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Incontinence

What is urinary incontinence?

Urinary incontinence is the loss of bladder control leading to leakage of urine.It is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.

Types of urinary incontinence include:

Stress incontinence: Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress urinary incontinence is usually caused by weakness of the pelvic floor muscles which is frequently related to childbirth or previous prostatic surgery.

Urge incontinence: A sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Most of the time, this is caused by overactivity of the bladder detrusor muscle and there is no underlying cause (Idiopathic detrusor overactivity), but it may sometimes be caused byserious conditions such as urine infection, bladder cancer, prostatic obstruction, bladder stones or neurological disorders.

Overflow incontinence: Frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

Mixed incontinence: More than one type of incontinence

What are the tests for incontinence?

Your doctor will likely order tests to further assess incontinence.

Urine tests: A sample of the urine is tested for infection, blood in the urine and cancer cells

Bladder diary: For several days you record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.

Pad weight: The severity of urine leakage is measure by weighing the continence pads before and after use over a 24 hour period.

Urodynamics study: A catheter is inserted into your bladder to fill your bladder with water. Meanwhile a pressure monitor measures and records the pressure within your bladder. A small catheter is also be inserted into your rectum to measure abdominal pressure. This test helps measure your bladder strength and urinary sphincter health, it is a important tool for distinguishing the different type of incontinence you may have.

What are the possible treatment options?

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause.

Some general behavioural techniques may improve continence:

Scheduled toilet trips: Urinate every two to four hours to keep the bladder empty

Fluid and diet management: Avoiding caffeine, spicy foods and alcohol which may stimulate the bladder. Reducing excessive fluid consumption, weight loss and increased physical activity can also ease the problem.

Pelvic floor exercises

The pelvic floor muscles control urinary and bowel continence. Exercises can strength these muscles and improve control.

Exercises involve tightening the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds.

Progressively work up to holding the contractions for 10 seconds at a time.

Aim for three sets of 10 repetitions each day.

To help you identify and contract the right muscles, your doctor may suggest you work with a continence therapist or try biofeedback techniques

What is the treatment for urge incontinence?

Apart from the general behavioural changes, there are medications that dampen and inhibit involuntary contractions of the bladder detrusor muscle. There are several groups of these medications that act on the sympathetic or parasympathetic nervous supply of the bladder to relax the bladder. Possible medications available in Australia include Ditropan, Oxytrol patches, Enablex, Vesicare and Betmiga.

Injections of Botox into the bladder muscle may benefit people who have an overactive bladder that does not respond to other first line medications. Botox last between 3-9 months, and repeat injections is required.

What is the treatment for stress incontinence?

Pelvic floor exercises are recommended to strengthen the pelvic floor muscles. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.

If pelvic floor exercises are unsuccessful various surgical interventions are available. These are designed to improve closure of the sphincter or support the bladder neck.

Injectable bulking agents: Synthetic polysaccharides or gels may be injected into tissues around the upper portion of the urethra. These materials bulk the area around the urethra, improving the closing ability of the sphincter.However, it is not a permanent repair. Multiple injections are required for most people.

Sling procedures: This is the most common procedure performed in women with stress urinary incontinence. In this procedure, the surgeon uses the person’s own tissue or synthetic material (mesh) to create a sling or hammock that supports the urethra. The success rate of sling procedures is approximately 90%. This is also used in men who have mild urinary incontinence following prostatic surgery.

Inflatable artificial urinary sphincter: This surgically implanted device is primarily used to treat men with severe incontinence after prostatic surgery. An inflatable cuff is fitted around the upper portion of the urethra, replaces the function of the sphincter. Tubes connect the cuff to a pressure-regulating balloon in the pelvic region, a manually operated pump is implanted in the scrotum which allows the cuff to be deflated during urination.

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