Urinary Incontinence

Urinary incontinence refers to loss of bladder control resulting in involuntary leakage of urine. It commonly occurs in women due to pregnancy and childbirth, menopause and the structure of the female urinary tract. 

For many people with urinary incontinence it is an embarrassment. Urine incontinence can mean that women alter their lives (eg) avoid running or sport.

Urinary incontinence in some individuals may be a normal part of growth and disappears naturally over  time. However, if it does not disappear, it requires treatment and the condition improves when the underlying cause is treated.

Urinary incontinence is more common in women than men. Older women experience urinary incontinence more often than younger women. The probable cause for higher incidence in women can be attributed to pregnancy and childbirth, menopause and the structure of the female urinary tract.

Individuals with urinary incontinence may experience strong, sudden, urgent and uncontrollable need to urinate, frequent urination and also involuntary loss of urine.

SYMPTOMS OF URINARY INCONTINENCE

Symptoms remain the mainstay of diagnosis and you may be ordered additional tests to identify and confirm the cause for incontinence. These tests include

  • bladder stress test,

  • urinalysis and urine culture,

  • ultrasound diagnosis,

  • cystoscopy and

  • urodynamics.

Causes of Urinary incontinence

Urinary incontinence may be caused by any of these factors:

  • Childbirth

  • Heavy lifting

  • Weak muscles in the lower urinary tract

  • Menopause

  • Problems either in the urinary tract or in the nerves that control urination

  • Physiological status such as pregnancy, weight gain or other conditions that stretch the pelvic floor muscles

  • Overactive bladder muscle

  • Urinary tract infection

  • Constipation

  • Bladder cancer or bladder stones

  • Blockage within the urinary tract

  • Removal of the uterus (Hysterectomy)

  • Neurological disorders

TYPES OF URINARY INCONTINENCE

Urinary incontinence can be categorized into five basic types depending on the symptoms:

  • Stress Incontinence - Leakage of small amounts of urine during physical movement such as coughing, sneezing, lifting heavy objects, and straining, that suddenly increases the pressure within the abdomen.

  • Urge Incontinence - Leakage of large amounts of urine at unexpected times. 

  • Overflow Incontinence - Uncontrollable leakage of small amounts of urine because of an incompletely emptied bladder.

  • Functional Incontinence - This refers to urine loss resulting from inability to get to a toilet.

  • Mixed Incontinence - Mixed incontinence is the presence of two or more types of incontinence in an individual. Most commonly, urge and stress incontinence occur together.

Dr Cook diagnoses your condition through physical, pelvic and neurologic examination and suggests appropriate treatments.

TREATMENT FOR INCONTINENCE

Treatment depends on the cause and severity of incontinence. Treatment options include

  • pelvic floor exercises - Shamara Lurie is an experienced physiotherapist with a special interest in pelvic floor rehabilitation who works at GOALS for women
  • bladder control techniques - Shamara Lurie can also assist with bladder retraining techniques
  • Diet - minimise caffeine
  • lifestyle changes - avoid heavy lifting and straining
  • sacral nerve stimulators
  • minimally invasive surgeries - including suburethral sling (TVT-O)
  • biofeedback treatments
  • medications, 
  • electrical stimulation
  • cathete risation

Treatments of Urinary incontinence

If these conservative treatment measures fail to treat your condition, Dr Cook may recommend surgical procedures. These procedures will treat stress incontinence.

Suburethral Sling

Also called TVT-O. This is minimally invasive surgical procedure. A very small sling is placed under the urethra. The procedure takes about 30 minutes and most women will stay in hospital overnight. Normal bladder function returns within a short period of time prior to discharge. Most women will note an instant improvement in their symptoms of stress incontinence.Women can return to work after 3-5 days.

This is the most common procedure for treating stress incontinence in the world. It is associated with a 90% success at 5years in the treatment of stress incontinence.

Laparoscopic Colposuspension

This is a minimally invasive procedure performed via keyhole surgery. The bladder neck is elevated. The procedure takes about 45 minutes and most women will stay in hospital overnight. Most women will recover after one week. (see gallery)

Voiding dysfunction

This condition refers to an inability to completely empty the bladder. It can be seen in women who have had numerous previous surgeries to bladder neck.It most commonly affects children. In normal cases, when an individual wants to have a bowel movement, the pelvic muscles relax and the abdominal muscles contract allowing to empty the bowel.

In voiding dysfunction, the pelvic muscles contract instead of relaxing, resulting in incomplete emptying of urine.

Voiding Dysfunction Treatment

Voiding dysfunction treatment options include

  • managing constipation,

  • treating urinary tract infections,

  • physical exercises, and

  • medicines to decrease the bladder hyperactivity.

Diet changes are suggested. Surgery is rarely considered and involves correction of anatomical abnormality that is causing the voiding dysfunction