Bladder Problems | Urinary Incontinence

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Urinary incontinence is a common and distressing problem

Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence affects approximately one third of women at some stage in their life. Many women feel embarrassed about discussing bladder problems but it is a medical condition and it can be treated.

Urinary problems generally fit into three broad categories:

  1. Urinary Stress incontinence: There can be weakness around the bladder neck which manifests itself in urinary leakage when you run or cough or skip. Read more…
  2. Urge Incontinence: This occurs when the bladder muscle contracts involuntarily and commonly manifests itself in urinary frequency, urinary urgency and getting up at night. Read more…
  3. Mixed Incontinence: Some women who will tend to have a mix of both types of urinary incontinence. Read more…

Urodynamic Studies

Treatment is dependent on diagnosis. Bladder studies, called urodynamic studies, are performed to accurately diagnose the type of urinary incontinence present so that treatment can be tailored to the needs of the individual. Urodynamic studies take about 20 minutes and show how your bladder functions and works.

Pelvic floor exercises are designed to strengthen your pelvic floor muscles through actively tightening and lifting them at intervals. Strong, well activated pelvic floor muscles help support the bladder, uterus and bowel. The exercises are designed to work three different parts of the pelvic floor muscles:

  1. the muscles that control urine flow
  2. the muscles that control the anal sphincter (muscles around the anus)
  3. the muscles that surround the urethra and vagina.

The pelvic floor muscles also interact with the deep abdominal muscles.

The exercises can be performed sitting, standing or lying down. You can do pelvic floor exercises while waiting in a queue or sitting at the office desk, without anyone noticing. It may take 2-3 months to notice a significant improvement.

As with any exercise program, you should start gradually, building up the number of contractions and perform the exercises regularly. More important than having strong pelvic floor muscles, however, is the ability to activate them in time against increases in abdominal pressure (eg when sneezing, coughing or lifting).

A physiotherapist is very useful in teaching techniques to optimise your results. If not done properly, the exercises may exacerbate symptoms. Physiotherapists can also assist with bladder-retraining.

Medications

There are medications that can be used to treat urinary incontinence.

Hormone replacement therapy can be used to improve the integrity of the pelvic floor to improve stress incontinence and can also be used to reduce the sensitivity of the bladder to improve symptoms related to urge incontinence.

There are some anticholinergic medications, namely Ditropan and Vesicare, that act by relaxing the bladder muscle. This can treat urge incontinence that is related to spasm of the muscle of the bladder.

Surgical Treatment

Surgical treatment is exclusively for the treatment of urinary stress incontinence. Surgical treatment is extremely successful. Over 90% of women will be dry after having surgery using the tension-free vaginal tape (TVT) system and will remain dry in the long-term.