Mom and Dad’s Untold Secret – Urinary Incontinence

Last week I met a middle-aged patient who had rashes and itch on the skin of her lower body. After a detailed inquiry, I found out that she had mild urinary incontinence and often used sanitary pads and diapers.

My mum had also suffered from urinary incontinence a few years back. I remember taking days off my job to take care of her during the period in which she spent time and effort on improving her health and treating the symptom. Do you know what urinary incontinence is?

Urinary incontinence is a common symptom among people above the age of 40, and is more common among women. However, adults are often embarrassed to voice out their problems regarding urinary incontinence. Urinary incontinence can affect daily life in the simplest of activities. Simple reactions like laughter and coughs can also cause involuntary urination. Urinary incontinence patients may drink less water to avoid urination, or avoid going out due to the anxiety of their conditions being noticed by others. In some cases, involuntary urination could also occur during sexual intercourse. If left untreated, urinary incontinence can undoubtedly affect the lifestyles of patients.

How to know if your parents have urinary incontinence:

1. If you can smell urine when you pass by your parents or their room
2. If you notice your parents frequently visit the toilet or change sanitary pads/diapers
3. If you notice your parents frequently wash or dry their pants/trousers and mattresses

If your parents show the above signs, there is no cause to panic! Juliet shall teach you a few steps on how to reduce symptoms of urinary incontinence. Before that, let’s understand what urinary incontinence is.

What is urinary incontinence?

There are 5 different types of urinary incontinence:

1. Overflow Incontinence

Symptom(s): Invluntary urination without feeling any urge to urinate

Cause(s): Weak bladder contraction or urethral obstruction (for men) cause an overfull urinary bladder without the urge to urinate.

Common patients: Men with prostatic hyperplasia (enlarged prostate gland); women who have undergone hysterectomy (removal of all or part of the uterus)

2. Genuine Stress Incontinence

Symptom(s): Increase in abdominal pressure (e.g. cough, laughter, sneeze, running, lifting heavy objects) cause involuntary urination or urine leakage without feeling the urge to urinate, usually in small amount. Most common type.

Cause(s): Abdominal pressure causes relaxation of the pelvic muscle, resulting in less or no control of bladder.

Common patients: Women, especially after childbirth (3rd child and beyond/had a huge foetus); women who have undergone menopauseMen or women with obesity or frequent coughing.

3. Urgency Incontinence

Symptom(s): Frequent urination (more than 8 times during daytime, more than twice during sleep at night)

Cause(s): Damage on the nerves around the bladder, causing a need to urinate as soon as there is a mild urge to do so.

Common patients: People with urethra or bladder infection; diabetic patients; stroke patients; people who have had spinal nerve damage, people with overactive bladder or inconsistent contraction of bladder

4. Functional Incontinence

Symptom(s): Inability to urinate due to physiological problems or disabilities despite having a normal urge to urinate

Cause(s): Disability of certain organs or parts of body

Common patients: Disabled people; elderly Alzheimer’s patients; Osteoporosis patients

5. Mixed Incontinence

Symptom(s): Mixed symptoms of genuine stress incontinence and urgency incontinence

Now, you know that urinary incontinence is a symptom, not a disease. So let’s take a look at how we can treat or prevent these symptoms!

1.Diet

• Avoid alcohol and caffeine (e.g. coffee, Coke, tea)
• Caffeine and alcohol can cause diuresis, which is the increased or excessive production of urine
• Avoid spicy food (e.g. chilies, curry)
• Spicy food can stimulate the bladder and cause frequent urination
• Take dietary fibre to keep bowel movement smooth – constipation can cause abdominal pressure, which induces genuine stress incontinence

2.Weight control

• Studies have shown that weight loss is especially effective in treating genuine stress incontinence

3.Sanitary pads/diapers

• Choose from a selection of sanitary pads or adult diapers from the market, specifically those designed for urinary incontinence with better absorption of smell and liquid
• It is important to frequently change the sanitary pads or diapers to prevent moisture accumulation and infection (e.g. Haemorrhoids).

4.Medication

• Doctors usually prescribe medications based on the situation and seriousness of the symptoms (e.g. medications to relax the bladder for urgency incontinence; medications like oestrogen ointment for genuine stress incontinence)

5.Training/practice

• Bladder training
  If you visit the toilet more than 8 times during the day, you may have an overactive bladder. While this does not necessarily mean that you have urinary incontinence, you can practise to reduce urination frequency. Normal urination occurs every two to three hours. If you feel the urge within an hour, practise holding it in by focusing on some other things, but not for too long. Start with about 15 minutes, then slowly increase the time gap between each urination.
  
  Try not to drink too much water within a short time, but be careful not to get dehydrated! Concentrated urine can stimulate the bladder or cause infection.
   
• Kegel exercise (also known as pelvic exercise)
  Kegel or pelvic exercises can increase pelvic strength and endurance. This exercise is useful for people experiencing frequent urination, urinary incontinence, women experiencing uterine prolapse (muscles unable to support uterus), and men experiencing premature ejaculation.

1. Lie down flat. Bend knees to shoulder’s width.
2. Lift buttocks and thighs upwards, contracting pelvic muscles for 10 seconds. Lie back down and rest for 10 seconds.
3. Repeat 10 times for 1 set. Do at least 1 set daily, and you’ll see the results of the exercise after 2 to 3 months.

This exercise is especially useful for genuine stress urinary inconsistency patients.

6.Treat your cough symptoms

• Cough symptoms can be caused by many different reasons. Since coughs can worsen conditions for genuine stress incontinence, Juliet recommends that you seek medical advice to cure your coughs!

7.Surgery

• Surgery is not a necessity for urinary incontinence, as it does not guarantee a success in recovery and may cause side effects or complications. It is recommended to discuss with your doctor in detail before attempting a surgical treatment. If other methods haven’t worked, you can consider the any of following surgical treatments: bulking agent/collagen injection, artificial urinary sphincter, anterior vaginal repair, or bladder neck suspension.

Juliet understands that sometimes our parents can be too stubborn or embarrassed to seek medical treatment. However, we should take our time to talk to them about any problems that they are facing to help them in the best way that we can. Have you talked to your parents today?

Juliet’s Reminder：Urinary incontinence does not only affect the elderly. Baby movements in the wombs during pregnancy can also cause some internal damage and lead to urinary incontinence after childbirth. If the incontinence continues for more than 3 months after childbirth, do seek for medical advice immediately! If you have any stories to share or any questions to ask, just leave a message for Juliet at juliet@erufucare.com!