By Dr Pius Musau
We have all had our moment under the sun when the urinary bladder acquired a mind of its own and decided to open at a socially inappropriate moment. Urinary incontinence is a common occurrence among both men and women. But what does a weak bladder tell us from a urological perspective? Here are the key types of a weak bladder.
Urge incontinence: Is when you are so pressed that you can no longer hold back urine. It may be due to inflammation of the bladder because of an infection, an early bladder cancer or sensitivity of the nerves that supply the bladder making it hyperactive.
Stress incontinence: Women are more likely to experience this problem due to their pelvic anatomy and the vagaries of child labour. This type of incontinence is associated with a rise in abdominal pressure as in giggling, coughing, squatting or sneezing.
Mixed type of incontinence: The two preceding types can combine and usually the dominant signs and symptoms are addressed accordingly.
Overflow incontinence: This condition can affect either an elderly man with prostate disease or a young man with a urethral stricture or other possible causes of obstruction. Pressure in the bladder builds up to sufficient levels that overcome the obstruction and akin to the overflow in a toilet cistern, the urine leaks out.
Continuous incontinence: This problem is present at all times. It suggests that communication with other passages has bypassed the sphincter mechanisms. Example is obstructed labour that leads to Vesicovaginal fistula (VVF).
Diagnosis: The diagnosis is based on an elaborate history and physical examination. Tests and diagnostic procedures may be required depending on the type and underlying cause. Laboratory tests include urinalysis, tumour markers, prostate specific antigen, and urea and electrolytes levels in the body. The imaging tests include a voiding cysto- urethrogram and plain X-ray and CT scan.
Diagnostic procedures include a cystoscopy and urodynamic studies that give the necessary information on the possible contributing factors in the bladder and the urethra.
With the heightened awareness on cancers, it is imperative that one consults a competent clinician early enough.
Treatment: It may be supportive or definitive depend on the type of incontinence and the underlying cause. Except for those that are self-limiting that may respond to medication and pelvic exercises, some form of surgery is necessary in the rest.
The writer is a lecturer at the department of surgery, Moi University, Eldoret