. Incontinence affects one's quality of life and even though it tends to be age-related, it can still be treated in most cases.

There are 4 types of incontinence:

  • Stress incontinence (this affects mostly women and occurs upon physical exertion)
  • Urge incontinence (this refers to the leakage of urine due to an overactive bladder)
  • Overflow incontinence (this refers to the leakage of urine due to persistent blockage)
  • Total incontinence (this occurs after surgical damage to the urethral sphincter muscle)

Symptoms

The severity and types of symptoms of urinary incontinence vary from person to person. Typical symptoms include a sudden, strong urge to urinate (urgency), urinating frequently (frequency), or awakening two or more times throughout the night to urinate. Bedwetting can also occur.

Causes

Certain foods, drinks and medications can cause temporary urinary incontinence. Also, urinary incontinence may be caused by a urinary tract infection, constipation, over-hydration, dehydration, and certain medications. Below are some of the conditions that may cause urinary incontinence:

  • Age - Ageing of the bladder muscle leads to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease. Also, women may produce less estrogen after menopause. With less estrogen, these tissues may deteriorate, which can aggravate incontinence.
  • Painful bladder syndrome (interstitial cystitis) - This rare, chronic condition occasionally causes urinary incontinence, as well as painful and frequent urination.
  • Enlarged prostate - In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH). The prostate begins to enlarge in many men after about age 40.
  • Prostate cancer - In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments - surgery or radiation - for prostate cancer.
  • Neurological disorders - Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Diagnosis

The list of medical tests used in the diagnosis of urinary incontinence includes:

  • Bladder diary - Your doctor may ask you to keep a bladder diary for several days. You record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.
  • Urinalysis - A sample of your urine is sent to a laboratory, where it's checked for signs of infection, traces of blood or other abnormalities.
  • Blood test - Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.
  • Pelvic ultrasound - Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.
  • Urodynamic testing - These tests measure pressure in your bladder when it's at rest and when it's filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health.
  • Cystoscopy - A thin tube with a tiny lens (cystoscope) is inserted into your urethra. This way, your doctor can check for - and potentially remove - abnormalities in your urinary tract.

Treatment

Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. Often a combination of treatments is used.

Treatment options for urinary incontinence range from more conservative approaches, including behavioural techniques and physical therapy to more aggressive options, such as surgery.

Prevention

Urinary incontinence is not always preventable. However, you may be able to decrease your risk of incontinence with the following steps:

  • Maintain a healthy weight - If you're overweight, reaching a healthy weight may help.
  • Don't smoke - Get help with quitting if you do smoke.
  • Avoid bladder irritants - Avoiding or limiting certain foods and drinks may help prevent or limit urinary incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do.
  • Eat more fiber - Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence.
  • Exercise - Physical activity reduces your risk of developing incontinence.

Resources

Find out more information from:

Society for Continence Singapore
Chin Chong Min Urology & Robotic Centre
MayoClinic
WrongDiagnosis.com
MedicineNet.com
eMedicineHealth.com

FAQs

1. Is incontinence a problem seen mostly in the elderly?

Incontinence is certainly more common as patients age, but incontinence can be seen in children, adolescence and adults, both male and female.

2. When should I seek medical attention?

Make an appointment to see your doctor if you:

  • leak urine
  • get up more than twice a night to urinate
  • feel the urgent need to urinate often
  • have difficulty starting the urine stream
  • feel the bladder is still full after urinating
  • dribble urine after going to the bathroom
  • have blood in your urine (pink or reddish urine)
  • have pain or burning with urination.

3. Do you have any tips to manage urinary incontinence?

  • Reduce intake of foods or beverages that increase urination or may irritate the bladder (e.g., coffee, tea, alcohol).
  • Take measures to ease pressure on the abdomen (e.g., lose weight if overweight).
  • Drink plenty of fluids during the day, but limit fluid intake 2 to 3 hours before going to sleep.
  • Empty the bladder completely when you urinate and try to give an extra push to get the last drops of urine out.
  • Only use absorbent pads, belts, or adult diapers as a last resort. They're not recommended because people tend to rely on them and not get proper medical treatment. Check first with your doctor before buying any of these products.

This article is reproduced with the permission from Agency for Integrated Care (AIC) and Singapore Sliver Pages.

For more information, please visit http://www.aic.sg/silverpages.

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