When It Comes To Normal Bladder Function, A Couple Of Questions Come To Mind.
1. How Many Times A Day?
A frequency 4-6 pees per day and at maximum 1 pee per night
2. How Much Is Normal?
1-2 cups of urine (250-500mls) each time you pee
3. Can You Hold It Back If Need Be?
You should be able to defer urinating until convenient
4. Is The Stream Strong?
Urine should be passed in a steady continuous stream until bladder is empty
5. Any Drips In Between Pees?
There should be no leakage between visits to the toilet
Stress and Urge incontinence can co-exist meaning you can have both at the same time. The causes for each of them however are very different.
In instances when the abdominal pressure increases like when we are laughing, sneezing, coughing, carrying heavy weights or even walking briskly or jumping, some of us can experience urinary leaks. This is called stress incontinence.
It’s a problem seen in younger women especially after childbirth.
When the pressure in the abdomen exceeds that at the bladder sphincter and if your pelvic floor muscles are not strong enough to compress on the bladder outlet that’s when the urine breaks loose leaving you in an embarrassing situation.
Urge incontinence occurs when an uncontrollable need to void urine occurs due to overactivity of the bladder wall muscle. This tends to occur in the oddest of moments like when you can hear a water tap running or when you’re fiddling with your keys trying to get in the house.
The difference here is, there is generally NO weakness in the pelvic floor muscles or muscles controlling the bladder outlet.
This urge incontinence is sometimes also called overactive bladder syndrome.
..Then There Is The Mixed Stress And Urge Incontinence
Mixed incontinence occurs when there is pelvic muscle weakness and an uncontrollable need to void.
How Common Is Incontinence?
Incontinence is a problem to 35.3% of women. Stress Urinary Incontinence is a problem to 20.8%; Urge: 2.9% and Mixed: 11.6%.
And if you thought incontinence is an issue only for older women or women who have delivered then you thought wrong!
10.9% of women who have never delivered suffer from urinary incontinence.
Management Of Stress Incontinence:
So Stress Incontinence = Weak Pelvic floor muscle
Therefore treatment would involve strengthening these muscle and hence better control of the bladder outlet.
Physiotherapy – can assist with achieving pelvic floor muscle contractions which many women find hard to localise. Control of continence is not achieved if all the muscles around the abdomen, pelvic floor and hips are contracted during the pelvic floor exercise so localised muscle training is needed to gain effect. (And trust me this is easier said than done, hence you need to work with a women’s health physiotherapist to ensure all of these muscles are contracting at the same time.)
How To Contract The Pelvic Floor Muscle
Vaginal Lasers – CO2 lasers – painless effective procedure
Commonly 3 session over 3 months are required to see good improvement in mild to moderate stress urinary incontinence
Platelet Rich Plasma Therapy (PRP) to the Skene glands located just below the urethral opening (an injection of platelet rich plasma delivered to the vulva region)
Vaginal Estrogens – creams or tablets have been shown to provide some control of incontinence
reserved for severe cases in incontinence only
Management of Urge Incontinence:
Bladder retraining – deferment to gradually increase bladder capacity
Urge control strategies (Pelvic Floor muscle contraction with a hold of the contraction, perineal pressure over the urethral outlet, toe pressure (grip floor with toes), distraction strategies)
Pelvic floor exercises
Remove irritants – eg. alcohol & tea & coffee
Anticholinergic medication – to decrease bladder wall muscle over activity
Sacral Nerve stimulation implants – Neuromodulation S2, 3, 4 dermatome
Our Female Doctors are ready to listen to your issues. Visit us at InSync Medical Located along East Coast Road in the heart of Katong, Singapore. We also open on Sundays to Serve you.
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