Urinary incontinence is the involuntary leakage of urine. It is a common and distressing 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. Urinary incontinence can significantly impair patients’ quality 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 (stress and urge) and therefore there are a number of different types of urinary incontinence:
- Patients with an overactive bladder are said to have urgency incontinence, where there is a sudden urge to urinate and it is very difficult to contain it often resulting in leakage, reporting 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, where the bladder cannot contain the urine when there is pressure exerted on it such as coughing, sneezing, bending, lifting and exercising.
- Patients with both types of symptoms are said to have mixed urinary incontinence.
There are a number of tests available to diagnose whether a patient has and the type of urinary incontinence.
Ultrasound scan KUB
This is done to assess the bladder emptying and the well-being of kidneys and the bladder.
Urodynamics is a test performed on the bladder to show what happens to the bladder on filling and emptying. Click here for an information sheet on urodynamics from the British Association of Urological Surgeons.
Treatment of Incontinence
This includes optimisation of weight and fluid intake and avoidance of irritant fluids such as caffeinated and carbonated drinks.
Bladder retraining is behavioural training that includes exercises that help overcome the urge to urinate and therefore increase the intervals between emptying the bladder.
Pelvic floor exercises (PFMT)
Aim of these is to strengthen the pelvic floor muscles. This can be learnt under the formal guidance of a dedicated physiotherapist.
These are medications that calm down the bladder and are effective in about 60% of patients.
Intravesical injection of Botox
This Involves a minor day case procedure where botox is injected at several places in the bladder wall. It is performed via a telescope inserted into the urethra (water pipe). It has an 80% success rate. The only serious side effect seen in about 10 -15% of patients is a temporary impairment of bladder emptying requiring use of a catheter. The treatment needs to be repeated once every 6-9 months. Click here for an information sheet on intravesical injection of Botox from the British Association of Urological Surgeons.