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Involuntary urine leakage, stress urinary incontinence, loss of bladder control and urge urinary incontinence affect many adult women in Singapore. It is well known that about 50% of elderly females above 60 years old suffer from a weak bladder. These women commonly complain of frequent urination, leaking urine whenever they cough or exercise, and overactive bladder or sensitive bladder symptoms which lead to urge urinary incontinence. In order to keep dry, the women often need to use incontinence pads, incontinence diapers or incontinence pants. Their bladder problem may become so severe that the elderly women avoid drinking fluids and keep away from social activities, until they submit themselves to definitive incontinence treatment.

What is urinary incontinence?

When you experience involuntary loss of urine, you suffer from urinary incontinence. It may occur rarely, occasionally, frequently or daily; and the volume of urine leakage may be minimal or substantial. If it is mild leakage, you may not be bothered. On the other hand, frequent severe urine leak may cause you unending distress. No matter how you are affected, urinary incontinence is an abnormal condition. You should not brush it aside, attributing it as a consequence of growing old. Although more elderly women suffer from it, women of all ages suffer from it.

Control of micturition

The human body needs to be adequately hydrated to have normal physiological processes. Excess body fluid is expel in different ways, one of which ends up as urine - filtered through the kidneys and stored in the bladder before being released as urine. The bladder acts as a reservoir for urine. A healthy woman maintains bladder continence throughout most of the day, and only void when it is socially appropriate at her convenience. During the storage phase, it is essential that the bladder remains relaxed and the urethra remains contracted, so as to allow its capacity to build up. This is possible only when there is normal neurological control involving the brain and spinal cord. When this normal balance exists, urine does not leak out. In situation when one or more of the control elements become disordered, the woman fails to maintain urinary continence, resulting in involuntary loss of urine.

What are the causes of urinary incontinence?

Women may suffer from urinary incontinence as a transient phenomenon or as a progressive pathological condition. Transient urinary incontinence is often seen when a women complains of urinary tract infection, vaginal inflammation or constipation. When a women becomes restricted in physical movements as in the acute phase of a stroke, severe arthritis or Parkinson’s disease, the impaired mobility prevent her normal toileting capacity. Certain medications can cause of worsen urinary incontinence as well. These situations are mostly temporary and continence is usually restored with the resolution of the initial impediments. When the urinary incontinence persists or progresses over time, it implies that the integrity of the continence mechanism has been bridged. It is likely that the bladder, urethra or nervous system has sustained pathological damage. The damage may be a result of:

1 Disruption of the ligament support of the urethra and bladder, usually from multiple child-bearing & labor, assisted or traumatic vaginal delivery.
2 Connective tissue atrophy that accompanies the menopause
3 Further damage to pelvic floor musculature from increasing body weight (obesity), regular and severe abdominal straining from physical weight, constipation and chronic cough.
4 Neurological diseases (stroke and dementia) affecting the central nervous system
5 Chronic lifestyle disease that impact on the normal functioning of the nervous system

Types of urinary incontinence

The leaking of urine occurs when the bladder control mechanism becomes defective. The position and the muscle tone of the water-pipe (urethra) usually keep the urine in the bladder effectively. When this continence device fails, urine flows out of the body at inappropriate times. Urinary incontinence is classified either as:

Genuine stress incontinenc

Loss of urine with coughing, sneezing, laughing or lifting a heavy weight.

Urge urinary incontinence

Loss of urine when the bladder fails to keep the urine in when a strong urge suddenly develops.

Mixed urinary incontinence

A combination of the above two types.

Overflow urinary incontinence

Intermittent loss of urine with the sensation of a full bladder and difficulty in completely emptying it.

Continuous urinary incontinence

Continuous loss of urine through a false passage that is formed between the bladder or the ureter and the vagina.

How does it impact?

The impact that urinary incontinence has on the suffering woman reflects on her anticipated quality of life desired. Urinary incontinence by and large is not a fatal illness; that is, no one dies directly from it. It does definitely has considerable bearing on how she lives her life – at home, at work, socially, financially and psychologically. The age and pre-morbid social and physical activity level affects how a woman copes with the inconvenience of urinary incontinence.

Treatment for Urinary Incontinence

Urine leakage may be mild and infrequent, or it may progress to become excessive and incapacitating. It tends to be severe when two or more types of urinary continence combine to complicate the condition in the same woman. Effective treatment may be prescribed once the cause of the urinary incontinence is determined. Life-style modification, pelvic floor exercises, bladder re-training and surgery have helped many women whose lives were scourged by the condition. The singular hurdle to management of urinary incontinence is the delay and reluctance of the woman to seek treatment. This is understandable because urine leakage is a highly embarrassing complaint that relates to a very private part of the body, and woman rather endures the inconvenience than talk about it. With proper evaluation and applying the apt treatment, success rate of 90% is expected. Women the world over is experiencing new freedom once their bladder function is restored.

What are the available treatments?

There are multiple strategies to manage urinary incontinence. Whether it is conservative measures, medication or surgical intervention, urinary incontinence can be treated according to the types and severity. Via life style changes, bladder retraining and pelvic floor exercises, may urinary symptoms may be obviated. Persistent and discipline suppression of urge restore significant central control on the continence mechanism, thereby improving overactive bladder. Effective contraction of the pelvic floor muscles in a timely fashion helps to reduce many stress leak accidents. Various groups of medications may be used to manage bladder infection, irritation and over-activity. Hormonal preparations are extremely useful in menopausal women with irritating symptoms of the lower uro-genital tract. New formulas have been introduced to treat mild to moderate stress urinary incontinence lately as well. When the condition becomes severe and does not response to conventional therapies, surgical procedures may be performed. It is recognized that surgery is the definitive treatment for severe stress urinary incontinence. Similarly surgery may have to be applied when the bladder has complete loss of control and is giving intolerable grief. It is usually the last form of treatment when all else failed. On the other hand, early access to surgical treatment alleviates tremendous suffering and restores a good quality of living for many years. It is extremely important to discuss this option with the expert before the appropriate decision is reached.

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