HEALTHNET

Urinary incontinence (Part 2)

There are five types of urinary incontinence.

(Posted on 11 January 2007)

There are five types of urinary incontinence:

Stress incontinence is the most common type of urinary incontinence and happens when a person leaks urine when they cough, sneeze, exercise or do anything that puts pressure on the bladder.

Urge incontinence occurs either when the bladder muscles are too active or the neurological functioning is unable to coordinate the bladder muscle and the sphincter leading to unstable contractions. People with urge incontinence lose urine as soon as they feel a strong desire to go to the bathroom.

Overflow incontinence is either caused by conditions of urological or neurological disorders which may subsequently weaken the contractility of bladder muscles; or prostate enlargement which may result in urethral blockage, causing the quantity of urine to exceed the bladder's capacity to hold it.

Functional or environmental incontinence occurs when people who have conditions such as physical or psychological disabilities cannot get to the toilet or get a bedpan when they need it.

Mixed incontinence is the combination of stress and urge incontinence.

UI can be treated in one or more of the following ways:

1. Elimination of precipitating factors such as obesity, constipation, urinary tract/bladder infection etc.
2. Bladder training
   People are taught to "hold on" for increasing amounts of time and to void at regular, scheduled intervals. This technique teaches patients to resist the urge to void and gradually expands the intervals between voiding.
3. Pelvic muscle exercises & physiotherapy
   They involve contracting the muscle of the urethra, vagina and rectum for a period of time and then relaxing them. These techniques can strengthen the muscles around the vagina and urethra. In addition to pelvic muscle exercises, biofeedback training commonly offered by physiotherapist can also help exercise and strengthen the pelvic muscle.
4. Medications
   Stress incontinence may be treated with alpha-adrenergic agents (e.g. phenylpropranolamine, pseudoephedrine, and imipramine) that increase the maximum contractility of the sphincters at the bladder neck and urethral closure pressure. In addition, hormone replacement therapy such as conjugated oestrogen is capable of facilitating urinary storage in postmenopausal women by increasing the urethral outlet resistance, and has an additive effect with alpha-adrenergic therapy.
   Urge incontinence may be treated with anticholinergic agents (e.g. oxybutynin, flavoxate, imipramine, propantheline, dicyclomine, and tolterodine) that directly relax the overactive bladder muscle and thus increase bladder capacity.
   Overflow incontinence may be treated alpha1-blockers (e.g. prazosin, doxazosin, or terazosin) and bethanechol that improve the symptom of urinary retention in overflow incontinence.
   
5. Surgery
   Surgery is indicated for severe types of UI and those complicated by conditions such as atrophy of bladder muscles and prolapsed uterus. Common surgery involves pulling the bladder up to a more normal position, and securing it with a string attached to sphincter muscle, which may eventually alleviate UI as well as the condition of prolapsed uterus in women.

Source: Hong Kong and Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong

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