Urinary Incontinence – No need to put up with it!
What is urinary incontinence?
By definition, urinary incontinence is the involuntary leakage of urine, it is a very common problem that affects women twice as often as men. Although it’s more common in older women, it’s not part of ageing. Indeed, women of all ages are at risk for urinary incontinence, from athletes to women of child-bearing age and women experiencing menopause and older.
How does urinary incontinence affect an individual?
A spectrum of complications are associated with urinary incontinence, including urinary tract infections, skin rashes, and skin infections (as a result of continuously wet skin). These in turn have an impact on your quality of life with limits on social activities, the need to look out for toilets when travelling and the inconvenience of pads. Work also becomes more stressful because you frequently require time away from your desk or have to be excused during meetings. Incontinence may disturb your sleep making you tired and irritable. It can also affect your personal life, or even sexual relationship, as you avoid intimacy because of the possible embarrassment from urine leakage.
Why do I leak urine on coughing?
Coughing results in an increase in pressure on the bladder, forcing urine out. Usually the pelvic floor muscles support the bladder and urethra (water passage) and prevent involuntary urine leakage. These muscles can be weakened by childbirth, obesity, menopause or an inherited tissue weakness. This is known as ‘genuine stress incontinence’.
Why do I need to rush to the toilet and get caught short (urgency incontinence)? Normally, the bladder muscle should contract only when you pass urine. Sometimes, the bladder muscle contracts before it is full, when you would rather not go to the toilet. If you don’t reach the toilet on time, you might leak. The urge to pass urine may be overwhelming and so you go to the toilet more often. If you don’t make it to the toilet on time, incontinence may occur. This condition is known as Overactive Bladder (OAB) syndrome.
Are there risk factors for urinary incontinence?
Childbirth, menopause and obesity are the most common risk factors for stress urinary incontinence, due to weakening of pelvic floor support.
Neurological diseases such as stroke, multiple sclerosis and spinal injuries are risk factors for OAB, although the majority have no apparent cause (idiopathic).
What treatments are available?
You need to see your doctor first, who may refer you to a urologist for more specialised treatment.
Simple things you can do:
- Lose weight
- Pelvic floor exercises (with or without biofeedback): as long as you do them regularly, long-term they will help both stress and urge incontinence.
- For OAB syndrome, anticholinergic drugs are the mainstay medical treatment. Drugs such as Solifenacin, Fesotoredine and Oxybutynin usually help with urgency; the main side effects being dry mouth and constipation.
- For stress urinary incontinence, Duloxetine is a new drug; it is not a cure but can help in some cases. The main side effect is nausea.
- Botulinum toxin (“Botox”) injection into bladder, currently off-license indication for refractory OAB.
- Placing a synthetic tape or a tissue sling underneath the urethra to support it
- Urethral bulking agent injection
- Fixing the bladder in a higher position with stitches at an operation (Burch colposuspension)
Of the above, most women prefer the synthetic tape, also known as TVT-O (tension-free vaginal tape-obturator), a tape or hammock which can be placed under the urethra to provide additional support. This reduces episodes of urine leakage so you enjoy a better quality of life as a result. The procedure is done under a short, general anaesthetic as a day-case procedure, normal activities can be resumed after a month or so.