Ask the Expert: Urinary Incontinence

Mr Matharu is a Consultant Gynaecologist with a specialist interest in the management of female bladder problems such as urinary incontinence, overactive bladder and cystitis, as well as prolapse of the womb and vagina. He is member of a number of professional bodies, including the British Society of Urogynaecology and International Continence Society.

What is urinary incontinence?
Urinary incontinence (UI) is a common condition affecting women of all ages. Many are reluctant to seek help for a number of reasons, including embarrassment, not knowing who to approach, thinking that nothing can be done and the concern of their problem not being taken seriously. Quality of life in terms of social, personal and sexual relationships may be affected. However, more and more women are coming forward for help and the good news is that effective treatments are often available.

Stress urinary incontinence (SUI) is the involuntary loss of urine on sneezing, coughing, laughing or exercise. Urge urinary incontinence (UUI) is leakage of urine preceded by an uncontrollable urge to pass urine. Mixed incontinence is a mixture of the two. Urgency to pass urine, frequent passing of urine and UUI are often referred to as overactive bladder (OAB) symptoms.

Can urinary incontinence be treated?
Usually, yes. If you are particularly overweight, weight loss can improve SUI. Also avoid straining and becoming constipated. OAB may be improved by avoiding caffeine (i.e. tea, coffee and fizzy drinks) and maintaining a good fluid intake.

The pelvic floor is like a hammock and consists of a layer of muscles at the base of your pelvis that supports the bladder, womb and bowel.  Pelvic floor exercises (PFE) are contractions of these muscles and you can increase the strength of these muscles by regularly exercising them. PFE can help both SUI and UUI.

For those women who cannot contract their pelvic floor muscles, it may be possible to stimulate contractions by electrical stimulation which is a technique that women can administer themselves following instruction. Other techniques used to strengthen the pelvic floor include biofeedback and vaginal cones.

Bladder retraining is a treatment for OAB and is an educational and behavioural process used to re-establish the control of your bladder. Bladder retraining may be taught by a physiotherapist or continence advisor. In many cases, bladder retraining is a matter of breaking bad habits, such as avoiding going to the toilet frequently or at specific times, which many women do even in the absence of a sensation to pass urine, just to keep the bladder empty. One of the aims of bladder retraining is to increase the volume of urine you allow your bladder to hold.

Drugs are commonly used to treat UUI and the overactive bladder and can be very effective. Some women need to take medication on a long-term basis. Only one drug has been specifically developed to treat SUI.

What about surgery?
For those women with SUI whose symptoms persist despite PFE, the next option may be surgery, which can be very effective. There are a number of minimally invasive procedures which are quick to perform and usually allow a reasonably early return to normal activities. The most popular operation for SUI is the insertion of mid-urethral tape, which is a mesh-like, synthetic sling placed beneath the middle of the urethra (the tube through which you pass urine). A small 1.5cm incision is made in the front wall of the vagina through which the tape is inserted. The tape is then brought out through two 1cm incisions below the bikini line. The tape stays in the body and does not dissolve. It is held in place by the body tissues. The operation takes approximately 20 minutes and most women go home the same day as surgery.

In most cases, the patient may drive after a week, return to work in one to two weeks and resume exercise in four weeks. Short-term success rates exceed 85%. 77% of women report still being dry eleven years after surgery. There is a small risk (5.6%) of difficulty passing urine afterwards, but this can be treated.

A recent development in the treatment of OAB which has not responded to PFE, bladder retraining and drugs, is the use of muscle paralysis treatment which aims to stop the involuntary contractions of the bladder muscle. The procedure takes about ten minutes. The majority of women report a significant improvement in symptoms. The benefits are not permanent, but can last many months and repeat treatment may be needed.

No single treatment is suitable for everyone, but in my experience, the above treatments help a significant proportion of suffering women.

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