Urinary incontinence, defined as any involuntary loss of urine, affects a significant proportion of the population, impacting seriously on sufferers' quality of life. It is not a disease in itself, but rather a symptom of an underlying disorder, and there are a number of different types of incontinence.
The good news, however, is that in many cases incontinence can be cured. In the relatively small percentage of cases where it can't be cured, it can be managed very effectively. This is according to Dr Margaret Fockema, a Roodepoort-based general practitioner with a special interest in incontinence.
According to Dr Fockema, the most common condition frequently, but not always, associated with incontinence is overactive bladder (OAB). According to international statistics, 16 to 20% of the general population suffer from it. Dr Fockema explains further: "As the bladder fills, signals to the brain allow it to interpret the degree of fullness at any time. When the bladder is overactive, however, it contracts, causing the brain to interpret it as full, even when it's not. This results in frequent visits to the toilet with a sense of urgency, but often very little urine."
Quality of life
She also notes that the impact on quality of life for sufferers can be profound. "If you're running to the toilet every 15 minutes, it's going to impact your productivity and your relationship with your employer. It's also going to take its toll on personal relationships – think of the effect on a romantic dinner in a restaurant, for example. We often find that OAB sufferers go in for what we call 'toilet mapping' – in other words, in any public place like a shopping centre they make sure they know where all the toilets are.
"When there is associated leaking of urine, the issues become even more severe. The considerable embarrassment experienced leads to a fear that greatly curtails normal activities. Those affected change jobs frequently, work from home, avoid long journeys and/or always wear black."
"Contrary to perception, OAB is not exclusively a problem of the elderly or of women. Young people suffer from it too, and it affects men and women equally. The specific underlying causes remain unknown, but it is associated with, among others, neurological impairment, diabetes, smoking, spinal injury, multiple sclerosis and high caffeine intake," says Dr Khanyi Mzolo, Medical Director at Pfizer SA.
However, Dr Fockema reassures that there is a diversity of effective treatments for OAB including behavioural treatment, smoking cessation and diet modification. "Being overweight exacerbates OAB, so weight loss is encouraged," says Dr Fockema. "Because constipation can irritate the bladder, it's important to restore regular bowel movements."
'Bladder retraining' is a commonly used strategy. This entails keeping a diary of symptoms, monitoring fluid intake and tracking toilet visits. Patients should suppress the urge to go, thus systematically increasing the time between visits, while at the same time cutting down on fluid intake. "A good rule of thumb is to drink only when you're thirsty," says Dr Fockema, noting that excessive intake of fluid is common and that various myths surrounding this need to be dispelled.
"Bladder retraining can be complemented by physiotherapy involving exercises to strengthen the pelvic floor, which is made up of layers of supportive muscle that hold the bladder in place. There are also very effective medications – the so-called anti-muscarinic or anti-cholinergic drugs. These block the receptors in the bladder responsible for the contractions that precipitate the symptoms of OAB. In severe cases where none of the above works, there are more sophisticated surgical alternatives," adds Dr Fockema.
Other types of incontinence
Dr Fockema adds that while OAB is the most common condition associated with incontinence, there are other types too.
"Stress incontinence refers to the leaking of usually small amounts of urine when coughing or sneezing. It's caused by weakness of the muscles that keep the bladder shut, and often occurs in women following childbirth and men following prostate surgery. It can be treated surgically, or by means of physiotherapy involving pelvic floor exercises.
"Urge incontinence is the need to pass urine urgently and often, with the patient not always reaching the toilet in time. The causes are uncertain, but it can be associated with drug side-effects or excessive intake of drinks that have a diuretic effect. Patients will usually be advised to cut down on these. Pelvic floor exercises can help here too. Medication may also be an option," she says.
She adds that overflow incontinence occurs when the bladder fails to empty properly and urine dribbles out from time to time. "It can be associated with an obstruction and is often seen in men with prostate disease, as well as in people who have worked in situations where the need to frequently hold urine in has caused the bladder to stretch and become flaccid. Once the cause has been determined, patients can be taught special techniques to empty the bladder properly. The use of a catheter may also be necessary."
Dr Fockema says that embarrassment often prevent sufferers from seeking the medical help they need. She encourages them not to suffer in silence. "Talk to your doctor or your pharmacist. It could be the first step toward a more comfortable future."
- (Information supplied by Drs Margaret Fockema and Khanyi Mzolo)
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