Urinary Incontinence
Introduction
Urinary incontinence is defined by the leakage of or the inability to hold urine.
There are several reasons why a woman can be incontinent, but the two most common forms of incontinence are:
Stress Incontinence, and
Urgency Incontinence.
Urinary Stress Incontinence is characterized by loss or leakage of urine, in situations that increase the intra-abdominal pressure such as sneezing or coughing, weight lifting, laughing and running.
The mechanisms and predisposing factors for the condition are similar to Genital Prolapse, i.e., changes in the anatomy due to damage to pelvic floor muscles and connective tissue.
There is an increase of mobility at the base of the bladder and the area where the urethra begins making it difficult to hold urine when the bladder is full.
Urgency or Urge Incontinence reflects a sudden urge to urinate with little control of the bladder resulting in leakage. Also known as Overactive Bladder or Detrusor Muscle Instability, it happens following uncontrolled contractions of the muscle around the bladder.
Diagnosis
The symptoms that suggest Stress Urinary Incontinence are leakage of urine in any or several situations such as: coughing, sneezing, physical exercise (jumping, running, squatting) sexual intercourse, etc. without the woman necessarily having felt that the bladder was full or that there was a need to go to toilet.
Urge Incontinence presents more like a sudden feeling that one needs to go to the toilet but not quite making it on time.
Physical examination may show a prolapsed bladder and urethra and leakage of urine on coughing.
If the diagnosis is not clear, a test called Urodynamic Study may be necessary to differentiate between stress and urge incontinence. During the study a catheter is inserted in the bladder which is then filled with fluid. A sensor records the pressure inside the bladder and produces a chart that helps make the diagnosis.
Treatment
The treatment of urge incontinence is achieved by conservative measures.
These involve a combination of life style changes that include weight loss, smoking cessation and reduction in caffeine intake, as well as the use of medication, the main ones being oestrogen and drugs that relax the bladder muscle. Surgery does not help.
The same conservative measures associated with pelvic floor exercises should be tried to improve Stress Urinary Incontinence.
If they fail to provide significant improvement, surgical treatment may be considered.
The surgical treatment for Stress Incontinence consists of procedures that lift and support the bladder and urethra to restore their function.
There have been considerable changes over the last 10 to 15 years thanks to a range of new procedures recently made available.
Please refer to the Minimally Invasive Surgery page for more details.
Sometimes both types of incontinence are present.
It is also common to find an association between Stress Incontinence and Prolapse, since both conditions share common causes. It is important to do a thorough assessment before any gynaecological surgery is done to make sure all conditions are addressed properly and the right operation is being done for the right woman.