Urinary Incontinence: Cure Exists

Edith suffered silently. Everyday posed a greater challenge than the previous and she constantly suffered shame and stigma.

It all started after the delivery of her first child. The episiotomy (a surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour) that saved the life of her beloved son turned out to be the cause of all her troubles.

"I had suffered incontinence for 10 years. It started after the birth of my son in 1990. Telling people about my experience is embarrassing; I would be standing and discover my shoes full of urine," she said.

The business meetings she used to chair now became a nightmare, calling for a recess after every few minutes to go and answer a call of nature. Her annual vacation to Mombasa became a thing of the past due to the embarrassing situation she had to endure all the way to the Coast, especially if she was travelling by bus. Having to stop the driver every now and then was not her cup of tea.

Her relationship with her husband became strained as she frequently passed urine during intimate moments causing her tremendous emotional distress. The risk of public embarrassment kept her from enjoying many activities with family and friends. Her self esteem took a downward plunge with the knowledge that she had to make do with diapers. Moreover, the diapers were causing her skin irritation and sores.

Two women standing outside KNH Casualty

Fortunately for her, she found out that the problem that had almost destroyed her life was curable.  She was suffering from urinary incontinence.

According to Dr. Martin Mutua, a gynecologist at Kenyatta National Hospital, millions of women experience involuntary passing of urine called urinary incontinence (UI).

“Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. During urination, muscles in the wall of the bladder contract forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine,” the doctor said.

Some women may pass a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. The disease can be slightly bothersome or totally debilitating.

Women experience UI twice as often as men due to the structure of the female urinary tract, pregnancy and childbirth

“It is more common in women mainly because of tearing experienced during childbirth, especially if the woman gives birth without the supervision of a qualified birth attendant,” Dr. Mutua said.

Dr. John Ong’ech, the head of the Gynecology and Obstetrics department at the hospital, reiterated this, adding that prolapse of the uterus and menopause also cause one to be susceptible to incontinence.

“When a woman reaches this stage, she stops producing hormones, predisposing her to urinary tract infections and subsequently incontinence,” he said.

But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.

There are many types of incontinences, but fortunately, all are curable. For some people, coughing, laughing, sneezing or other movements that put pressure on the bladder may be a cause for leaking. This is called stress urinary incontinence.

If you pass urine for no apparent reason after suddenly feeling the urge to urinate, you may have urge incontinence. Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower).

Another type of incontinence is functional incontinence which normally occurs in people with medical problems that interfere with thinking, moving, or communicating. A person with Alzheimer’s disease (a degenerative disorder that affects the brain and causes cognitive and intellectual deterioration), for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may also have a hard time getting to a toilet in time.

KNH Signboard to Fistula Care Unit

Overflow incontinence happens when the bladder doesn’t empty properly, causing it to spill over. Weak bladder muscles or a blocked urethra can cause this type of incontinence.

Nerve damage from diabetes or other diseases can lead to weak bladder muscles. This form of incontinence is more common in men than in women.

Transient incontinence is a temporary version of incontinence, normally triggered by medications, urinary tract infections, mental impairment, and restricted mobility. Severe constipation can cause transient incontinence when the impacted stool pushes against the urinary tract and obstructs outflow. A cold can also trigger this incontinence, which resolves once the coughing spells cease.

Dr. Ong’ech asserted that treatment is available for people who suffer incontinence.

“The hospital, in collaboration with AMREF holds free medical camps every year, where patients undergo corrective surgery to repair fistulas which cause incontinence,” he said. 

He further added that the hospital has been engaging in sensitization and outreach programs in order to reduce the stigma associated with the condition.

Treatment of incontinence involves both behavioural and medical remedies. One behavioural remedy is bladder retraining. This involves making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As one gains control, they can extend the time between scheduled trips to the bathroom.

Kegel exercises can also enhance treatment of incontinence. This involves squeezing the pelvic muscles making them strong enough to hold urine. This process is repeated severally, but one must be careful not to overdo it. The best position for Kegel exercises is lying down because the muscles don’t need to work against gravity. When the muscles get stronger, one can do the exercises while sitting or standing.

Medical remedies are also available and one only needs to see a doctor who can advise them on which remedy to take up, depending on the type of incontinence.

For instance, there is biofeedback which uses measuring devices to help the patient become aware of his/her body’s functioning. The patient can gain control of these muscles by using electronic devices or diaries to track when the bladder and urethral muscles contract.

Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Neuromodulation is another medical remedy which is used in instances where urge incontinence does not respond to behavioral treatments or drugs. It involves stimulation of nerves to the bladder leaving the spine. Although neuromodulation can be effective, it is not for everyone. The therapy is expensive, involving surgery with possible surgical revisions and replacement.

KNH Hospital View

In some women, the bladder can move out of its normal position, especially following childbirth. Surgeons have developed different techniques for supporting the bladder back to its normal position.

If one is incontinent because their bladder never empties completely or cannot empty because of poor muscle tone, past surgery, or spinal cord injury, one might use a catheter to empty the bladder. This remedy is called catheterization. A catheter is a tube that can be inserted through the urethra into the bladder to drain urine. One may use a catheter once in a while or on a constant basis, in which case the tube connects to a bag that can be attached to the leg. If using an indwelling—long-term—catheter, one should watch for possible urinary tract infections.

Aside from the remedies, many women manage urinary incontinence with menstrual pads that catch slight leakage during activities such as exercising. Also, many people find they can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol. There is no need for embarrassment. After all, all types of urinary incontinence are treatable at all ages.


Acknowlegement:LOUIZA KAMAU