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Incontinence Q&A

Three of our leading specialists answer common questions on incontinence including the causes and symptoms, prevention and effective treatments.

Mohammed Belal
Consultant Urological Surgeon
BMI The Priory Hospital
BMI The Edgbaston Hospital
BMI The Droitwich Spa Hospital

David Griffiths
Consultant Gynaecologist
BMI The Ridgeway Hospital

What is incontinence and what are the causes?

Mohammed Belal

Incontinence is the involuntary loss of urine. This can be acutely embarrassing and have a severe impact on your quality of life and mood. Incontinence affects all ages and both sexes. There are multiple causes of incontinence including overactive bladder, post childbirth, neurological disease and following surgery.

David Griffiths

Female incontinence is the involuntary loss of urine. With 1 in 3 women over 40 experiencing this embarrassing and at times debilitating condition most suffer in silence. The causes of incontinence are multifactorial but vaginal child birth is undoubtedly top of the list. Other factors include chronic pressure on the pelvic floor from coughing, lifting of heavy weights and constipation.

What are the symptoms of urinary incontinence?

Mohammed Belal

The main symptoms are the involuntary loss of urine. This may be associated with other symptoms such as needing to rush to the toilet, frequently voiding and getting up at night. The symptoms also occur with coughing, sneezing and exercise with is known as stress incontinence. The leakage of incontinence associated with rushing to the toilet is known as urge incontinence

David Griffiths

Stress incontinence is the most common type and leakage is experienced with physical activity e.g coughing, running, sneezing. Women with urge incontinence suffer with a strong desire to void, frequency and often have to get up at night. Symptoms are exacerbated with caffeinated drinks. Women will frequently ‘toilet map’ their journeys out and often turn down over night stays for fear of bed wetting.

Approximately a third of women will unfortunately experience both types of incontinence. Understandably many women worry about odour, wear dark coloured clothing in the summer months and shy away from intimate contact.

How is incontinence diagnosed?

Mohammed Belal

Incontinence is diagnosed by obtaining a detailed clinical history and examination of the patient, including assessing the pelvic floor and eliciting incontinence. Other causes such as infection are excluded. Further detailed testing might be required before considering surgery.

David Griffiths

A sensitive and careful history taken from the patient is the first place to start. Most women will have suffered with their symptoms for many months or years before they present and are understandably anxious. A gentle internal examination is performed to assess the pelvic floor and exclude anything exerting undue pressure on the bladder from above, such as an enlarged womb.

The bladder is known as an ‘unreliable witness’ and for women in whom conservative treatments have not been successful we offer bladder studies, (urodynamics) to ascertain the diagnosis and make a personalised management plan.

How can incontinence be prevented or managed?

Mohammed Belal

Incontinence can be often prevented by maintaining a good pelvic floor, reducing caffeinated drinks and preventing excess weight gain. Sanitary products can alleviate some of the difficulties of managing incontinence on a day by day basis.

David Griffiths

Looking after your pelvic floor is paramount in prevention. Starting pelvic floor exercises from an early age ideally before children is beneficial. Many women are unaware of their pelvic floor muscles and being taught by a womens’ health physiotherapist is far preferable to learning from a given sheet of instructions.

For those suffering with urge problems careful avoidance of bladder irritants will pay dividends. Many women find that their bladder dominates their life and bladder retraining with specialised physiotherapy helps them take back control. Our physiotherapists are invaluable members of the team. Urge incontinence tends to be a chronic problem and so the management and treatment options vary individually over time.

How can incontinence be treated?

Mohammed Belal

Initially lifestyle changes are advised, such as reduction in caffeinated drinks, weight loss, and supervised pelvic floor exercises. Several medications can help incontinence which is due to an overactive bladder. Surgery may be required. This involves a synthetic tape or using a patient’s own tissue to support the pelvic floor and prevent incontinence. There is some evidence that using a patient’s tissue is advantageous in the long term; I am one of the few consultants in the UK that regularly performs this surgery.

David Griffiths

For those women suffering with stress incontinence pelvic floor exercises are the recommended first line of treatment. Weight loss can sometimes be beneficial. Some women will benefit from pelvic floor stimulators and our physio will be happy to advise on these which can be bought on line. The last resort is surgical intervention and the most common procedure performed is the TVT – tensionless vaginal tape. Drug therapy is a mainstay treatment as is specialised physiotherapy for urge incontinence. The drugs are very helpful for some although some cannot tolerate the potential side effects of a dry mouth and eyes. Percutaneous tibial nerve stimulation (PTNS) is an incontinence treatment which is widely available which works by gently stimulating the nerves to the bladder with electrical impulses.

What made you want to be a consultant?

Mohammed Belal

Since a young age I have been fascinated by medicine and had a strong desire to help others. I developed a passion for urology as it is a field where I can really engage with and listen to patients and provide positive improvements to their health. This inspired me to train as a consultant. I feel privileged to be able to provide excellent clinical care in this field. I am passionate about making changes for patients which can have such a profound impact on their quality of life.

David Griffiths

On entering Leicester Medical School in 1982 I had every intention of becoming a GP. However, during my 4th year placement in obstetrics and gynaecology I became inspired by my senior consultants Mr Nick Naftalin and the late Prof John Macvicar. They were both extremely dedicated, passionate, skilled and caring role models. I fully appreciate the opportunity that I had to work with them as they changed my mind set and future career path.

What has been your career highlight to date?

Mohammed Belal

Several career highlights include a year long fellowship in Melbourne, which was a world leader in its approach to trauma care. Since moving to Birmingham I have instigated innovative treatment approaches, such as sacral neuromodulation and perform complex reconstructive surgery for the West Midlands and beyond. On a national level, I am involved in running an internationally recognised course training other specialist urologists and am an invited speaker to national and international meetings.

David Griffiths

Aside from being appointed as a consultant in Swindon during my training I was awarded a fully funded 12 month fellowship to Harvard Medical School in Boston. This was to undertake research on the pelvic floor using the first ever upright MRI scanner. The intellectual milieu was infectious. I also had opportunity to spend time with internationally acclaimed gynaecologists in the US and work for several months in New Zealand. My two year career break was extremely beneficial and I count myself as very fortunate to have had the opportunity. I now actively encourage my trainees to seek out overseas experience.

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