Urinary Incontinence

Causes and Symptoms

Common types of Urinary Incontinence include Stress Incontinence, Urge Incontinence, Overflow Incontinence and Functional Incontinence:

Stress Incontinence

Causes:

• Weakened pelvic muscle resulting in reduced control over the urethral sphincter
• Urine leaks when intra-abdominal pressure increases
• Common in the multiparous women, elderly and people with obesity, chronic cough or constipation

Signs and Symptoms:

• When there is a sudden increase in intra-abdominal pressure (e.g. coughing, laughing, sneezing, on effort or exertion), urine leaks out involuntarily

Urge Incontinence

Causes:

• Most commonly patients have overactive bladder, causing involuntary detrusor contracts
• Damage of Central Nervous System inhibitory pathways, leading to ineffective suppression of bladder contractions

Signs and Symptoms:

• Involuntary urinary leakage accompanied by or immediately preceded by urgency
• Urgency, increased in daytime frequency, nocturia

Overflow Incontinence

Causes:

• Due to neurogenic problems (e.g. neurodegenerative disease, spinal cord disorder), leading to the absence of detrusor activity
• Bladder outlet obstruction (e.g. urethral stricture)
• Over-distended bladder which resulting in an elevated intra-vesical pressure overcomes the urethral resistance, leading to overflow incontinence

Signs and Symptoms:

• Frequent leakage of small amount of urine with or without urgency

Functional Incontinence

Causes:

• Physical disability (e.g. Poor vision, Arthritis)
• Cognitive impairment (e.g. Dementia, Parkinson’s disease)
• Environmental constrains

Signs and Symptoms:

• Due to physical, mental or environmental constrains, clients with urgency are unable to get to the toilet on time

Investigation

• Urodynamic Study:
  By measuring the pressure in the rectum and the bladder during filling and voiding phase, it helps diagnosing the causes and severity of urinary incontinence.

Treatment

Non-surgical:

Stress Incontinence

• Pelvic floor exercise for strengthening the pelvic floor muscle

Urge Incontinence

• Bladder training
  Under the guidance of healthcare professions, patient learns how to delay urination when urge strikes. This will strengthen the ability of holding urine. As a result, the interval between voiding will be gradually lengthened.

• Medication
  • Anticholinergics Inhibit the involuntary bladder muscle contractions.
  • Intravesical Botulinum Toxin (Botox) Injection through cystoscopy block the transmission of impulses in neuromuscular tissue, thus relaxing the bladder muscles.

Overflow Incontinence

• To find out the underlying cause and manage accordingly. Clean Intermittent Self Catheterization may be needed.

Functional Incontinence

• Management depends on the patient’s underlying medical conditions.

Surgical:

• Tension-Free Vaginal Tape (TVT) and Transvaginal Tension-Free Tape Obturator (TVT-O) Procedure
  People with urodynamic stress incontinence may consider this treatment. The synthetic sling is placed under the mid-portion of the bladder neck (urethra) to support the pubo-urethral ligament, thus to help preventing leakage.