Incontinence
Incontinence refers to the leaking of urine that is frequent or severe enough to be a problem. This condition often can be treated with success. There are different forms of incontinence:
- Stress incontinence is the involuntary loss of urine with activities such as coughing, sneezing, laughing, lifting heavy objects or during physical activity. Stress incontinence often results from weakened pelvic floor muscles, which support the bladder.
- Urge incontinence describes a sudden and urgent desire to urinate and an inability to hold the urine until a toilet is reached. Urge incontinence is caused by the involuntary contractions of an overactive bladder muscle.
- Overflow is characterised by an over distended bladder due to the bladder not emptying properly. Overflow incontinence occurs when the bladder is unable to sense that it is full (caused by damage to the nerve supply to the bladder, diabetes, drugs, multiple sclerosis) or because of an obstruction to the bladder opening. Women with overflow incontinence may only have a weak dribbling stream of urine or feel that they need to empty their bladder but cannot.
- Functional incontinence results from the inability to reach a toilet on time due to poor mobility, poor dexterity, memory loss and/or the unsuitable positioning of the toilet in the building. This is more common in the elderly or disabled.
Some women can complain of a mixture of stress and urgency incontinence, referred to as mixed incontinence.
As each form of incontinence is treated differently it is important to correctly diagnose the type of incontinence. This requires a thorough history and examination. The examination will also assess for pelvic organ prolapse, as this may be an associated problem.
A special test called Urodynamics may be performed to determine how the bladder works while filling and emptying. This test allows for an accurate diagnosis of incontinence and assists with the decision on the correct treatment.
There are a number of different treatment options for urinary incontinence. The best treatment option is dependent on the type and severity of the incontinence.
- Conservative measures such as weight loss, avoiding heavy lifting and treating conditions such as chronic cough and constipation will decrease the pressure on your bladder and may reduce symptoms.
- Physiotherapy exercises designed to strengthen the pelvic floor muscles improve symptoms. Concurrent use of low-dose oestrogen cream may be of benefit when the tissue is very thin and dry.
- Medications can be used to assist in keeping dry while the retraining of the bladder with exercise and bladder training exercises occur. They work to increase the capacity of the bladder. They do have side effects such as dry mouth, constipation and confusion but these are less common with the newer drugs.
- Surgery may assist with stress incontinence. Tape or sling procedures involve the insertion of a tape that sits under the urethra.
To prevent urinary incontinence it is important to maintain a healthy weight, perform regular pelvic floor exercises, and manage any chronic cough or constipation before it causes damage.
During pregnancy and childbirth it is of particular importance to take care of your pelvic floor and to initiate pelvic floor exercises prior to delivery and continue after delivery.
DR Kylie Isaacs hopes to provide women the environment they need to feel comfortable to come and talk about their issues of incontinence. With appropriate treatment incontinence will no longer be a problem in your social life.
