For many people passing urine is a natural process. When the bladder is full, you feel the urge to urinate, when it is not full, the urge is simply not there. But what happens when there is no control over this process?
Urinary incontinence is the involuntary loss of urine. It is probably the most distressing symptom and has a huge impact on a person’s quality of life. It is associated with loss of confidence, self-esteem, relationship difficulties including marital disharmony, loss of jobs and even depression.
There are two main types of this condition namely stress and urge incontinence.
Stress incontinence is when urine loss is preceded by events such as laughing, sneezing or coughing. In urge incontinence, a person usually has a compelling urge to pass urine which they cannot defer and therefore sometimes leak.
The problem mainly affects women and major risk factors include age, menopause, having had vaginal deliveries and pelvic surgery, especially hysterectomy.
The treatment options available include simple lifestyle adjustments, physiotherapy, medications and surgery.
Before surgery, it is recommended a patient gets a thorough evaluation which may involve specific test called urodynamics which looks at how the bladder is functioning.
Another condition that causes the bladder to contract suddenly and frequently without control particularly when not full is overactive bladder.
Also known as irritable bladder or detrusor instability, patients usually complain of going to the toilet frequently during the day and at night. Sometimes they wet themselves.
This condition is very common but the exact cause is unknown. Whereas in normal circumstances the bladder fills and empties under voluntary control, in an overactive bladder, this happens uncontrollably even when the bladder is empty.
One in six men suffers from overactive bladder and half of these will experience urine leakage. This impacts negatively on the quality of life of patients, their partners and careers.
Simple measures like watching what patients drink, avoiding caffeine containing drinks, alcohol, smoking and exercises can greatly improve this condition.
Medications can be prescribed and on rare occasions surgery is recommended. A continence adviser can also give simple steps (bladder training) that can be taken to improve symptoms of an overactive bladder.
Bladder problems affect all age groups although they become worse as one ages. There is scantiness of local data but elsewhere, the incidence of incontinence is quoted as one in five women and one in nine men. Overactive bladder affects eight to 45 per cent of the general population at some stage in their lives.
Bladder problems cause considerable embarrassment, shame and stigma to the patient.
A survey showed that almost 70 per cent of sufferers put up with symptoms and failed to seek medical advice because they were reluctant to talk spontaneously about their illnesses. On average, it takes four years of enduring the symptoms before patients seek treatment.
Traditionally, urologists used to treat women and men with both lower and upper urinary tract disorders.
It is now recognised that in women many conditions can neither be dealt with by the gynaecologist nor the urologist in isolation. This calls for multidisciplinary team approach working which can improve patient care.
Some gynaecologists have specialised in dealing with disorders of the lower urinary tract (bladder and urethra) and the pelvic floor.
Known as urogynaecologists, they treat women suffering from urinary incontinence, overactive bladder, painful bladder, bladder infections and disorders of the pelvic floor like prolapse and fistulae.
Dr Miheso is a consultant urogynaecologist at the Aga Khan University Hospital.
