This condition affects over 20% of adult women. It is often improved or cured with medical and surgical treatments, often combined with physiotherapy and behavioural therapy. There are several causes of incontinence and understanding the cause in order to make a diagnosis is important. This usually involves a detailed history, in particular relating to specific symptoms. The 2 most common conditions are the overactive bladder and stress incontinence.
Overactive bladder:
This condition is typically associated with the symptom of urgency. This can result in leakage if the person is unable to make it to the toilet in time. Other symptoms may include frequency (going to the toilet too often), disturbed sleep and occasionally, bed wetting. Treatment for overactive bladder usually involves bladder training, drug treatments and occasionally, Botox injections into the bladder, which may repeated every 6 months or so.
Stress incontinence:
This condition is associated with leakage of urine on exercise, coughing & sneezing. It can also occur with less strenuous exertion such as walking (particularly walking downhill), lifting or stumbling or anything that increases the pressure in the abdomen).
It is usually caused by weakness of the pelvic floor muscles and supports (particularly those related to the urethra – the tube that carries urine out from the bladder). Treatment options include physiotherapy and surgery. Physio aims to strengthen pelvic floor muscles and can significantly improve symptoms in over 60% of women.
If this proves unsuccessful, then surgery is an option. This usually involves a short-stay procedure, carried out under an anaesthetic (general or spinal). The most commonly performed operation is the Tension Free Vaginal Tape (TVT). The operation takes about 20 minutes.
Most women can go home on the same day or the day after surgery & overall recovery usually takes 2 – 6 weeks. The success rate for this operation is approximately 90%, though there are some risks involved & these will be discussed in full if you are considering this option.
Tests & Investigations:
Pelvic and abdominal examination is an important element in the assessment of patients with incontinence. Additional simple tests may include completing a personal bladder diary (Frequency Volume Chart) as well as testing a urine sample for signs of infection or inflammation.
If surgery is being considered, it may be useful to undertake a test of bladder function, to help find out the cause of symptoms and the best form of treatment. This test is called Urodynamics and involves measuring the pressure in the bowel and bladder (using small catheters or tubes) as the bladder is filled over about 10 minutes or so. Sometimes scans, xrays and cystocopy (telescopic inspection of the bladder) may be offered to better understand the cause of problems.
