Health Files

Urinary incontinence

What is urinary incontinence?
It is the involuntary leakage of urine which causes a hygiene or social problem.

How common is the problem?
It is estimated to affect 5-15% of the elderly persons living in Singapore.

Can urinary incontinence in the elderly person be considered as part of the normal ageing process?
Even though there are some changes in the bladder and the urinary tract which are associated with ageing and which make the elderly person more prone to urinary incontinence, the problem is not and should not be considered as part of ageing.

So what are the causes of urinary incontinence?
The causes can be generally divided into 2 groups:

Transient causes: these are causes which are usually reversible if treated.
They can be represented by the mnemonic "Diapers" in which the "p" and "e" each represent 2 groups of causes.

D Delirium; This is a state of confusion which can be due to many problems such as serious infection, side-effects of medications, etc.

I Infection of the urinary tract which can result in irritation of the bladder and increased frequency of urination.

A Atrophic vaginitis; this is a condition characterised by dryness of the vagina as a result of the drop in the hormone estrogen in the body following menopause, that is, permanent cessation of the periods.

P Psychological problems such as severe depression in which the person may ignore the urge and lose the motivation to even go to the toilet.

P Pharmacological causes meaning the adverse effects of medications. Common medications which can result in urinary incontinence include certain medications
for high blood pressure, certain medications for depression and medications that cause sedation.

E Endocrine problems such as diabetes which result in increased urine production if the diabetes is not well controlled.

E Environmental causes such as unfamiliar environment, poor access to toilet, inconducive toilet facilities or lack of privacy in which case the person may hold on to the urine until it leaks.

R Restricted mobility such as caused by stroke or joint problems. The problem may range from not being able to get to the toilet or not being able to unzip the trousers in time due to poor manual dexterity.

S Stool impaction which is caused by severe constipation.

Established causes: these are causes which are more long-term and may not be removable. However, with appropriate management, the person affected can be kept continence as far as possible. The causes can be classified based on the different patterns of incontinence:

Urge incontinence:
The involuntary leakage is associated with a strong urge to pass urine. It is commonly due to an "unstable bladder" which can be caused by conditions such as stroke, Parkinson’s disease, etc.

Stress incontinence:
The leakage of urine is related to physical activities which strain the abdominal muscles such as coughing, sneezing, lifting of heavy objects, climbing of stairs, etc. This condition is more common in the female population and is usually associated with weakened pelvic muscle related to multiple births and menopause. In the male population, it may be related to certain surgical procedures.

Overflow incontinence:
The leakage is associated with over-distension of the bladder. It can be either due to obstruction of the outlet of the bladder, for example, by an enlarged prostate in the male population or due to problem of the nerves supplying the bladder resulting in poor contraction of the bladder, for example, in patients with diabetes.

What are the problems associated with urinary incontinence?
These include:
It can be the manifestation of some serious problem which needs to be treated.
It can cause problems with hygiene and disease of the skin which comes into contact with the urine.
It can cause embarrassment and social isolation. These can result in depression.

Where to seek help if you or a family member has this problem?
Very often, the elderly person may not complain about this problem and suffer silently. This may be due to the lack of understanding of the problem and attributing it to something which is part and parcel of ageing, embarrassment or not knowing where help is available.

Seek help from the Polyclinic’s doctor or your family physician. Referral to the continence clinics at the hospitals including Tan Tock Seng Hospital, Alexandra Hospital or Kandang Kerbau Women’s Hospital or at the Senior Citizen’s Health Care Centres can be made if necessary. Alternatively, you can call the Society for Continence Helpline at 787 0337 for professional advice.