Patient InformationUrinary Incontinence
Involuntary loss of urine happens to many people. When it interferes with daily life it becomes a problem. Causes of incontinence may be multiple and complex but we should take simple steps to prevent or minimise the problem. Usually urine leakages are of two types, often both types are present. If the bladder does not empty adequately, leakages of both types are more likely. This retention of urine may be associated with vaginal prolapse and vaginal atrophy (due to low oestrogen).
a) Urgency Incontinence
A leakage when there is a strong urge to pass urine is urge incontinence. This symptom may lead to urinary frequency and the “overactive bladder”. Symptoms will be worse if there is infection or vaginal atrophy.
Treatment for the overactive bladder
Treatment for the overactive bladder includes treating any infection, treating vaginal atrophy, and occasional use of medications to relax the nerves controlling the bladder muscles.
Applying topical oestrogen to the vagina is a very healthy treatment. This is safe because the oestrogen stays in the vaginal skin and is not absorbed into the body. There are no hormonal effects elsewhere such as in the uterus, the breasts or the blood clotting system.
Physiotherapy and bladder training are important treatments.
b) Stress Incontinence
Leakage during an increase in abdominal pressure is stress incontinence. Actions that lead to this include coughing, sneezing, laughing, jumping, lifting a heavy weight etc. Stress incontinence occurs when the pressure above the bladder exceeds the support below the urethra. The urethra is the tube through which urine is passed from the bladder.
Treatment for stress incontinence
Reducing the pressure from above
- Treating cough and hay fever
- Quit smoking
- Reducing weight
Increasing the support of the urethra
- Pelvic floor physiotherapy
- Surgery may be necessary after all of the above measures have been tried. Before surgery the function of the bladder can be assessed objectively, usually by Urological investigations and a Urodynamic test. This can help indicate the likely results of the procedures used. This allows discussion about realistic expectations regarding results of surgery before the surgery is carried out. The leakages may cease after surgery but sometimes other bladder symptoms may persist or new ones may develop.