Know the do’s and don’ts of the most common types of urinary incontinence – stress incontinence and urge incontinence.
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Despite the fact that about 20 per cent of local women below the age of 40 suffer from urinary incontinence at least once in their lives, it remains an issue that frequently gets swept under the rug. “Many people are unaware it’s a problem because they’re too shy to talk about it. Even doctors may brush it off as a natural part of ageing and advise that nothing can be done,” says Dr Christopher Chong, urogynaecologist at Singapore Urogynae Centre.
Treatment for urinary incontinence depends on the type of incontinence as well as the severity and cause of the condition. Here’s how you can relieve – and prevent! – the most common types of urinary incontinence with simple lifestyle changes.
Symptoms include… Leaking pee when you laugh/cough/sneeze
Don’t be embarrassed; you’re not alone. Stress incontinence happens as the “door” of the bladder cannot close fully when one strains, says Dr Chong. This is the most common type of incontinence among women here, according to the Health Promotion Board (HPB). It occurs when pelvic floor muscles – the ones that hold up the bladder, rectum and vagina – weaken due to pregnancy and childbirth, low oestrogen levels, obesity, and/or heavy lifting.
How to treat stress incontinence: Exercise
Dr Koh Li-Tsa, associate consultant at the department of urology at Changi General Hospital, recommends swimming, as water’s natural buoyancy can reduce the amount of stress on the pelvic area. Avoid physical activities like jumping or running, which can worsen the symptoms when pelvic floor muscles are already weakened. “This means any slight movement can press on the bladder and cause unwanted leakage,” explains Dr Koh.
Alternatively, try kegel exercises, which require you to squeeze pelvic floor muscles as though you’re trying to stop your urine flow. Experts generally recommend completing three sets of 10 one-second contractions, followed by one set of 10 five-second squeezes a day. If you can’t keep to this routine, just do the exercises as often as you can, says Dr Chong.
What to avoid if you have stress incontinence: Strain
Chronic constipation can be a real pain, but you should learn to relax as the rectum shares many of the same nerves as the bladder. This means chronic straining can cause irritation to both the rectal and bladder muscles. According to Dr Chong, this can lead to an overactive bladder with lowered capacity – from the usual 400ml to just 200ml.
So don’t force yourself to clear your bowels every morning unless you have to, adds Dr Chong. It can lead to pelvic organ prolapse and urinary incontinence in the long run. Meanwhile, take steps to prevent constipation by consuming between 18 and 30g of fibre (about three medium-sized guavas) each day, recommends the National Health Service (UK). Besides vegetables and fruits, prune juice and stool softeners can also help.
Symptoms include… A sudden need to pee
This could be your problem if you are generally unable to hold your tinkle for more than a few minutes once you feel the urge. Although the exact cause is difficult to establish, risk factors typically include recurrent urinary tract infections (UTI), trauma to the bladder, previous surgery, and pelvic organ prolapse (when pelvic organs fall from their normal position).
How to treat urge incontinence: Hold it in
Don’t get into the habit of going to the loo “just in case”, especially if you’ve no urge to. It’s better to let the bladder fill up completely first. Holding it in – as long as it’s within a comfortable and reasonable limit – can help you better control the pelvic floor muscles, says Dr Chong.
But don’t keep it in for too long; it shouldn’t get to the point where it becomes urgent to go. Besides overstretching the bladder muscles, it could also cause UTI if urine flows backward into the bladder, kidney or urethra (the tube that passes fluid out of your body). These could lead to an overactive bladder in the long run, says Dr Chong.
Train your bladder by postponing bathroom visits by five minutes whenever you first feel the peeing sensation, suggests Dr Koh. Do this at home for a week, and if successful, delay the visit to the toilet by 10 minutes the following week. The aim is to gradually condition the bladder so that it is able to hold about 200 to 350ml of urine comfortably before you feel the urge to go, explains Dr Koh. This roughly translates to peeing once every three to four hours.
UTI can irritate the bladder and cause urge incontinence. If you get frequent UTIs, it means the problem has not been treated completely. Besides drinking more water to flush bacteria out of the body, it’s important to do a urine culture test to determine the cause for treatment. “There are many different types of bacteria. Knowing the exact strain will help doctors prescribe the right antibiotics, which is crucial in preventing recurrent UTIs,” says Dr Chong.
What to avoid if you have stress incontinence: Drink several cups of coffee
Caffeinated beverages like tea and coffee are diuretics, explains Dr Chong. This means they increase the volume of urine in the body. If the bladder is already inflamed (usually due to bacterial infection or certain medications), caffeine can irritate it further and increase your need to go to the loo. In some instances, this can lead to urge incontinence, so stick to one cup in the morning if you must, advises Dr Koh.
>> Next: How do you know if you have urinary incontinence?