Urinary Leakage and Incontinence, What are its causes?

What is Urinary Incontinence?

It is the involuntary leakage of urine that is a social or hygienic problem.

How common is it? It affects 10-20% of women in Singapore and increases with age.

What are its causes?

There may be more than a single cause (multifactorial), these include:

• Urinary tract infection
• Complication due to medications
• Congenital weakness of ligaments, collagen deficiency
• Pregnancy and natural childbirth leading to damage to the pelvic floor muscles, ligaments, fascia and nerves
• Pelvic organ prolapse
• Menopause
• Ageing
• Stroke, dementia
• Spinal cord disease or injury
• Complication of surgery
• Restricted physical mobility (inability to reach the toilet in time)
• Obesity, heavy lifting, constipation, chronic cough

Types of Urinary Incontinence

There are generally 4 types of primary urinary incontinence:

• Stress incontinence: Involuntary urinary leakage on effort or exertion, e.g., when you cough, sneeze, laugh, run, exercise or lift something heavy. This is usually due to pregnancy, natural childbirth, congenital causes, prolapse, obesity.
• Urge incontinence: Involuntary urinary leakage accompanied or immediately preceded by urgency, e.g., before you can reach a toilet or before you can undo your clothes. This is due to the causes of overactive bladder (please refer to the web page on Frequent urination and overactive bladder)
• Some patients may present with both stress and urge (mixed) incontinence.
• Overflow incontinence: Involuntary urinary leakage not related to physical exertion or urgency, e.g., 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.
• 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.

Therapeutic options

The treatment of urinary incontinence depends on its type.

Please refer to the web page on Frequent urination and overactive bladder (OAB) for the treatment of urge incontinence.

Women suffering from stress incontinence may be taught or referred for pelvic floor (Kegel) exercises. If the latter fails a urodynamics, investigations will be performed to confirm the diagnosis and to exclude detrusor overactivity (abnormal bladder contractions) before surgery is planned.

Incontinence

Urinary incontinence is a condition that is embarrassing and distressing – and far from uncommon in women of all ages. There may be various causes, from childbirth to infection, and from gynaecological surgery to loss of oestrogen at menopause. In too many cases women do not discuss the problem with their doctor early enough for the right help or advice to be given. For many women, incontinence may be more of an annoyance than a serious problem and they can benefit from methods that restore their ability to control urination. Others may need surgical help.

How it is diagnosed

Your gynaecologist may ask you a series of questions about your symptoms. These will help determine the bladder-control condition you have. The complete diagnosis will involve a physical examination and a series of simple tests.

Bladder function is tested by asking the patient to drink large quantities of fluid and seeing how much urine is passed under normal circumstances. A second test, called urodynamics, involves several procedures: the pressure in the bladder and the flow of urine are checked, a sample of urine is taken for analysis to detect any infection or bladder stones, the whole urinary system is examined by ultrasound, and a fibreoptic cystoscope may be inserted into the urethra so that the urinary tract can then be inspected from the inside.

Range of Treatment Options

Treatment of incontinence depends on its type. Women suffering from stress incontinence may be referred for gynaecological physiotheraphy sessions to learn Kegek and other exercises. Postmenopausal women may be asked to consider hormone replacement therapy (HRT) to restore estrogen levels. If stress incontinence persists, surgery may be suggested.