What is Urinary Incontinence?

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Urinary incontinence is  'the complaint of any involuntary leakage of urine'. It is a common problem that can affect women of all ages. The severity ranges from occasional leaking to frequent urinary loss. It is not a normal part of ageing or something that you just have to live with.

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What are the types of urinary incontinence?

There are two main causes of urinary leakage in women.

Stress Incontinence is involuntary urine leakage on effort or exertion or on sneezing or coughing.

Urgency Incontinence is involuntary urine leakage accompanied or immediately preceded by urgency (an urge to urinate that's so sudden and strong you don't get to a toilet in time).

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Some women can suffer from both stress and urge incontinence.

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Although it is more common in older women, it can also affect younger women as well. If urinary incontinence affects your daily activities, don't hesitate to see your doctor. Your doctor may advise you some simple lifestyle changes like caffeine reduction, fluid modification and pelvic floor exercises. Urge incontinence can be treated with simple medications. These drugs control muscle spasms or unwanted bladder contractions and can help prevent leakage and relieve the symptoms of urgency and frequency. If these measures do not help, your doctor will suggest you see a specialist.

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What are the investigations for urinary incontinence?

Urodynamics investigation

Urodynamic tests assess the function of your bladder and help investigate the cause of any urinary incontinence you may have. It guides doctors in choosing the most appropriate treatments for you.

 

What types of surgery are available to treat Stress Incontinence?

Tape procedures

A mid-urethral sling operation is a type of operation for stress urinary incontinence. It involves placing a tape (called a sling) underneath the urethra (the tube that connects your bladder to the outside). The sling supports your urethra when you laugh, sneeze, cough or when you are physically active and prevents urine leaking from your bladder.

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The operation is carried out by one small incision (1 cm) in your vagina and two incisions in your lower abdomen or on both sides of your inner thighs. The procedure is usually carried out as a day case procedure under general anaesthetic. Tape procedures and based on current evidence have a high success rate (80-85%) and can last for over 15 years.

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Autologous Facial slings

Sling procedures involve making an incision in your lower abdomen and vagina, so that a sling can be placed around the neck of the bladder, in order to support it and prevent accidental urinary leaks. In many cases, an autologous sling is used and will be made using part of the layer of tissue that covers the abdominal muscles (rectus fascia). These slings are generally preferred because more is known about their long-term safety and effectiveness.

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The most commonly reported problem associated with the use of slings is a transient difficulty in emptying the bladder fully when going to the toilet. A small number of women who have the procedure also find they develop urge incontinence afterwards which may require long-term medications (anticholinergics).

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Urethral Bulking Agents

A synthetic substance is injected into the tissues around the urethra under direct visualisation through a telescope (cystoscope). The substance acts to “plump up” and narrow the opening of the urethra, which may decrease leakage.

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This is less invasive than other surgical treatments for stress incontinence. However, this procedure is generally less effective than the other options available. The effectiveness of the bulking agents will also reduce with time and you may need to have these injections repeated.

 

Colposuspension

Colposuspension involves making an incision in your lower abdomen, lifting up the neck of your bladder, and stitching it in this lifted position.

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Colposuspension is an older procedure for urinary incontinence. It has a good success rate but it is more invasive and usually requires a hospital stay of 3-4 nights.

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What other treatments are available for overactive bladder and urge incontinence?

If medications fail to control an ‘unstable’ bladder, then you may be offered Botox treatment. This is a short procedure that requires no incisions or stitches. It involves injecting Botox into the bladder wall via a camera called a cystoscope. You will be able to go home the same day after passing urine.

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Although the symptoms of incontinence may improve after the injections, you may find it difficult to fully empty your bladder. If this happens, you'll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the urine from your bladder. The effects of botox often last for 3-12 months and the treatment can be repeated if required.

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