Piss on earth and other leakage issues

MANILA, Philippines - If you’ve got to go, you’ve got to go. With the pre-ponderance of pink and blue MMDA male urinals in Metro Manila’s sidewalks, one would think that more Filipino males are afflicted with weaker bladder control than their female counterparts. The truth, however, is that urinary incontinence or the involuntary passage of urine is more common in women.

“Childbearing can cause trauma to the pelvic floor,” says urogynecology and pelvic reconstructive surgery specialist Dr. Jennifer Marie B. Jose of the Makati Medical Center. “Likewise, pregnancy or being overweight can increase both abdominal pressure and pressure to the urethra, leading to incontinence. Women also have shorter urethras, predisposing them to uncontrollable leaking.”

Notably, however, 85 percent of women who experience incontinence are 50 years old and above. “The problem with incontinence is that Filipinos generally think that it is a normal part of aging,” continues Dr. Jose. It is estimated that one of every 10 is troubled by the condition, but exact numbers are difficult to come by in the Philippines. “Most people find it embarrassing, so they keep quiet. They generally won’t admit until it gets bothersome.”

Aside from a decrease in anti-diuretic hormone levels in the elderly, the female urethra and vaginal tissues thin out and become rigid due to estrogen deficiency in menopausic women. This can lead to what is called “intrinsic sphincter deficiency,” where the urethra is left permanently open, resulting in continuous leakage.

The most common cause of incontinence in men is benign prostatic hypertrophy, or enlargement of the prostate. For both men and women, other causes of urinary incontinence are stroke-related nerve damage, spinal problems such as spina bifida and slip disc, urinary tract abnormalities, and carrying heavy loads. Excessive coughing or sneezing can result in stress incontinence, and uncontrolled diabetes may lead to neuropathy and loss of sensation in the bladder. Because of this, the bladder becomes distended, leading to overflow incontinence. Infection, psychological problems, Alzheimer’s disease, depression, and certain medications can also lead to loss of bladder control.

“The condition can significantly affect quality of life, especially since constant and unexpected urine flow may result in dependence and disability,” says Dr. Jose.

It is easy to understand that an individual’s normal schedule may become impaired by the fear of possibly being caught in awkward accidents involving wet underpants. The problem can be remedied by incontinence pads and absorbent undergarments. Others resort to pessaries (vaginally inserted devices) and urethral insertion devices used at regular intervals to release urine and avoid bladder distention.

Treatment options may also involve estrogen replacement therapy and estrogen creams, but in cases where there is damage to the pelvic floor of a female patient, a minimally invasive surgical procedure called “tension free vaginal tape placement” is performed. Dr. Jose explains that this entails placing a permanent mesh-like material under the urethra to serve as a permanent sling or hammock, preventing incontinence. A doughnut-shaped device with a knob at the end called “incontinence dish” can also be placed underneath the urethra to close it. Another treatment option is the use of “bulking agents” made up of collagen injected to the walls of the urethrea.

“Incontinence can affect women of all ages,” says Dr. Jose. She reminds pregnant women that delivering babies that are too big can cause trauma to the pelvic floor. Kegel exercises, or pelvic floor muscle exercises which involve tightening the vaginal muscles normally used to stop urination, may also prevent incontinence later on. 

Although it might be best to avoid carrying overly heavy loads to keep fit, certain exercises can be beneficial in preventing uncontrolled bladder control. In her clinical practice, for example, Dr. Jose observes that women yoga practitioners have “good levator tone” of the pubococcygeus muscle and are seldom incontinent.

A bit of trivia about urinary incontinence, however: Some medical journals report that habitual bladder emptying or excessively frequent urination can later lead to incontinence.

Men who point and piss whenever and wherever should take a hint. Sometimes it is good to hold it and exercise the urinary sphincter muscles for a while. 

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More information about treatment options for incontinence can be obtained at the Incontinence Center of the Makati Medical Center. Call Dr. Jennifer Marie Jose at Suite 252, New Wing, Makati Medical Center, telephone number 8888-999 local 2252.