A Leaky Issue…
Laughter, so they say, is the best medicine.
But laughter can also be a problem if it makes you pee in your pants.
It’s not an understatement to say that urinary incontinence (UI) reduces your quality of life. Both men and women, young and old, can experience uncontrolled urine leaks which may occur at any time. Up to 20% of the population aged 15-60 will experience UI; after 60 years of age, up to 40% will get it! It’s embarrassing to sufferers and most are ashamed to seek help. And unfortunately, many elderly people think accidental urination is a normal part of aging.
Must we all learn to live with this?
As any good plumber or mechanic would advise, anything that leaks must be properly fixed. What typically happens to UI sufferers who don’t seek proper treatment is that they end up spending a lot of money buying diapers, paying for unproven alternative medication and avoiding friends and family. Some even self-medicate, which may result in a worsening of the condition as the patient may not fully understand the underlying causes.
It is a problem that cannot be ignored because complications such as urinary infections, bedsores, depression and sexual dysfunction may arise as a result of it. Not only that, caregivers of elderly patients may find the condition stressful to deal with.
Not all UI are the same. It can be broadly divided into 3 major types: urge urinary incontinence, stress urinary incontinence and overflow incontinence.
The first type, urge urinary incontinence, is as the name describes, feels like one has to keep peeing and stay close to a toilet. Otherwise, an ‘accident’ can easily happen.
It occurs when one has an overactive bladder, leading to urine leaks. The main ‘lifestyle’ culprits of this condition are caffeinated products such as coffee and tea, carbonated products, citrus drinks and alcohol. Medical conditions such as Parkinson’s, spinal cord injury and even stroke can also contribute to urge urinary incontinence.
It is important to rule out urinary tract infection here as it also displays symptoms of a leaky overactive bladder. Men with large prostates, a condition that also needs to be ruled out, may also experience urge urinary incontinence. This is due to the fact that overactive bladders develop when constantly contracted against a large obstructed prostate.
The treatment for urge urinary incontinence ranges from lifestyle modifications such as avoidance of caffeinated products, to physiotherapy, medication, bladder Botox injections (to partially paralyse the bladder muscle) and neuromodulation (bladder pacemaker to regulate the bladder contraction). If urge incontinence is due to a large prostate, surgical resection of the prostate gland will solve the problem.
The other kind of UI, stress urinary incontinence is usually experienced by women who have had multiple or instrumental deliveries or pelvic surgery (e.g. hysterectomy). Obesity is also a contributory factor to stress urine leaks.
Men occasionally experience this issue after prostate surgery or any pelvic trauma. These people often encounter urine leaks when coughing, laughing hard, sneezing, carrying heavy things or whenever they exert themselves, a condition brought about by the weakening of the pelvic muscle that supports the bladder after the surgeries/injuries. Imagine experiencing a ‘leak’ during a party or exercising at the gym!
Treatments usually involve lifestyle modifications, physiotherapy and surgery. There is no medicinal fix for this condition so it is important to differentiate this type of leak from other types of urine leak. To state the obvious, it is important to avoid strenuous physical activities.Those with chronic medical conditions such as cough and constipation should seek treatment for these issues as the exertion will make the leaks recur even after treatment.
If surgery is needed, the options range from bulking agents, sling procedures and artificial urinary sphincters, depending on the severity of the condition. These are aimed to tighten/approximate the urinary passage without obstructing it.
Some patients may experience both stress and urge urinary incontinence. Treatment will be tailored to individuals according to the predominant symptoms and may involve a combination of medication and surgery.
The third kind, overflow incontinence, may result from an underactive bladder or bladder outlet obstructions such as stones or prostate diseases.
Underactive bladders are commonly observed in patients with diabetes and neurological conditions or those on medications such as antihistamine and antidepressants. Aging bladders may also exhibit underactivity. As Stephen Fry succinctly put it, “I don’t need you to remind me of my age. I have a bladder to do that for me.”
Patients with underactive bladders can hold unusually large amounts of urine but they do not feel it when their bladders are full. They cannot contract the muscles efficiently and as forcefully as they should, resulting in incomplete bladder emptying. Impaired bladder sensations and poor emptying will eventually lead to the bladder overfilling and leaking.
Again, there are no effective medications to treat this condition. Most patients are advised to undergo ‘double voiding’ or use a urinary catheter to drain the urine to avoid complications such as urine leaks and urinary tract infections.
Someone with overflow incontinence due to bladder outflow obstructions can be easily treated by surgery if they are caused by large prostates, bladder stones or narrow urinary passages. Those with functional bladder disorders can be treated with neuromodulation to facilitate urine flow.
For Dryer Days Ahead
On a serious note, it is vital to differentiate the various types of urinary incontinence as the management varies from one to the other. Patients will be advised to prepare a ‘bladder diary’ detailing the fluid intake and urine output. Urine and blood tests, ultrasound, bladder scopes and bladder function tests will assist the physician to determine the type of urine leak. Each patient’s condition may be unique especially if he or she has a combination of several types of urinary incontinence.
Once identified, the physician will manage the patient’s condition and expectations to help him or her lead as normal a life as possible. Managed right, this is a problem that can be flushed down the toilet, literally!