Urinary Incontinence, UTI, Prolapse of pelvic organs

​The female bladder stores and passes urine at the appropriate time and place. When there are problems with bladder function, the patient will need to visit the toilet often, or is unable to pass urine or even leak urine. 

On the other hand, prolapse of the pelvic organs such as the urinary bladder (urine “bag”), womb, and rectum (back-passage) is very common and occurs in more than 10% of women. 

Urinary Frequency and Urgency 

Urinary frequency is the need to pass urine for mo​re than seven times during the day or less than every 2 hourly. 

Urgency is a strong and sudden desire to void which, if not relieved immediately, may lead to urge incontinence. 

Urge Incontinence is an involuntary leakage of urine, usually preceded by urgency. 

​What are the common causes of frequency and urgency?​

​​Classification Causes​
​Psycho-social​Excessive drinking
Habit
Anxiety​
​Urological​Urinary tract infection
Detrusor (bladder muscle) over-activity
Bladder tumor
Bladder stones
​​Gynecological​
Pregnancy
Bladder prolapse
Pelvic mass, e.g. fibroids​
​Medical​Diuretic therapy
Diseases of the brain/spinal cord
Diabetes​

​

What to do if you have urinary frequency and urgency? 

​You should visit you family doctor. The doctor will then ask you a few questions on your medical history and urinary habits. After a physical examination, he/ she may perform a few simple tests such as collecting your urine specimen for analysis to exclude urinary tract infection. Depending on the cause of your condition, the doctor may start you on medication or refer you to a specialist for further management. 

Urinary Incontinence 

Urinary incontinence refers to an involuntary loss of urine.

Types of incontinence includes: 

  • ​​Stress urinary incontinence — involuntary loss of urine associated with coughing, sneezing, carrying heavy things and even running or jumping. 
  • Urge incontinence — involuntary loss of urine preceded by a sudden strong desire to pass urine and voiding before the ability to reach the toilet. 
  • Overflow incontinence — involuntary loss of urine due to an inability to empty the bladder well. 

What should you do if you have urinary incontinence? 

Mild urinary incontinence may not be troublesome, but moderate to severe urinary incontinence can affect the quality of life of the woman drastically. It can also cause social and hygiene problems. ​

​These women should seek help from their doctor. Management depends on the type of incontinence and the severity of the condition. ​

Management of urinary incontinence 

Regularpelvic floor exercises​ can be performed to improve the incontinence for mild cases. 

In severe cases of stress urinary incontinence, surgical correction by your gynecologist should be considered (Table 52.1). 

Table 52.1 Management of Incontinence

​​Types of
incontinence
 ​Management​Comments
​Stress urinary
incontinence
​		​Pelvic floor exercises​This is helpful in mild stress incontinence
with success rate of 50%–60%.​
​Continence surgery​There are many types of continence procedures but the gold standard is the suburethral sling procedure (Figure 52.1).
It involves a minimally invasive procedure, which can be performed as a day surgery procedure. Its success rate is about 90%.
​Urge incontinence​Oral medication​Medication will relieve the symptoms in 80%–90%.
​Overflow
incontinence
May require clean intermittent ​draining of urine or placement of continuous urine catheter (tube).
​May be prone to urinary infection.​​


​

Urinary Tract Infection (UTI) 

UTI is due to the presence of bacteria in the urine. UTI can be divided into either upper tract infection (kidney) or lower tract infection (bladder). 

Pyelonephritis is the acute bacterial infection of the kidneys. Patients have severe back pain and high fever. There may be presence of frequency and urgency of urine as well. 

Cystitis is the infection of the urinary bladder and patients complain of frequency, urgency and dysuria (pain on passing urine). 

What should you do if you have a urinary tract infection (UTI)? 

General measures for simple cystitis include ​taking fluids of more than two litres a day to encourage more urine formation to flush out the bacteria. 

You would need to consult a doctor if the symptoms persist or if you have a fever. Oral antibiotics prescribed by the doctor would eradicate 90% of infection in a normal person. The doctor may order some investigations relevant to your condition if necessary. 

Patients having severe UTI associated with fever and kidney infection may require intravenous antibiotics and hospitalisation. ​

​

​Uterovaginal Prolapse 

What is uterovaginal prolapse (UVP)? 

This is the protrusion of the pelvic organs (bladder, uterus and rectum) down into or out of the vagina. Patients usually complain of feeling something heavy at the vagina or sensation of a lump protruding out of the introitus. 

There are different degrees of severity as shown in the diagram below (Figure 52.2). ​

What are the causes of uterovaginal prolapse (UVP)? 

How can I prevent uterovaginal prolapse (UVP)? 

The risks of UVP may be reduced by: 

Management of uterovaginal prolapse (UVP) 

The patient complains of a lump at the introitus. She would not be able to differentiate whether the protruding organ is the bladder (cystocele), womb or rectum (rectocele). The doctor needs to perform a pelvic examination to ascertain the site and degree of the prolapse. 

Conservative measures include using a ring pessary and local hormone therapy. However, the use of the ring pessary may be associated with vaginal infection or ulceration of the vagina leading to vaginal discharge or bleeding. 

Surgery is presently the treatment of choice for pelvic organ prolapse unless patient is not fit for surgery. 

Conservation of the uterus is possible if the patient chooses to keep her womb. 

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Acknowledgement

​Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.