Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is when a woman is unable to control the flow of urine from her bladder and it results in accidental or involuntary leakage of urine.

There is a common belief that incontinence is a normal part of aging but this is INCORRECT. It is a medical condition that can be treated and we recommend you see your doctor for treatment advice.

There are 2 main types of incontinence:

> STRESS Incontinence (click for more info)

This is usually small volume leaking with coughing, sneezing, jumping or specific movements.

> URGENCY Incontinence (click for more info)

This is part of a condition called Overactive Bladder Syndrome where you get leaking after an urgent feeling of needing to urinate and you are not able to get to the toilet in time.

Stress Incontinence

Stress urinary incontinence is when an increase in the pressure applied to the abdomen (eg. during lifting, coughing, sneezing, standing, laughing, etc) is stronger then the pressure of the pelvic floor muscles and ligaments that hold the urethra (tube of the bladder) closed. This forces some of the urine out when performing some of the activities above.

Conservative Management

This includes management options that are not surgical. The main benefit of conservative treatment is that they are less risky then surgery, but often require a bit more day to day commitment.

Managing risk factors - the things that increase your abdominal pressure (eg. weight loss, controlling your cough, quit smoking)
Pelvic floor muscle exercises (PFE) - we recommend this happens with an appointment with a womens health physio to start with to ensure the exercises you are doing are correct and then you are not causing harm instead of good. There are also some online helpful video's which you can view below to get you started
Stress incontinence pessaries - these are devices that get inserted into your vagina and help support your urethra from inside. They are low risk and if they work can be a life changer.

Surgical Management

This includes management options that require an operation. They are often more likely to work longer term, with the downside of potential surgical risk. Your Gynaecologist will discuss your specific risks with you at the time of your appointment.

Mid-Urethral Slings- This is a small day procedure where a "tape" is placed under the urethra to help support it during coughing, jumping or sneezing. the tape is constructed of mesh and is not suited to everyone. Your specialist will discuss your suitability at your appointment.
There is a very specialised group of Gynaecology called Uro-Gynaecologists who perform some more advanced stress incontinence operations including Burch Colposuspension and they use Urethral Bulking agents. Your Gynaecologist might discuss these with you or arrange a referral to a Uro-Gynaecologist if necessary.

Pelvic Floor Exercises

Pelvic Floor Physical Therapist Michelle Kenway explains pelvic floor exercises simply.

Overactive Bladder - Urge Incontinence

Overactive bladder or Urge incontinence is when the muscle of the bladder, called the Detrusor muscle, contracts with very little prompting and tries to empty the urine when you are not ready. Often there are triggers in your environment which will stimulate it to contract. Common triggers include: When you try to open the door when you get home, When you feet hit the floor when getting out of bed first thing in the morning and often running water will also trigger.

Lifestyle changes

Management of overactive bladder can be achieved by changing some lifestyle behaviors and habits. These are some of the non-medication based ways of managing urgency.

Remove bladder muscle irritants: below is a list of substances in your diet that cause the bladder to over contract. removing them will reduce the number of times that you will experience urge sensations.

- Caffeine (Coffee, Tea, energy drinks)

- Alcohol

- Carbonated drinks (soda water, soft drinks, energy drinks)

- Smoking

Bladder retraining - This is a process where you re-condition your bladder to respond to your request when you tell it not to empty. This takes practice and usually takes 4-5 days to start to see results.

Medical Management

When lifestyle changes are not working or are to difficult then there are a number of medical therapies that can be used to decrease your urgency.

Medications- There are a number of medications that are available for treatment. They have a mix of different side effects and are different costs. As a general the lower side effect profile medications tend to be more expensive and usually treatment will start with Oxybutanin patches or tablets and then your doctor will discuss Betmiga or Vesicare as alternative options. These medications block the contraction of the Detrusor bladder muscle and that decreases the strength of the urgency sensation yuo may experience.
Cystoscopy and hydrodistension - This is a small procedure where we have a look inside your bladder and use some fluid to stretch the muscle. The stretching is aimed at relaxing the muscle and decreasing the urge. It is also a way of checking that there is not another cause for the urgency in the bladder such as abnormal cells or chronic inflammation
Intravesical botox - This is where we use a camera to look inside the bladder and then inject botox into the bladder wall. The botox is in small doses and stops part of the bladder muscle from contracting. This decreases your urge sensation. It can last up to 18 months but most it will be 9-12 months.

Urinary incontinence and Overactive bladder
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