URINARY INCONTINENCE

Urinary incontinence is the unintentional passing of urine. It is a common problem which affects millions of women and men.

There are several types of urinary incontinence:

  • stress incontinence – when urine leaks out at times when your bladder is under pressure, for example, when you cough or laugh 

  • urge incontinence – when you feel a sudden and urgent need to urinate. It is also referred to as an unstable or overactive bladder

  • overflow incontinence (chronic urinary retention) – when you are unable to fully empty your bladder, which causes frequent leakage 

  • total incontinence – when your bladder cannot store any urine at all, causing you to pass urine constantly or have frequent leakage 

It is possible to have a mixture of both stress and urge urinary incontinence.

When to seek medical advice

Urinary incontinence is a common problem and you should not feel embarrassed talking to your doctor about your symptoms. The London Urogynaecology Centre believes in a holistic approach to healthcare. Our medical professionals will discuss with you what your main concerns are as well as finding out about your health and lifestyle more generally. The doctor will take urine and blood samples and discuss a treatment plan with you during your appointment.

Causes of urinary incontinence

Stress incontinence is usually as a result of the weakening or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.

Urge incontinence is due to overactivity of the detrusor muscles which make the bladder empty.

Overflow incontinence is often caused by a blockage in the urethra (water pipe) or a weak detrusor muscle.

Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a fistula (an opening between the bladder and vagina).

Factors increasing your risk of urinary incontinence:

  • pregnancy and vaginal birth, especially with forceps or ventouse deliveries

  • being overweight 

  • a family history of incontinence 

  • certain triggers specific to individuals

Treating urinary incontinence

Non-surgical treatments

Initially, we may suggest some simple measures to help improve your symptoms, such as:

  • Reviewing your diet and lifestyle 

  • A series of specialised blood tests and urine cultures

  • A course of pelvic floor exercises with a specialist physiotherapist

  • Bladder training, where you learn ways to wait longer between needing to urinate and passing urine

  • A course of medical treatment

  • Determining causes or urinary tract infections

  • Investigating pelvic and bladder pain

  • Vaginal pessaries for vaginal prolapse and incontinence

  • Posterior tibial nerve stimulation for the overactive bladder

  • Bladder instillations for bladder pain syndrome

  • 3D ultrasound of the urethral sphincter and pelvic floor to assess pelvic floor damage due to pregnancy and childbirth

  • Urodynamics

Surgical treatments

  • Diagnostic cystoscopy may be recommended to look inside the bladder with a camera. Tissue samples can be taken at the same time which can further help in diagnosis

  • Vaginal wall repair for vaginal laxity and prolapse

  • Botox to the pelvic floor for pelvic pain or painful sex

  • Botox to the bladder for overactive bladder

  • Urethral injections for stress incontinence

  • Colposuspension for stress incontinence

  • Sacrospinous ligament fixation for vaginal vault prolapse

  • Sacrocolpopexy for vaginal vault prolapse