Urinary incontinence, or the involuntary leakage of urine, is a common issue, particularly among women. It can cause significant distress, anxiety, and can affect quality of life. Some individuals may need to use absorbent pads or wear urine collection bags, leading to physical and mental health challenges as they are unable to engage in daily activities as desired.
How does urinary incontinence occur ?
Urinary incontinence is caused by weakened pelvic floor muscles that support the urethra and bladder. This can result from stretching or tearing of the supportive tissues, causing the urethra to drop and lose its ability to withstand pressure from the bladder during activities that increase abdominal pressure, such as coughing, sneezing, or exercising. It can affect people of all ages, including children, adults, and the elderly. In Thailand, about 20% of women of reproductive age to menopause experience this condition, which can range from occasional dribbles to constant leakage that stains clothing.
Risk factors for urinary incontinence
- Pregnancy and childbirth: The number of childbirths increases risk, regardless of whether the births were vaginal or cesarean. Pregnancy places significant pressure on pelvic organs.
- Age: Women over 40, particularly post-menopausal, may experience leakage during coughing or sneezing.
- Obesity: Increased weight adds pressure to the abdomen and bladder.
- Hysterectomy and menopause: The lack of estrogen can lead to atrophy of supportive tissues in the urinary and pelvic regions.
- Sexual activity: Certain sexual practices may increase risk.
Types of urinary incontinence and treatment options
There are several treatment options available for urinary incontinence, allowing patients to choose based on their specific situation. For mild symptoms, pelvic floor exercises (Kegel exercises) can improve muscle strength without surgery.
- Kegel exercises: Strengthening the pelvic floor can take time and requires consistent practice. To perform correctly, contract only the pelvic muscles without engaging the abdominal or thigh muscles. Hold each contraction for 10-20 seconds, then relax for the same duration. Initially, practice a few times and gradually increase both duration and frequency.
- Medications: Anticholinergic medications can help with muscle contractions in the urethra and reduce bladder spasms, leading to decreased urgency and frequency. Side effects may include dry mouth, blurred vision, and constipation.
- Botox injections: Small amounts of Botox can be injected into the bladder to reduce overactivity, helping to prevent sudden urges to urinate. However, side effects can include difficulty urinating and may require intermittent catheterization. Botox effects last about six months, necessitating repeat treatments every 6-12 months.
- Electrical stimulation: For patients unable to perform pelvic exercises effectively, low-level electrical stimulation can help strengthen pelvic muscles and promote bladder relaxation.
- Surgical options: The sling procedure involves placing a mesh tape under the mid-urethra to provide support. It is less invasive than traditional surgery and has a high success rate. Approximately 80-90% of women report improvement or resolution of symptoms after the surgery. Recovery is typically within 2-4 weeks, though some may experience discomfort or mild bleeding in the initial days post-surgery.
In summary, urinary incontinence can significantly impact daily life, but various treatment options are available. Consulting a healthcare provider can help determine the best approach for individual needs.
