Urinary incontinence (involuntary leakage of urine) is a common problem affecting approximately 1 in 3 people over the age of 60 years. It is seen more frequently in women, but can affect men as well among whom it is often caused by prostatic surgery. Incontinence is not life threatening, but can significantly impairquality of life by affecting their physical, psychological and social wellbeing.

Urinary incontinence is either caused by an overactive bladder, a weak pelvic floor/urinary sphincter or a combination of both. Patients with an overactive bladder are said to have urgency incontinence and report symptoms such as going to the toilet too often, having to rush to the toilet and getting up at night to urinate. Those with a weak pelvic floor/urinary sphincter are said to have stress urinary incontinence and report leakage on exertion such as coughing, sneezing, bending, lifting and exercising. Patients with both types of symptoms are said to have mixed urinary incontinence.

The diagnosis is established by a careful history, bladder diary (documenting fluid intake and urine output), physical examination and specialised investigations such as flow rates, post-void bladder scan and urodynamics.

For patients with urgency incontinence, the initial management includes the following:

If these measures fail, more invasive options are available and include the following:

Urinary diversion – This is used as a last resort for patients who either are not willing to use a cathet