💦 Men's Health

Urinary Incontinence (Nigeria Guide)

Involuntary urine leakage — a common, treatable condition affecting women and men in Nigeria

Urinary incontinence — the involuntary leakage of urine — affects millions of Nigerians, predominantly women. It is a source of significant shame, social isolation, and reduced quality of life. Many sufferers believe it is a normal part of ageing or childbearing and never seek help. Yet most types of urinary incontinence are highly treatable with pelvic floor exercises, bladder training, medication, or surgery. Obstetric fistula — a devastating form of urinary incontinence resulting from obstructed labour — remains a major public health issue in Nigeria.

Signs and Symptoms

✓ Stress incontinence — leakage with coughing, sneezing, laughing, or lifting

✓ Urge incontinence — sudden strong urge to urinate followed by involuntary leakage before reaching the toilet

✓ Mixed incontinence — combination of stress and urge types (most common in women)

✓ Overflow incontinence — dribbling of urine due to incomplete bladder emptying (more common in men)

✓ Continuous leakage of urine (day and night) — suggests fistula

✓ Nocturia — waking multiple times at night to urinate

✓ Wet underwear or pad use required daily

Risk Factors

Vaginal childbirth — pelvic floor muscle and nerve damage, especially after prolonged labour
Multiple pregnancies
Menopause — reduced oestrogen weakens pelvic floor and urethral mucosa
Obesity — increases intra-abdominal pressure on the bladder
Chronic cough — COPD, smoking, or persistent bronchitis
Constipation — straining increases pelvic floor load
Benign prostatic hyperplasia (in men) — causes overflow incontinence
Obstetric fistula — vesico-vaginal fistula (VVF) after obstructed or neglected labour — a major Nigerian public health issue

When to Seek Help

UrgentSudden onset of incontinence with back pain, leg weakness, or numbness — possible spinal cord compression

SoonNew incontinence with blood in urine, pelvic pain, or weight loss — exclude bladder cancer or pelvic malignancy

RoutineAny incontinence affecting daily activities — highly treatable; do not suffer in silence

Specialist referralObstetric fistula (continuous uncontrolled leakage after difficult delivery) — specialised VVF repair surgery; centres available at LUTH, UCH, VVF centres in Kano and Sokoto

Plan aheadPelvic floor physiotherapy before and after delivery — reduces risk of postpartum stress incontinence

Tests & Diagnosis

🧪 Bladder diary (frequency-volume chart)

Patient records time and volume of all voids, leakage episodes, and fluid intake for 3 days. Invaluable for characterising incontinence type

🧪 Urine dipstick and MSU

Exclude UTI (which causes urgency and frequency mimicking urge incontinence)

🧪 Post-void residual (PVR) urine

Bladder ultrasound after voiding — detects incomplete emptying (overflow incontinence). PVR >150 ml is significant

🧪 Urodynamic studies

Cystometry measures bladder pressures during filling and voiding — gold standard for classifying incontinence type. Available at LUTH and UCH urology units

🧪 Pelvic ultrasound

Assesses pelvic organs, bladder wall, and uterus — excludes pelvic pathology

🧪 Cystoscopy

If haematuria or bladder pain — excludes bladder cancer, stones, or interstitial cystitis

Treatment Options

Pelvic floor exercises (Kegel exercises) — first-line for stress incontinence

Contract the pelvic floor muscles (as if stopping urine flow) for 10 seconds, relax 10 seconds. 10 repetitions, 3 times daily. Minimum 3 months before assessing benefit. Most effective intervention for stress incontinence — taught by a pelvic floor physiotherapist

Bladder training — first-line for urge incontinence

Gradually extend the time between urinations. Start by voiding every hour; increase by 15 minutes each week until voiding every 2.5–3 hours. Urge suppression techniques — deep breathing, distraction, rapid pelvic floor contractions when urge strikes

Weight loss

Even 5–10% weight reduction significantly improves stress incontinence by reducing intra-abdominal pressure

Fluid management

Adequate hydration (1.5–2 litres daily) — concentrated urine irritates the bladder and worsens urgency. Reduce caffeine (tea, coffee, energy drinks) and alcohol — both are bladder irritants. Do not restrict fluid to manage incontinence — worsens bladder irritation

Antimuscarinic drugs (urge incontinence)

Oxybutynin 5 mg twice daily or solifenacin 5 mg daily — relax the overactive detrusor muscle. Side effects: dry mouth, constipation, blurred vision. Use with caution in elderly (confusion risk)

Topical vaginal oestrogen (postmenopausal women)

Restores urethral and vaginal mucosa. Significantly improves both stress and urge incontinence. Apply pea-sized amount to vaginal opening. Safe — systemic absorption is minimal

Duloxetine (stress incontinence)

SNRI antidepressant — increases urethral sphincter tone. Modest benefit. Nausea is the main side effect

Botulinum toxin (refractory urge incontinence)

Botox injected into the bladder muscle under cystoscopy — very effective for overactive bladder not responding to medications. Effect lasts 6–9 months. Available at specialist urology centres

Surgery for stress incontinence — mid-urethral sling

Tension-free vaginal tape (TVT) or trans-obturator tape (TOT) — a small mesh sling placed under the urethra. Highly effective (>80% cure rate). Performed under spinal anaesthesia as day case. Available at LUTH, UCH, and private urology centres

VVF repair

Vesico-vaginal fistula surgery — specialised repair performed by expert surgeons. Available at National VVF Centres: LUTH Lagos, UCH Ibadan, Aminu Kano Teaching Hospital, Usmanu Danfodiyo University Teaching Hospital Sokoto, and state-level VVF repair centres

Frequently Asked Questions

Is urinary incontinence normal after having children?

While it is common (affecting up to 30% of women after vaginal delivery), it is never normal in the sense that it should be accepted. Pelvic floor physiotherapy is highly effective. Starting Kegel exercises during pregnancy and continuing postpartum significantly reduces incontinence risk. Seek help — this is not something to endure indefinitely.

Will I need surgery for incontinence?

Most women with stress incontinence are significantly improved by pelvic floor exercises alone if practiced consistently for 3 months. Surgery is reserved for those where conservative treatment fails. Urge incontinence responds better to bladder training and medication than surgery.

Can men have urinary incontinence?

Yes. Post-prostatectomy incontinence (after prostate surgery) and overflow incontinence from BPH are common in Nigerian men. Pelvic floor exercises and bladder training help. BPH-related incontinence requires treatment of the underlying prostate problem.

What is vesico-vaginal fistula and where can I get it repaired?

VVF is an abnormal opening between the bladder and vagina, usually caused by obstructed labour destroying the tissue between them. It causes constant uncontrolled urine leakage. It is highly treatable with surgery. Free or subsidised VVF repair is available at government-supported centres — contact your state ministry of health or UNFPA Nigeria for referral.