Urinary incontinence is a widely prevalent condition – and there’s no need to be embarrassed. Dr Donald Maasdorp gives the facts.
In Western societies, between 25 and 55 percent of women suffer from urinary incontinence, defined as “the involuntary leakage of urine”. The wide range is due to the fact that only 1 in 4 women report it to medical professionals. Most people with this condition are embarrassed and consequently feel isolated.
The prevalence of incontinence increases gradually with age, and Caucasian women have a higher rate of incontinence than other races. Obesity (more specifically, increased body mass index) is a significant and independent risk factor.
Pregnancy and childbirth, even Caesarean sections, increase the risk of incontinence. Repeated pregnancies as well as complicated deliveries, needing forceps and suction, will put you at a much higher risk than someone who has never been pregnant.
Menopause and the hypo-oestrogenic state increase the risk for older women, as does smoking. Chronic lung disease such as asthma, COPD and persistent coughs can also cause incontinence. Women who have had a hysterectomy for any reason are also at risk, due to pelvic floor prolapse.
Bladder continence is under voluntary and subconscious control, which can be overcome by many factors. During normal voiding the appropriate setting – such as a toilet – will allow a person to voluntarily relax the muscles in the pelvic floor and the sphincters, resulting in passage of urine.
Different types of incontinence include urge, stress and mixed incontinence where the symptoms and causes are slightly different.
Urge incontinence is the inability to hold one’s urine. This is as a result of smaller bladder size and the inability of the bladder to distend and hold more increased quantities of urine. This condition can be determined using a urodynamic study, and it usually responds to medical treatment.
A degree of force is required to overcome the control mechanisms of the bladder. The common complaint with stress incontinence is usually loss of urine on coughing, laughing and when the intra-abdominal pressure exceeds the control pressures. These types of condition are an anatomical dysfunction and as such often require surgery to resolve.
Mixed incontinence is usually a combination of the above, and it can be treated medically.
The condition can be prevented or symptoms relieved with pelvic floor-strengthening exercises, or training, electric stimulation of the pelvic floor, avoiding food that results in urinary frequency or urgency, planned or scheduled voiding or hormone replacement.
Urge incontinence is usually treated with medication, which is often effective enough on its own. The newer types of medication have fewer side effects (they used to include dry mouth, constipation and blurred vision).
Stress incontinence is best treated by surgery to correct the anatomical defect. These include injecting bulking agents next to the urethra, muscle or fascial slings or synthetic meshes that are placed to correct the urethral anatomy and function.
The most important first step is to “destigmatise” the condition, thus allowing women to feel free and to investigate and treat as soon as possible.
Don’t suffer in silence! Seek help – early diagnosis can result in significantly improved quality of life.
Doctor’s note: This article does not cover all aspects of incontinence, especially where it occurs in paraplegics or quadriplegics.