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Urinary incontinence

Urinary incontinence is the involuntary loss of urine. It is an extremely common condition – nearly half of women are said to suffer from embarrassing urinary symptoms at some point in their lives.

Types of incontinence

  • Stress incontinence – urine leaks when there is a sudden extra pressure on your bladder caused by a weak pelvic floor
  • Urge incontinence – you frequently need to pass small amounts of urine. This is caused by an overactive bladder wall muscle that contracts before the bladder is full and squeezes out urine. You may have a bladder infection
  • Mixed incontinence – you have both of the above
  • Overflow incontinence – you can’t hold urine in a full bladder because the urinary tract is blocked or nerves supplying the bladder are damaged.

Other causes of incontinence include side effects of certain drugs, diabetes, which can cause excessive production of urine, and problems with the urinary system including bladder stones.

Symptoms

  • Loss of urine when coughing, sneezing or changing position
  • A sudden strong need to empty your bladder 
  • Urine leaks if you can’t get to the toilet in time
  • Urine leaks during sex
  • Needing to empty your bladder more than six or seven times a day or once or twice at night

This is not a definitive list and symptoms will vary with each patient. Please ask your doctor for more information.

Diagnosis

Your consultant will press on your lower abdomen to feel your bladder. They may feel inside the vagina while pressing on your abdomen to check if there is any abnormality in the pelvic area and they may also use a speculum. They may also check for leakage when you cough and test the sensation around the bridge between your vagina and bottom (the perineum).

A sample of mid-stream urine will probably be taken to test for infection, bladder stones or other problems and the pressure inside your bladder will be measured.

For more information, and if you have any queries about being diagnosed, speak to your consultant.

The following can help overcome incontinence:

  • Giving up smoking
  • Eating a high fibre diet, and drinking plenty of water
  • Pelvic floor exercises to strengthen the pelvic floor
  • Electrical stimulation or biofeedback can help with exercise. With electrical stimulation a probe is inserted inside your vagina, carrying a safe, gentle electrical current to stimulate your muscles and help strengthen your pelvic floor. Biofeedback uses sensors to check if you are using the correct muscles when performing your pelvic floor exercises. Ask your physiotherapist for details
  • Bladder training. If you have an overactive bladder or urge incontinence, training the bladder by emptying it at set intervals and gradually increasing the length of time between intervals could help
  • Medication. Some drugs help improve the symptoms of a weak pelvic floor, by tightening the muscles at the neck of the bladder (the urethra) to prevent leakage. Others reduce or prevent contractions in an overactive bladder, or relax the muscles so that the bladder can empty more completely.

Surgery

If you have urinary incontinence caused by a weak or damaged pelvic floor, and physiotherapy and medication haven’t helped, your consultant may recommend vaginal slings and tapes. These support the entrance to the bladder (the urethra), by holding it in the correct position. The tape is inserted through very small cuts in the vagina.

The procedure is performed under local or general anaesthetic and usually takes around 40 minutes.

Other treatment options include injecting collagen or silicone into the tissues of the pelvic floor. This is injected around the neck of the bladder (the urethra) to reduce the opening and helps to reduce leakage.

For more information on drugs and their side effects, or if you have any queries about surgery, speak to your consultant.

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