Urinary Incontinence affects approximately one out of every five adult women in the United Kingdom, and is more prevalent than diabetes, hypertension, or depression. There are three main types of urinary incontinence.
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- Stress Urinary Incontinence
This is involuntary loss of urine which occurs during sudden increases of intra-abdominal pressure such as laughing, coughing, sneezing, lifting, or exercising.
- Urge Urinary Incontinence
This is the "I can’t hold" leakage which occurs with a sudden uncontrollable urge to pass urine and is usually caused by an overactive bladder.
- Mixed Urinary Incontinence
A combination of stress and urge incontinence.
There are three main types of treatment: behavioural, pharmacological, and surgical.
Behavioural Therapy is a treatment approach by which aims to improve or lessen the degree of incontinence thorough modification of diet and activity. For example, tea, coffee, acid fruit juices (orange, apple), fizzy drinks and alcohol can contribute to urgency, increased frequency, and urge incontinence. By reducing or eliminating these items, women can help decrease their symptoms dramatically. In addition, timed voiding and bladder retraining, which involve urinating on a set schedule during the day regardless of the need or urge to void, is often helpful. These options tend to be most useful in the mild to moderate forms of incontinence.
Pelvic Floor Exercises
Pelvic Floor Exercises can be used for both mild stress and urge incontinence. When properly and consistently performed these exercises strengthen the sphincter muscles thereby lessening the degree of incontinence. The key to these exercises, as with most other exercise regimes, is that they must be done indefinitely. Once the exercises are stopped, the involved muscles will weaken, and the incontinence may return. In many cases, the patient will need to perform these exercises for several weeks before she notices any improvement in her urine loss.
Stress incontinence, is the most common type of incontinence and accounts for roughly 75% of all urinary incontinence. It can occur in any stage throughout a women's life: college, university, pregnancy, following childbirth, and on into menopause. This condition results from a weakening of the pelvic supportive structures for the bladder, bladder neck, and urethra which can be caused by pregnancy, childbirth, obesity, and prior pelvic surgery.
The mainstay of treatment for significant stress urinary incontinence is surgery.
Operations to correct Stress Incontinence have traditionally involved major abdominal surgery, under general anaesthetic and a recovery of five days in hospital and a total of six weeks in all. Over the last several years, slings (mid-urethral tape procedures) have taken the forefront as the first-line surgical correction of stress urinary incontinence. An example of this is the Tension-free Vaginal Tape which is a product which is inserted using small incisions in the lower abdomen or upper thigh and the front wall of the vagina. The tape is placed so that it supports and stabilises the urethra. The whole procedure takes about 30 minutes.
A special bladder investigation called urodynamics needs to be undertaken beforehand so that the diagnosis is confirmed prior to the TVT procedure.
Less invasive surgeries for stress incontinence include peri-urethral bulking agents which unfortunately require multiple injections and the results may last from 1-5 years.
Patients with overactive bladders usually present with symptoms of urgency, frequency, and urge incontinence. Unlike women with simple stress incontinence whose urine loss is associated with strenuous activities that can be avoided or prepared for, women with an overactive bladder never knows when the incontinence will strike. Coughing, the sound of running water or hand/dish washing may trigger the urge incontinence. The causes of overactive bladder are many. An infection can irritate the bladder lining resulting in overactive bladder, the nerves that normally control the bladder can be overactive, and in a large majority of cases, the cause is unclear.
As with stress incontinence, behavioural therapy is the first-line of treatment, and when behavioural methods alone are unsuccessful, medication may be added. Although none of these medications are 100% successful in eliminating sign and symptoms of overactive bladder, they can provide substantial improvement.
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