What is urinary incontinence?

Urinary incontinence arises due to poor bladder control. This is a prevalent but embarrassing issue. The severity of urinary incontinence may be the slow leakage of urine or sudden urge to urinate with leakage before one gets to the toilet. In some instances coughing and sneezing, can result in the dripping or slow leaking of urine.

There exist various forms of urinary incontinence, such as the following:

• Stress incontinence: Urine unexpectedly leaks when pressure is exerted on the bladder, such as lifting weights, exercising, laughing, sneezing, and coughing. Stress incontinence occurs from the sudden loss of urine due to high intraabdominal pressure that affects the patient’s lifestyle and life quality.
• Urge incontinence: Urge incontinence is one of the primary forms of urinary incontinence that leads to the frequent urge to urinate, often due to the uncontrollable loss of urine.
• Overflow incontinence: Overflow incontinence is the increased urge to urinate due to incomplete bladder emptying (i.e. the bladder is always full) with only a slow release of urine from the bladder. Then, slowly, urine trickles from the bladder. As a result, when the bladder becomes too full, urine empties (overflows) from the bladder. 
• Functional incontinence: Functional incontinence means you cannot get to the bathroom in time to urinate. It may become challenging to remove clothing to urinate, or you may find it difficult to reach the bathroom on time.
• Mixed incontinence: Mixed incontinence is a combination of stress incontinence and urge incontinence. Mixed incontinence leads to the frequent need to visit the bathroom to relieve oneself. Coughing, sneezing and physical exercise stimulate symptoms of mixed incontinence.

What are the signs of urinary incontinence?

• Minor urine leakage
• Bed-wetting
• Urine leakage during sexual intercourse

How is urethral bulking used to treat urinary incontinence?

Urethral bulking is a medical procedure that utilises urethral bulking injections to resolve stress urinary incontinence (SUI). A bulking agent is administered around the urethral wall to restrict the width of the wall.

Urethral bulking is a straightforward 20-minute procedure. Before the procedure, you will be requested to provide a urine sample. Dr Ramloutan checks the sample for signs of a urinary tract infection. If a UTI is present, he will offer treatment to help resolve the condition before performing the procedure. Urethral bulking is very similar to a pelvic exam since you will be asked to undress below the waist and lie flat on the examination table with your feet in stirrups. The staff then uses an antiseptic solution to cleanse the genital region. Furthermore, a numbing agent is applied to the urethra before the urethral bulking procedure, and an antibiotic is administered orally. Once the area is numb, Dr Ramloutan inserts the cystoscope within the urethra and uses a needle to inject the bulking agent within two or more sites of the specific region. 

Apart from urethral bulking, Dr Ramloutan specialises in the following treatments for urinary incontinence:

• Botox for urgency incontinence: Botox prevents the bladder muscle wall from contracting, which in turn helps minimise the urinary frequency and urgency and alleviates urinary incontinence.
• Neuromodulation: Neuromodulation involves activating the nerves responsible for the function of the bladder and is considered a treatment option for those suffering from urinary incontinence who fail to respond to medications or behavioural treatments.

Furthermore, additional urogynaecology treatments consist of the following:

• Mid-urethral slings: Mid-urethral slings are pieces of surgical tape that help support the urethra. These slings are required for those suffering from stress incontinence.
• Laparoscopic sacrocolpopexy: Laparoscopic sacrocolpopexy is a keyhole (minimally invasive) surgery performed under general anaesthesia to help correct vaginal vault prolapse.
• Anterior colporrhaphy: During the procedure, the bladder is returned to its usual position and the supportive tissue that rests in the anterior part of the vagina and bladder is securely tightened.
• Sacrospinous fixation: Sacrospinous fixation is a procedure meant to reinforce the uterus and vaginal vault through an incision made over the vagina, and stitches are made in the sturdy ligament, also known as the sacrospinous ligament within the pelvis and the cervix and vaginal vault.