Millions of women experience it, the involuntary loss of urine called urinary incontinence (UI). UI is a loss of bladder control resulting in urine leakage or an uncontrollable and immediate need to urinate. Women experience UI thrice as often as men and it can be slightly bothersome to totally debilitating. UI can cause emotional stress and for some, the risk of public embrassment will keep them away from enjoying many activities with family and friends. InfoMed sat down with Dr. Warren Lo Hwa Loon, consultant urologist from Hospital Kuala Lumpur, Ministry of Health Malaysia, to discuss this important and common medical condition.
“It is a taboo subject,” says Dr. Lo, who sub-specialises in neuro reconstructive and female urology. “No one wants to talk about how they’re leaking every time they cough.”
The problem affects 10 to 30 per cent of the general population with age and gender playing a factor. Older people are more susceptible to UI due to the lost of muscle strength while women are more susceptible to UI due to anatomical differences and childbirth that loosens the pelvic floor.
UI is an under-reported problem, partly due to the fact that it is not fatal, so people’s attitudes are more “grin and bear it” rather than “know and fix it”. There’s also the fact that many people accept it as a part of growing old, not realising treatment options are available. Young people affected with UI on the other hand, may simply not report it due to shame.
UI isn’t simply “not being able to hold your pee”, as there are several types and thus different associated causes and risk factors. The two most common type of incontinence are Stress Incontinence and Urge Incontinence. It is not uncommon for people to be affected by a mix of the two, or other types of incontinence, like overflow incontinence.
There is no effective medication to strengthen the pelvic floor muscle, so if Kegel exercises (a type of pelvic strengthening exercise) do not work, surgery may be necessary. For men, a male sling procedure can be performed on those with mild to moderate stress urinary incontinence but artificial urinary sphincter (with a pump that allows for manual urine control) should be performed in severe cases. Both procedures have up to 90 per cent success rates.
Women suffering from stress urinary incontinence are usually fitted with a tension free vaginal tape, which sits around the mid urethra to tighten the urinary passage without obstructing it. For those who do not respond to the tension free vaginal tape, Burch colposuspension, which involves lifting the bladder neck by suturing the tissue around it to the strong ligaments of the pelvic floor muscle. There is also an outpatient alternative for elderly candidates or those unsuitable for surgery to undergo a process where a bulking agent is used to occlude the passage and stop the leaking.
Sharing horror stories, Dr. Lo said he’s come across male patients who have used penile clamps to stop the leaking. It is not a method endorsed, as there is a high risk of infection and erosion to the skin.
Most importantly, Dr. Lo says, is the need for general practitioners to have frank discussions and diagnose the problem, as patients are not likely to bring it up on their own. As one of the few practitioners in the country who specialises in and performs these surgeries, Dr. Lo also mentioned that more public awareness is needed to highlight that UI is a treatable condition and does not have to be an inevitable part of ageing. With greater public education, more treatment options can be made available so people don’t need to suffer in silence.
Practise Your Kegels
- Practise Your Kegels
To identify your pelvic floor muscles, stop urination in mid-stream or tighten the muscles that keep you from passing gas. These are your pelvic floor muscles.
Perfect your technique.
Empty your bladder in the toilet and then lie on your back comfortably with your knees bent and spread apart. Tighten your pelvic floor muscles, hold the contraction for three seconds, and then relax them for another three seconds. When your muscles get stronger, try doing Kegel exercises while sitting, standingvor walking.
- Maintain your focus.
For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
- Repeat three times a day.
Aim for at least three sets of five to eight repetitions a day.
Up to 43 per cent of men develop stress incontinence after a prostatectomy, while more than 50 per cent of women develop stress incontinence as they age above 40 years old, with probabilities doubling if they had multiple vaginal childbirths or traumatic deliveries. Obese individuals are likely to develop stress incontinence due to the additional pressure caused by excess weight in the abdominal area.
Caffeinated products (tea, coffee, soda) and alcohol should be avoided or consumed in moderation. Neurological conditions like Parkinson’s disease, Alzheimer’s disease and spinal cord injury can result in poor control of the bladder muscles, leading to urge incontinence. Urinary tract infection can also result in overactive bladders with incontinence.
The first hurdle is in recognising the need for medical care, Dr. Lo says, as patients are apt to ignore the problem and suffer in silence or modify their lifestyle. Modifying lifestyles, he says, are things when patients stop themselves from laughing or sneezing because of stress incontinence, or cutting off their favourite latte rather than admitting they have incontinence. In fact, it’s not until the problem is severe enough to require pads and diapers do they seek medical attention.
The first line of treatment is always pelvic floor exercises (Kegel exercises), involving a very specific set of movements. Dr Lo recommends his patients perform about three minutes of Kegel exercises, repeated five times throughout the day. Kegel exercises are effective for both urge and stress incontinence.
Various treatment options for both urge and stress incontinence should be offered.
Intermittent self-catheterisation or indwelling urinary catheters are treatment options. Unfortunately there is no medication at the moment that can be prescribed for this condition.
Dr. Warren Lo Hwa Loon, consultant urologist from Hospital Kuala Lumpur, Ministry of Health Malaysia