Leaky bladders: Malaysian specialist discusses risk factors, treatment options

Milad Hassandarvish
Urinary incontinence is the unintentional passing of urine mostly affecting women. — Picture from Pxhere.com

KUALA LUMPUR, Nov 26 — Urinary incontinence is an embarrassing health complication that stops some people from leaving the house or even keeping a relationship.

Yet, many people choose to bear the consequences of the complication as they find it too embarrassing to seek doctor’s attention about their symptoms, said Gleneagles Kuala Lumpur Hospital consultant urologist Dr Warren Lo Hwa Loon.

Describing the life-altering condition, Dr Lo said urinary incontinence is the involuntary leakage of urine, where control over the urinary sphincter is either lost or weakened.

According to him, urinary incontinence can occur at any age for any number of reasons, and is three times more common among women than men.

However, the good news is that there are many options to effectively treat the illness.

Dr Lo said the first step in determining what treatment option was right for the patient was to diagnose them with the correct type of urinary incontinence.

Gleneagles Kuala Lumpur Hospital consultant urologist Dr Warren Lo Hwa Loon talks about the various types of urinary incontinence. — Picture by Choo Choy May

He added that there were four main types of incontinence: stress, urge, mixed and overflow.

Stress Incontinence

If urine leaks out when you cough, giggle, or laugh out loud, Dr Lo said you likely have stress incontinence.

According to him, the condition occurs when the pelvic floor muscles have been weakened or damaged and cannot hold in urine.

Urge Incontinence

As the name dictates, Dr Lo said urge incontinence is when you get a sudden urge to pass urine immediately followed by leaks before you can reach the restroom.

He added that the main cause of stress incontinence is due to relaxed pelvic floor and increased abdominal pressure, while urge incontinence is the result of bladder insensitivity from infection and neurological disorder.

Highlighting the difference between the two types, Dr Lo said stress incontinence is due to the weakening of the pelvic floor, which has no medications to strengthen it.

“The only way is to exercise the muscle and if it doesn’t work, surgical procedure will be the last resort.

“But for urge incontinence, there are medications to relax the bladder, and for more severe cases, surgical procedures may be considered,” he said.

Mixed Incontinence

According to Dr Lo, if you have symptoms of both overactive bladder and stress incontinence, you likely have a combination of both types called mixed incontinence, which is the commonest type among women.

Overflow Incontinence

Most common among men, Dr Lo said this occurs when a person is unable to empty their bladder completely and it leaks due to overflow.

He added that overflow incontinence occurs when something blocks urine from flowing normally out of the bladder, as in the case of prostate enlargement among elderly men that partially closes the urethra (the tube that carries urine from the bladder to the outside).

Prostate-related conditions may often lead to overflow incontinence in men. — AFP pic

“The reason why men more frequently are diagnosed with overflow incontinence than women is because it is often caused by prostate-related conditions,” he added.

Dr Lo also said that underactive bladder could be due to other illnesses such as dementia, Parkinson’s disease, stroke, Alzheimer’s disease or spinal cord injuries that affected the nerves connected to the brain.

“This is because the bladder contractility is governed by the nerves that goes from the back all the way up to the brain,” he added.

What causes urinary incontinence?

According to Dr Lo, damage to the nerves, muscles and connective tissues of the pelvic floor can be the cause of stress incontinence, which can often happen when physical activities or pressures such as chronic cough and constipation or heavy exercises such as weight-lifting puts lots of stress on the bladder.

He also pointed out that women who have had two or more vaginal deliveries or hysterectomy were more likely to experience incontinence.

“The bladder, uterus and rectum is held together by the pelvic floor muscle but if you constantly want to challenge the pelvic floor muscle by multiple deliveries or hysterectomy, the nerve gets damaged and the pelvic floor will be destroyed.

“Weakened pelvic floor may also result in bladder prolapse or rectum prolapse inside the vagina due to the lack of support from the pelvic floor,” he added.

Diagnosis

To accurately diagnose urinary incontinence and the type, Dr Lo advised patients to go for urodynamic or bladder function study to assess how the bladder and urethra are performing their job of sorting and releasing urine.

He said it was imperative for the patients to go for a thorough examination to correctly determine the type of urinary incontinence as symptoms of the condition may sometimes be vague.

“For instance, urinary tract infection(UTI) can often present symptoms of overactive bladder with urge incontinence, therefore, it is important to check if the patient is free of UTI before the doctor orders any treatments,” he added.

Treatment

Treatment for urinary incontinence mainly depends on the type of incontinence, its severity and the underlying causes, but the good news is that there are various invasive and non-invasive procedures to correct or improve the condition.

For some cases, Dr Lo said the doctors may recommend pelvic floor exercises to strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum.

For those with Stress Urinary Incontinence, Dr Lo said tension-free virginal tape was often used to close the urethra and bladder neck.

“We’ll use the net-form tape (synthetic mesh) to hitch up the bladder to its original position so that when the patient coughs or sneezes, they don’t leak,” he said.

Dr Lo added that the technique could also be done for men, which is called “sling procedure”.

The procedure requires a minimally-invasive surgery which takes about half-an-hour.

Artificial urinary sphincter is an implanted device to treat moderate to severe stress urinary incontinence. — Picture by Choo Choy May

Apart from that, Dr Lo said Artificial Urinary Sphincter is also often used to treat moderate to severe urinary incontinence, especially for those who have continuous flow of leak.

“This is common among men who have gone through prostate cancer surgery,” he added.

The handy device, which comes with a cuff, control pump and reservoir, is to supplement the function of the natural urinary sphincter that restricts urine flow out of the bladder.

In a minor surgical procedure, Dr Lo said the small fluid-filled cuff will be implanted around the urinary passage and the pump will be placed in the scrotum beside the testicles (or in the labial for women), while the reservoir will be placed up next to the bladder.

“To urinate, just press the pump and the fluid in the cuff will rush up to fill up the reservoir, opening the passage to pass urine,” he added.

For those who can’t undergo invasive surgery under general anaesthesia, Dr Lo said they may opt for “bulking agent” injection.

“The procedure involves injecting silicon in the urethra wall to tighten the wall and hold urine inside the bladder.

Dr Lo said botox injections may also be considered for those with overactive bladder to paralyse some of the nerves and ease the symptoms such as severe urgency and inability to delay urination.

Alternatively, he added, patients may opt for the Percutaneous Tibial Nerve Stimulation (PTNS) procedure to modulate the bladder contraction by sending electrical impulses to the nerves that control the bladder.

“The procedure can be done weekly for 12 weeks and it would last for three years,” he added.

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