Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine. About one woman in three may report urinary incontinence at some time in her life, especially as she becomes older. Fortunately, treatment can often be highly effective.

Types of Urinary Incontinence

Stress incontinence

Stress incontinence is the involuntary leakage of urine that occurs during increased abdominal pressure. This is most likely to happen during actions such as sneezing, coughing, laughing, jogging, rapid walking, jumping or lifting heavy items.

Stress incontinence is usually a result of the urethra being too mobile and not being compressed against the vaginal wall during increased abdominal pressure.

Urge Incontinence

Urge incontinence is the involuntary loss of urine associated with a strong sensation to pass urine. It is sometimes called an “overactive bladder” and may be due to the detrusor muscle contracting when it should be relaxed. It may also be caused by irritation of the bladder from a number of cases, no cause for this condition can be found. Other medical problems may provoke the condition. Some women may be born with a tendency for this condition.

Mixed incontinence

Mixed incontinence is a combination of both urge incontinence and stress incontinence.

Risk Factors

  • Pregnancy and method of delivery
  • Previous prolapse surgery
  • Menopause
  • Medications, smoking and caffeine
  • Constipation, obesity, chronic cough and heavy constant lifting
  • Other conditions including diabetes, multiple sclerosis, arthritis, back problems, pelvic masses, hypothyroidism and chronic lung disease
  • Genetic factors.

Effective Treatments For Incontinence

Pelvic floor muscle training

Pelvic floor muscle exercises involve learning to contract the pelvic floor muscles. These muscles are the ones that you normally squeeze when you try to stop wind from escaping.

Bladder training

Bladder training is used to improve urge incontinence. It involves learning to increase the time interval between passing urine so that the bladder does what you want it to.

Electrical stimulation

Urge incontinence can improve with the use of medications called anticholinergic or antispasmodic drugs.

Devices

Some of these are pessaries that support the urethra.

Surgical treatment

Surgery may cure stress incontinence but is usually not effective for urge incontinence. The particular operation best suited to your case depends on:

  • Whether additional problems in the pelvic region require surgical repair, such as bladder or vaginal prolapse
  • Your general health and well-being
  • Your personal preference, following discussion with your gynaecologist
  • Your gynaecologist’s preference.

Surgical Options For Stress Incontinence

Mid-urethral tape procedures (minimally invasive slings)

Mid-urethral tape procedures have become increasingly popular. These operations are generally performed through the vagina via a small cut made in the vaginal wall.

Pubovaginal sling

This operation may be performed by two gynaecologists working together, using both a vaginal approach and an abdominal approach.

Periurethral injections

A bulking agent is injected into the tissues of the urethra to create a cushioning effect. This bulking agent may be collagen or silicon.

Possible Complications of Urinary Incontinence Surgery

  • Difficulty with passing urine that lasts for a few weeks occurs in about two to five woman in 100 due to urethral outlet being elevated
  • Up to five women in 100 have permanent difficulty passing urine. In these cases, there is often a pre-existing weakness in bladder emptying
  • A urinary tract infection
  • Injury to the bowel, urethra or bladder.