Definition & Overview
Urinary incontinence refers to the involuntary leakage of urine due to loss or weakened control over the urinary sphincter. As a result, the body is unable to effectively hold the urine in the bladder. This condition can be treated using a combination of medications, surgery, and long-term management with the goal to improve the patient’s quality of life despite the problem. The techniques used are chosen based on the type of incontinence, its cause, and the severity of the problem.
Who Should Undergo and Expected Results
Urinary incontinence treatment is offered to patients with:
- Stress incontinence, wherein the patient leaks urine when coughing, laughing, or sneezing due to the sudden extra pressure on the bladder. This is commonly caused by bladder damage due to vaginal childbirth or neurological and connective tissue disorders.
- Urge incontinence, which is commonly caused by excessive consumption of alcohol and caffeine, urinary tract infections, and inadequate fluid intake that leads to bladder irritation and overactive bladder.
- Overflow incontinence, which is caused by bladder stones, nerve damage, or an enlarged prostate gland
- Mixed incontinence, which occurs due to a combination of different causes
- Functional incontinence, which is caused by an underlying medical condition
- Total incontinence, which is caused by congenital bladder abnormalities or any long-term injury to the spinal cord
Incontinence can be either temporary or persistent:
Temporary urine incontinence is caused by infection (such as urinary tract infection) or diuretic foods, drinks, or medications that stimulate the bladder and increase urine volume
Persistent incontinence occurs as a result of pregnancy, childbirth, menopause, ageing, disease (such as prostate cancer, neurological disorders or a spinal cord injury), and surgery (such as a hysterectomy).
The long-term goal of urinary incontinence treatment is to help patients hold in their urine to prevent unintentional leakages.
How is the Procedure Performed?
Urinary incontinence treatment may involve:
• Behavioural techniques
- Bladder training, wherein the patient is trained to delay urination, starting with a 10-minute interval between each toilet trip, with the goal of lengthening this interval from two to four hours
- Double voiding, wherein the patient is trained to empty the full contents of the bladder with each toilet trip
- Fluid and diet management, which is done by limiting the intake of alcohol, caffeine, and acidic foods, as well as increasing physical activity
- Scheduled toilet habits, wherein patients are trained to urinate every two to four hours regardless of whether they feel the urge to urinate or not
- Kegel exercises, which help restore the strength of the pelvic floor muscles that are responsible for stopping urine flow.
- Anticholinergics, which are effective in calming overactive bladders
- Alpha blockers, which are used by male patients suffering from urge or overflow incontinence. This type of medication relaxes muscle fibres in the prostate area as well as the bladder neck muscles so the bladder is easily emptied.
- Oestrogen creams, also known as vaginal creams, which are used by women to help tone and restore strength to the vaginal and urethral tissues
- Mirabegron, which relaxes the bladder muscles, thus increasing the amount of urine the patient can hold at any given time
- Medical devices
- Urethral inserts
- Pessary, a stiff ring inserted into the vagina to hold up the bladder. These medical devices are highly effective among female patients who experience urine leakage due to a bladder prolapse.
- Long-term therapies
- Botox injections, which work by temporarily paralysing the bladder muscle so it can hold urine in better
- Nerve stimulators, which work by stimulating the sacral nerves to help with bladder control. This is done by implanting a nerve stimulating device under the skin in the buttock area to deliver timely electrical pulses to the sacral nerves
- Surgery and medical procedures
- Sling procedure, wherein a pelvic sling is created around the urethra to keep it closed until the patient is ready to urinate
- Artificial urinary sphincter, wherein a small ring is implanted around the neck of the bladder to keep the sphincter sealed.
- Bladder neck suspension, wherein additional support is provided to the urethra and bladder neck
- Prolapse surgery, which is performed on female patients who suffer from pelvic organ prolapse that causes urine leakage
- Catheterisation, wherein a soft catheter tube is inserted into the urethra to empty the bladder
- Electrical stimulation, which is performed by inserting electrodes into the rectum or vagina to stimulate and strengthen the pelvic floor muscles
Possible Risks and Complications
Patients who undergo surgical intervention are at risk of bleeding, blood loss, and infection, as well as adverse reactions to anaesthesia. Meanwhile, patients who use a variety of techniques are at risk of recurrence, especially in cases related to disease or other causes of persistent incontinence. Thus, it is important that urinary incontinence treatment is accompanied by necessary lifestyle changes.
Subak L., Wing R., West DS., et al. “Weight loss to treat urinary incontinence in overweight and obese women.” N Engl J Med 2009; 360:481-490. http://www.nejm.org/doi/full/10.1056/NEJMoa0806375#t=article
Hersh L., Salzman B. “Clinical management of urinary incontinence in women.” Am Fam Physician. 2013 May 1; 87(9) 634-640. http://www.aafp.org/afp/2013/0501/p634.html