Urinary Incontinence

Epidemiology

Urinary incontinence in women is a worldwide medical problem, with an incidence rate ranging from 17% to 60%. In Hong Kong, there are 13% to 21% of women suffering from urinary incontinence. As women get older, they are more likely to develop this problem.

What is Urinary Incontinence?

Female urinary incontinence is closely related to the pelvic floor muscles, which are made up of bulbocavernosus and ischiocavernosus muscles. Vaginal tears during childbirth or chronic intra-abdominal pressure may cause muscles and ligaments to loosen. The muscles are no longer able to maintain support for the bladder neck, resulting in the bladder becoming compressed. This leads to urine leakage, frequent urination, and even urinary incontinence (also known as “pelvic floor dysfunction”). Urinary incontinence can be classified into stress incontinence, urge incontinence, and mixed incontinence.

Symptoms

Involuntary urine leakage
Constant feeling of urge to urinate
Frequent urination of a small amount
Nocturia

Causes

Causes of each type of urinary incontinence are different, and women are more likely to experience urinary incontinence during pregnancy and childbirth.

Type	Cause
Stress Urinary Incontinence	Due to the relaxation of pelvic floor muscles, the ability to control the urethra is weakened. Urine leaks when the abdomen is strained when coughing, laughing, or lifting heavy objects.
Urge Urinary Incontinence	The bladder is oversensitive and the bladder muscles have abnormal contractions, which causes a feeling of urination urgency. This condition is also known as an overactive bladder. The cause is unknown, and some cases are related to neurological or spinal diseases, bladder stones, or tumors.
Mixed Urinary Incontinence	Patients have both stress urinary incontinence as well as urge urinary incontinence.
Overflow Urinary Incontinence	Problems in the urinary system weaken the bladder muscles, causing excessive urine to accumulate in the bladder. Patients may leak urine in situations where they have no intention to urinate.
Functional Urinary Incontinence	It occurs in patients whose bladders function normally but are unable to access the toilet as they have difficulty in mobility.

Urinary incontinence caused by pregnancy and childbirth

During pregnancy, a woman’s bladder will be pushed upward by the growing uterus that includes the amniotic fluid and the fetus, and the urethra will become elongated. In addition, a pregnant woman’s pelvis tends to become more susceptible to trauma due to the effects of pregnancy hormones. The weakened pelvic ligaments are unable to support the weight of the fetus, which increases the mother’s risk of developing urinary incontinence.

As for urinary incontinence after childbirth, it is caused by the compression of the baby on the bladder and the urethra during the delivery process, causing surrounding ligament muscles to tear. This is especially common when the delivery process is long. During delivery, the obstetrician making cuts to the vagina and using various types of delivery equipment may cause damage to the pelvic floor muscles and nerves. Although most women recover from their pregnancy and postpartum urinary incontinence after delivery, around 3% of patients will still suffer from regular urine leakage.

Risk Factors

Female
Family history
Age
Overweight
Pregnancy
Numerous childbirths
Have undergone a hysterectomy
Urinary tract stones
Diabetes

How is Urinary Incontinence Diagnosed? + Treatment

Doctors may make a clinical diagnosis of the patients and ask them to keep a urine diary.

If necessary, the patient may be advised to take a urine flow test - catheters will be inserted in the urethra and anus, and bladder pressure will be measured to determine the cause of the urinary incontinence.

Treatment

Pelvic Floor Muscle Exercises	Studies have shown that for women who are in their 20th week of gestation and who exercise their pelvic floor muscles regularly, their urinary incontinence conditions tend to improve. Therefore, doctors recommend that pregnant women should start moderate pelvic floor muscle contraction exercises before giving birth, so to have better weight control at the same time.
Electrical Stimulation	Electric currents can help adjust the contraction of the pelvis muscles to reduce bladder overactivity. A surgery option is also possible by connecting a device to the sacral nerves. The device will send out a regular current similar to a cardiac rhythm to improve urge incontinence.
Medication	Medication is mainly used to treat overactive bladders by reducing abnormal contractions, improving bladder control function and reducing the urgency of urination as well as the leakage of urine. Patients must also do pelvic floor muscle contraction exercises when they are on medication to have their conditions improved.
Surgical Treatment	If the patient’s urinary incontinence is severe or if the medication is not effective, doctors may consider surgical treatment. A suburethral sling will be placed around the urethra to strengthen the support of the bladder neck and to increase the patient’s urethral control.

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