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Chang Wai Ken, 16-Aug-2017
Chang Wai Ken, 19-Dec-2017
Admin, 30-Mar-2017
Ts Shaharidan Karim, 08-Jun-2019
Chang Wai Ken, 20-Dec-2017
Urinary incontinence (UI) [1] is the involuntary leakage of urine. It often remains undetected and undertreated. It is a common and embarrassing problem affecting millions in the world. The severity varies from occasional leaks when you cough or sneeze to having a sudden and strong desire to urinate that you might wet your pants while dashing to the toilet. Readers should be made aware that urinary incontinence is not a disease but a symptom due to personal habits, physical problems or underlying medical conditions.
Aetiology [1,2,3]
The different types of urinary incontinence, common causes, and clinical features are discussed in the table below:
Type
Definition
Common Cause
Clinical Features
Stress UI
Involuntary loss of urine due to increased pressure on the bladder
Typical provoking events – sneezing, straining due to constipation, laughing
Occurs largely in women
Weakened pelvic floor muscles due to multiparity, obesity, chronic cough, straining of stool
Pelvic Organ Prolapse
Previous vaginal/bladder surgery
Frequent, small amounts of urine leakage
Typically follows a stressor
No irritative symptoms or nocturia (excessive urinating at night)
Normal bladder capacity
Urge UI
(overactive bladder)
Involuntary leakage associated with a sudden strong need to void, larger amount
Affects both males and females
Urinary tract infection
Upper motor neuron lesion
Stroke
Parkinson’s Disease
Irritative voiding symptoms:
Often co-exist with stress UI – called mixed UI
Overflow UI
Involuntary leakage associated with loss of bladder muscle contractility and/or bladder outlet obstruction, resulting in incomplete emptying of the bladder and retention of urine
Largely affects male
Medications
Lower motor neuron lesion
Cystocele
Urethral Stricture
Pelvic Cancer
Faecal Impaction
Benign Prostatic Hyperplasia
(commonest cause in Male over the age of 60)
Obstructive voiding symptoms:
Functional UI
Involuntary leakage associated with cognitive, functional or mobility difficulties that impair the ability to use the toilet, but without failure of the bladder’s capacity for storage and emptying.
Dementia or cognitive repair
Delirium
Depression
Immobility
Continence improves when appropriate help is provided
Evaluation
Urinary incontinence does not increases the mortality rate however, if prolonged it can cause severe impact on other aspects of a patient’s life such as quality of life, sexual dysfunction, increased morbidity, and increased care giver burden.
Patients may be reluctant to initiate discussions about their incontinence and urinary symptoms due to embarrassment, lack of knowledge about treatment options, and/or fear of surgery.
If urinary incontinence affects your daily activities, don't hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.
A thorough evaluation by your doctor can help determine what's behind your incontinence.
References
1. Urinary incontinence Causes - Mayo Clinic [Internet]. Mayo Clinic. 2017 [cited 22 June 2017]. Available from: http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/basics/causes/con-20037883
2. Urinary incontinence in men [Internet]. www.uptodate.com. 2017 [cited 22 June 2017]. Available from: http://www.uptodate.com.ezp.imu.edu.my/contents/urinary-incontinence-in-men
3. Evaluation of women with urinary incontinence [Internet]. www.uptodate.com. 2017 [cited 22 June 2017]. Available from: http://www.uptodate.com.ezp.imu.edu.my/contents/evaluation-of-women-with-urinary-incontinence