Urinary Incontinence

Urinary incontinence is the inability to control the release of urine from your bladder. It is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that is so sudden and strong that you do not get to a toilet in time.

There are various types of urinary incontinence which include:

• Stress incontinence
  Involuntary urinary leakage on effort or exertion, for example when you cough, sneeze, laugh, run, exercise or lift something heavy. This can usually be due to pregnancy, natural childbirth, congenital causes, prolapse, obesity.

• Urge incontinence
  Involuntary urinary leakage accompanied or immediately preceded by urgency, for example, before you can reach a toilet or before you can undo your clothes. This is due to the causes of overactive bladder.

• Overflow incontinence
  Involuntary urinary leakage not related to physical exertion or urgency, for example, when you experience occasional dribbling of urine due to difficulty in emptying your bladder adequately or obstruction to your urine-pipe. This is can be due to stroke, dementia, spinal cord disease or injury, diabetes mellitus, significant pelvic organ prolapse, post-delivery or surgical complication.

• Mixed incontinence
  Some patients may present with both stress and urge (mixed) incontinence.

• True incontinence
  When there is continuous urinary leakage due to congenital abnormality of the urinary tract or a fistula (false passage) from the urinary tract to the vagina, a rare complication of vaginal delivery, caesarean section or gynaecological surgery.

Urinary incontinence can be caused by underlying medical conditions or physical problems. Some temporary causes of urinary incontinence include alcohol, excessive fluid intake, caffeine, medications, urinary tract infection or constipation.

Common causes of incontinence in women include, pregnancy/childbirth, changes with aging, post hysterectomy or painful bladder syndrome otherwise known as interstitial cystitis. For men, some of the causes of urinary incontinence include prostatitis, enlarged prostate or prostate cancer. Bladder cancer, bladder stones and neurological disorders can be some of the other causes of urinary incontinence.

Treatment will depend on the type of urinary incontinence, the severity and the underlying cause. Necessary tests will be performed to clearly understand the specific cause of incontinence. This will include:

• Urinalysis - A sample of urine is examined for the presence of infection, blood or other abnormalities.

• Post void residual measurement - After the patient urinates, the amount of urine left over in the bladder is measured. This can be done by placing a small catheter into the bladder through the urethra and measuring the urine that comes out or by examining the bladder with ultrasound.

• Ultrasound - Ultrasound can be used as a more comfortable way to measure the post void residual amount of urine. Ultrasound also demonstrates the size and shape of the kidneys, ureters, and bladder to evaluate whether urine has backed up within the kidneys (hydronephrosis).

• Urodynamic testing - This in depth examination evaluates bladder and urinary sphincter function as the bladder is filled and emptied. A small tube - (known as a catheter) is placed through the urethra into the bladder to measure the pressure inside the bladder. At the same time, a catheter is place inside the rectum to measure the pressure in the abdomen. This test also assesses whether a patient has normal bladder sensation and capacity. The whole evaluation takes about 30 to 45 minutes.

• Voiding diary - The patient keeps a close record of when the urge to void occurs and when voiding and leakage occur. The amount of leakage is also recorded. This allows the physician to better understand the patient's incontinence.

• Cystoscopy - The urologist places a cystoscope into the bladder through the urethra. The cystoscope is a long, narrow tube with a lens at the tip, which allows the urologist to thoroughly inspect the inside of the bladder for any abnormalities.

Treatment options for urinary incontinence range from more conservative approaches, to more aggressive options, such as surgery. In most cases, the least invasive treatments will be suggested first before moving on to other options only if these techniques fail. In many cases, a combination of treatments will be used.