More than three million women in Britain have urinary incontinence and it can affect all age-groups. Only a small number seek help because women often think incontinence is unavoidable, especially after having children or don't realise that effective treatments are available.
Urinary incontinence can have a major impact on your quality of life affecting self-confidence, physical activity, and relationships.
What is Incontinence?
Incontinence is the leakage of urine from the bladder. There are different types of urinary incontinence and it's essential to get the diagnosis right so that you get the correct treatment.
- Stress incontinence
- Urge incontinence
- Mixed incontinence
- Overflow incontinence
Stress urinary incontinence (or SUI) is when urine leaks after coughing, sneezing or physical activity. SUI is caused by weakness of the muscles that hold the urine in the bladder.
This is when you get a sudden urgent desire to pass urine that you can’t resist, and urine starts to pass before you can get to the toilet. Having to rush to the toilet urgently is called Overactive Bladder. Urge incontinence affects around 6% of women and also many men.
This is when there is both urge and stress incontinence.
This when you can’t hold urine in a full bladder because the urinary tract is blocked or nerves supplying the bladder are damaged
How is it diagnosed?
A bladder diary is a chart on which you write down how often you have to pass urine and also the amount of urine. You also record what drinks you have, and any leaks that occur. This can be a useful way of recording the bladder's behaviour and helps the specialist to diagnose what kind of incontinence you have.
The specialist will take a detailed account of your symptoms and perform a simple urine test in clinic. You will need to have an examination also. Usually, this is all that is needed to make a diagnosis and start treatment. Sometimes, additional tests may be recommended, such as urodynamics.
Urodynamics (or Bladder Pressure Studies) is a test which measures the pressures inside the bladder while it is filling up and emptying. This shows how the bladder behaves and can help to diagnose the underlying problem. Not every patient will need urodynamics diagnose the problem.
Treatments for Urge Incontinence
Common treatments for urge incontinence and overactive bladder include:
- Bladder retraining
- Oestrogens therapy
- Botulinum Toxin bladder injections
- Sacral Neuromodulation
Usually, the doctor will try simple things to treat your symptoms first. Patients often respond well to “conservative measures” and tablets can make the bladder less sensitive.
For people who do not get better with simple treatments, Botulinum Toxin injections can be very effective.
Treatments for Stress Incontinence
Stress incontinence can be managed in a number of ways. Your specialist will go through the benefits of each and any side effects or complications.
- Pelvic floor exercises
- Vaginal tapes (eg TVT, TOT)
- Urethral injections
We usually recommend that you try pelvic floor exercises before considering operations. If further therapy is needed, vaginal tapes are a highly effective treatment.
Which specialist should you see?
It is important to see a specialist who has expertise in dealing with incontinence. This will usually be a urologist of urogynaecologist. BMI have specialists all over the UK who will help you find the right treatment for you.
The National Institute Of Clinical Excellence says: “The expertise of the surgeon is one of the factors that influence surgical outcomes. The best outcomes are achieved when surgeons and their teams have specialist training and regular practice in continence surgery.”
“Some procedures for incontinence are technically simple, yet potentially harmful if carried out incompetently or in inappropriate patients. Others are complex and require higher levels of expertise.”
Paying for the treatment
Incontinence treatment costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own treatment the cost will be explained and confirmed in writing when you book. Ask the hospital for a quote beforehand, and ensure that this includes all associated costs.
Author: Mr Richard Parkinson Ph.D FRCS(Urol), Consultant Urological Surgeon, BMI The Park Hospital, Nottingham
Further information: www.nottinghamurologygroup.co.uk