Urinary incontinence in women

By Dr Alfred Murage

Urinary incontinence is the involuntary leakage of urine. It is embarrassing and stigmatising, and occurs in women for various reasons.

Nobody should live with incontinence as there are various treatment options that allow the condition to be controlled or completely cured.

Stress incontinence is the commonest cause of incontinence in women. Urine leakage occurs with coughing, laughing, while exercising or having sex.

Stress incontinence is due to weakening of the pelvic muscles, with loss of control of the urethral sphincter mechanism that allows urination when convenient. It is associated with childbirth, damage to pelvic nerves, older age and obesity.

Fistula

Another condition that causes incontinence is called overactive bladder. It is commoner in older women; there is usually an urgent need to pass urine more frequently, even when the bladder is not full. The associated involuntary urinary leakage is called urge uncontinence. Specific bladder conditions can cause urge incontinence, and usually need to be excluded.

Incontinence following labour and delivery is common in developing countries, and is linked to the quality of obstetric services. The condition is referred to as obstetric fistulae.

It occurs when labour is prolonged, and corrective actions are delayed. The baby’s head compresses the urethra and bladder against the pelvic bones. This leads to injury that causes a communication between the bladder or the urethra with the vagina.

Urinary control, is thus, lost, and urine freely leaks through the vagina. In some cases, the rectum may also be injured, with consequent leakage of stool into the vagina. Incontinence can also occur after pelvic surgery following inadvertent injury to the bladder or urethra.

Any woman experiencing involuntary urinary incontinence warrants a medical review. A gynaecological assessment usually identifies the most likely cause of the incontinence. A urine infection must always be excluded, and specialised tests may need to be done to differentiate the different forms of incontinence.

Treatment

General measures can improve both stress and urge incontinence. Pelvic floor exercises, optimisation of fluid intake, stopping smoking, weight reduction and bladder training, can all be beneficial.

Specific treatment may, however, be required. Women with stress incontinence can undergo simple surgical procedures to improve urethral sphincter function. Such procedures are highly successful, with majority of women subsequently remaining dry.

Urge incontinence is mainly successfully controlled by medications, but intractable symptoms may sometimes require complex surgical remedies.

If leakage is due to an obstetric fistula, surgical repair is usually required. Specially trained gynaecologists must do this to increase the chances of successful repair. Subsequent deliveries must be by Caesarean Section to avoid disruption of the repair by vaginal birth. Obstetric fistulae are preventable; every pregnant woman must be encouraged to seek skilled birth attendantes in accessible and well-equipped health facilities.

Stress and urge incontinence are treatable conditions, and no woman should silently suffer the indignity of urinary incontinence.