Insights into urinary incontinence: Causes, lifestyle changes, and treatment options

In his latest online article, Professor Vik Khullar gives us his insights into urinary incontinence. He talks about the main causes, lifestyles changes that can help manage this condition and the available treatment options.

What are the main causes of urinary incontinence?

Urinary incontinence has various causes, with 85% attributed to the weakening of the urethral muscle, resulting in leakage during activities like coughing or straining. Vaginal delivery is a primary factor, as sphincter damage can occur after the cervix dilates more than five centimetres, leading even those with emergency caesarean sections to experience stress incontinence. Another significant cause is abnormal bladder contractions, leading to an overactive bladder characterised by frequent urination.

The key symptom is the inconvenience of timing of where to pass urine, where individuals may find themselves needing to locate toilets during inconvenient moments, a phenomenon known as "toilet mapping." Inability to delay urination is notable, and urgency urinary incontinence manifests as a sudden, compelling urge to urinate, often necessitating a rush to find a toilet, particularly noticeable when individuals reach home and experience the need to urinate immediately.

Are there lifestyle changes that can help manage urinary incontinence?

Effective management of urinary incontinence involves lifestyle adjustments, particularly in monitoring fluid intake. It's crucial to dispel the misconception that fluid consumption should be two litres of water a day. The commonly recommended two litres of water per day is based on a 70-kilogram individual, with over 500 mL typically derived from food. Therefore, the average person should aim for around one and a half litres of daily fluid intake. Consuming more than three litres per day increases the likelihood of urinary incontinence and urinary tract infections. This is believed to stem from excessive drinking prompting the kidneys to eliminate water throughout the day and night, resulting in significant dehydration upon waking.

Additionally, lifestyle changes can mitigate urinary tract infections, especially for those experiencing post-sex complications. It's advisable to refrain from urinating before intercourse and instead urinate afterward. Other supportive measures include the use of d-mannose, with one gram taken twice daily, as it has demonstrated a risk reduction for urinary tract infections in placebo-controlled studies. For postmenopausal women, the use of vaginal oestrogens has shown a 50% decrease in the risk of urinary tract infections. Embracing these various changes and approaches can effectively manage and alleviate urinary incontinence or related symptoms.

What are the available treatment options for urinary incontinence?

When it comes to available treatment options for women dealing with urinary incontinence, there is a broad spectrum to consider. On the simpler side, approaches include bladder training, where individuals regulate urination by the clock for an overactive bladder or engaging in pelvic floor exercises guided by a physiotherapist for stress incontinence. Notably, many women attempting pelvic floor exercises independently tend to relax rather than contract the pelvic floor, underscoring the importance of professional guidance to ensure the correct exercises are performed.

Tablet treatments are available for overactive bladder concerns, typically administered over three to six months, with over 50% of women, no longer requiring tablets by the end of this period as their bladder returns to normal function. Alternative treatments for overactive bladder include acupuncture needle stimulation of the ankle nerve (posterior tibial nerve stimulation) and botox injections into the bladder, while severe cases may involve nerve stimulation in the back through a permanent implant known as SNS.

Addressing stress incontinence, options range from injections around the bladder neck, performed as a day case or under local anaesthesia, to surgical interventions like slings or stitches such as colposuspension. These procedures aim to provide support to the bladder, creating a hammock around the urethra to prevent urinary incontinence. Long-term follow-ups for operations like colposuspension or slings indicate success rates of approximately 80% over 20 to 25 years.

It's crucial to recognise that urinary incontinence affects both men and women, with prevalence increasing with age. Despite it being commonplace in older demographics, experiencing such issues doesn't necessitate acceptance, as effective treatments are available. Seeking treatment for bladder-related concerns is essential, as it has the potential to significantly improve the quality of life for individuals facing these challenges.

Professor Vik Khullar is an esteemed gynaecologist and urogynaecologist with over 30 years of experience. You schedule an appointment with Professor Khullar on his Top Doctors profile.