Managing urinary incontinence: treatment options and lifestyle changes

Urinary incontinence is a condition where there is a dysfunction in the storage and passing of urine. It involves the involuntary leakage of urine at inopportune moments, and an increased frequency in the urge to urinate. An expert urologist sat down with us to tell us all about urinary incontinence and the options for treating it.

There are many causes of urinary incontinence and it isn’t always cut-and-dry – the urethral sphincter could be damaged, it could be a side effect of a medication, it could be a symptom of a neurological issue like Parkinson’s, or it could be a manifestation of a different ongoing illness or condition. Urinary incontinence is common in people over the age of 80, pregnant or post-partum women (especially those who delivered vaginally), and those with weak pelvic strength.

What is urinary incontinence?

There are four kinds of urinary incontinence:

• Stress: any pressure placed on the abdomen (and therefore the bladder) overpowers the bladder’s ability to stay closed due to weakness or damage to the muscles, causing leakage. Physical exertions like laughing, sneezing, or lifting heavy things can trigger urination.
• Urge: there are muscles in the walls of the bladder called the detrusors. When they are relaxed, the bladder can fill with urine, and when they are contracted they facilitate the release of that urine. However, when the muscles contract too often, the need to go to the toilet becomes more frequent, causing an overactive bladder.
• Overflow: the bladder cannot be completely emptied due to a blockage, so pressure builds up in the bladder and leads to leakage. The bladder could be blocked by bladder stones, an enlarged prostate gland, or constipation, or it could be that the detrusor muscles aren’t relaxing correctly which stretches the bladder.
• Total: the bladder cannot store urine at all and large amounts of urine need to be passed often, or there is frequent leaking in between passings. This can be caused by congenital bladder problems, nerve damage, or a hole in the bladder.

How can urinary incontinence be treated?

There are multiple treatment avenues for urinary incontinence, ranging from medicinal intervention to behavioural changes. The treatment plan will differ depending on the type and cause of urinary incontinence. The doctor will likely take a sample of the urine to check for traces of blood, unusual chemicals, or infection.

Pelvic floor exercises, done multiple times daily, to strengthen the pelvic muscles amd reduce leakage. You may also know them as Kegels. The exercises do not require any preparation and only consist of “reps” of squeezing the pelvic floor muscles – this will feel like trying to stop urinating mid-release. Squeezes should be in increments of a few seconds over 10 reps, and breathing should be normal throughout. Over time, reps should lengthen from two seconds to 10 seconds at a time. It can be easy to have an incorrect technique for pelvic floor exercises, so it is important to remember the stomach should not be engaged during these exercises.

Exercises that put pressure on the abdomen or that have a high impact, like lifting and jogging can increase risk.

Smoking and drinking alcohol or coffee excessively irritate the bladder and make incontinence worse.

Keeping the right diet and hydration practices can help normalise the urinary process.

It can help to adhere to a urination routine. The doctor may recommend:

• Bladder training in which urination is purposely delayed even after feeling the urge, so that the time in between bathroom trips can increase, as well as training the muscles so that urine can be retained purposely.
• Double voiding in which a few minutes after urinating once, you go to try and urinate again so that the bladder can truly be emptied.
• Scheduling bathroom trips, much like bladder training, so that the time between bathroom trips is fixed at every two to four hours and the feeling of urgency is eventually conquered.

There are some medical devices that can be used to address urinary incontinence. For example, urethral inserts work to plug the urethra and should be inserted in anticipation of activities like running or tennis, but there is a tendency to contract a urinary tract infection (UTI) with them. Or a pessary, which was originally meant for women to help with pelvic organ prolapse, can support the urethra and help involuntary leakage and can be worn all day.

Surgery may be suggested if lifestyle alterations and exercises are insufficient to treat the incontinence. Possible procedures include:

• Sling procedure, where a sling underneath the urethra and bladder neck, made of either strips of tissue or a synthetic mesh, helps to keep the urethra closed, especially during sudden movements like sneezing or coughing. This procedure is best for stress incontinence.
• Bladder neck suspension, performed on women and also most apt for stress incontinence, involves incisions to the abdomen to anchor the bladder and urethra to nearby structures, securing them to prevent leakage.
• Artificial urinary sphincter implantation to replace a weakened sphincter. There is a valve under the skin that will be pressed in order to allow urine flow when needed.
• For men experiencing blockage due to an enlarged prostate, an ablation can remove excess prostate tissue, freeing space in the urethra for urine flow.

If even surgery is not possible, there are also medicines that can be utilised as treatment. Antimuscarinics (anticholinergics) are used for urge incontinence, such as oxybutynin and tolterodine, but possible side effects include a dry mouth, constipation, fatigue, and in rare cases, glaucoma. Mirabegron is another alternative, and causes the bladder muscle to relax allowing it to store more urine, though there is a risk of contracting UTIs and an increased heartbeat. For women in the midst of menopause, topical oestrogen can help to revitalise the tissues in the groin area to improve pelvic floor capacity.

If you are struggling with urinary incontinence or other issues of the urinary tract, book a consultation with a urologist via Top Doctors.