What is urinary incontinence?

Urinary incontinence is an involuntary loss of urine where an individual has difficulty controlling their bladder. For women, this can range from occasional leaks when coughing or laughing to a sudden, strong urge to urinate that's difficult to control. In this article, leading consultant urogynaecologist Dr Vladimir Revicky goes into expert detail about this condition.

What are the most common types?

There are several types of urinary incontinence that commonly affect women:

• Stress incontinence : This occurs when physical activity or exertion such as coughing, sneezing, or exercising puts pressure on the bladder, causing leakage.
• Urgency incontinence: Characterised by a sudden, intense urge to urinate followed by an involuntary loss of urine. It is often associated with conditions like overactive bladder.
• Mixed incontinence: A combination of stress and urge incontinence, where a woman experiences symptoms of both types.
• Overflow incontinence: This happens when the bladder doesn't empty completely, leading to dribbling of urine.
• Functional incontinence: Incontinence due to physical or mental impairments that prevent one from making it to the bathroom in time.

What causes urinary incontinence in women?

There are several factors that can contribute. These include:

• Pregnancy and childbirth: One of the effects of these, is that the muscles needed for bladder control, nerves and supportive tissues are damaged.
• Menopause: The decrease in oestrogen levels can affect the lining of the bladder and urethra, leading to incontinence.
• Obesity: Excess weight increases pressure on the bladder and surrounding muscles, which can weaken them and lead to incontinence.
• Aging: The muscles in the bladder and urethra can weaken over time, contributing to incontinence.

How common is urinary incontinence among women?

Urinary incontinence is a common issue among women, particularly those who are older or have had children. Studies estimate that between 25 per cent and 45 per cent of women experience some form of urinary incontinence at some point in their lives.

What are the risk factors surrounding urinary incontinence?

The likelihood of developing urinary incontinence can increase due to several factors:

• Age: The risk increases as you get older.
• Childbirth: Vaginal delivery can increase the risk.
• Obesity: Excess body weight can put additional pressure on the bladder.
• Smoking: Chronic coughing associated with smoking can cause stress in the pelvic floor muscles.
• Family history: Genetics can sometimes play a role in the likelihood of developing incontinence.
• Other health conditions: Diabetes, neurological diseases, and conditions that affect mobility can increase the risk.

What are the symptoms of urinary incontinence?

Symptoms can vary depending on the type of incontinence but generally include:

• Involuntary leakage of urine when laughing, coughing, sneezing, or during physical activities.
• A sudden, strong urge to urinate.
• Frequent urination.
• Waking up multiple times at night to urinate (nocturia).
• Inability to reach the toilet in time.

How is urinary incontinence diagnosed?

Diagnosis typically involves:

• Medical history and physical exam: Your doctor will ask about your symptoms, medical history, and may perform a physical examination.
• Bladder diary: Recording your urination patterns and symptoms can help identify the type of incontinence.
• Urinalysis: A urine sample is tested to see if there are signs of infection, blood or other abnormal results.
• Postvoid residual measurement: This measures the amount of urine left in the bladder after urination.
• Urodynamic testing: Assessing how well the bladder and urethra are storing and releasing urine.
• Imaging tests: Ultrasound or other imaging to check for abnormalities.

How is urinary incontinence treated?

Treatment options vary based on the type and severity of incontinence and can include:

• Lifestyle changes: Losing weight, dietary adjustments and quitting smoking.
• Pelvic floor exercises: Kegel exercises strengthen the muscles that control urination.
• Bladder training: These are techniques to increase the time between urination.
• Medications: To calm an overactive bladder or increase bladder capacity.
• Medical devices: Pessaries or urethral inserts for additional support.
• Surgery: For severe cases of stress urinary incontinence, options include Urethral bulking procedures, Colposuspension and Autologous fascial sling procedures
• Bladder Botox™ injections and sacral neuromodulation for treatment of urgency urinary incontinence.

If you're experiencing urinary incontinence, there are several effective treatment options available, particularly for severe cases. Here’s a closer look at some surgical and advanced treatments for different types of urinary incontinence.

Surgical treatments for stress urinary incontinence

Urethral bulking procedures

• What is it: This minimally invasive procedure involves injecting a bulking agent into the tissues around the urethra (water passage).
• How It works: The bulking agent helps to thicken the urethral walls, improving the urethra’s ability to close and thereby reducing urine leakage.
• Pros: It is usually an outpatient procedure with a quick recovery time.
• Cons: The effectiveness may diminish over time, and repeat injections might be necessary.

Colposuspension (Burch Procedure)

• What is it: This surgical procedure involves lifting and securing the bladder neck and urethra to the pelvic bone using sutures.
• How It works: By providing support to the bladder neck, this surgery helps prevent urine leakage when pressure is placed on the bladder.
• Pros: It has a high success rate for reducing stress incontinence.
• Cons: It is more invasive and requires a longer recovery time compared to minimally invasive procedures.

Autologous fascial sling procedure

• What is it: This involves creating a sling from a strip of your own tissue (fascia) which is then placed under the urethra to provide support.
• How it works: The sling acts as a hammock, supporting the urethra and preventing urine leakage.
• Pros: Uses the patient's own tissue, which reduces the risk of rejection or infection.
• Cons: It is a more complex surgery and involves a longer recovery period.

What are advanced treatments for urgency urinary incontinence?

Bladder Botox injections

• What it is: This treatment involves injecting Botox (botulinum toxin) directly into the bladder muscle.
• How it works: Botox helps to relax the bladder muscle, reducing involuntary contractions and increasing bladder capacity.
• Pros: It can significantly reduce the symptoms of urgency incontinence and overactive bladder.
• Cons: The effects are temporary, usually lasting about 6-12 months, requiring repeat injections.

Sacral neuromodulation (InterStim Therapy)

• What is it: This therapy involves the implantation of a small device (similar to a pacemaker) that sends electrical impulses to the sacral nerves, which control the bladder.
• How it works: The electrical impulses help to modulate the nerve signals to the bladder, improving bladder control.
• Pros: It can provide long-term relief from symptoms of urgency incontinence and has been shown to improve quality of life significantly.
• Cons: It involves a surgical procedure to implant the device, and there may be risks associated with surgery and the implanted device.

Conclusion

Choosing the right treatment for urinary incontinence depends on the type and severity of your condition. Surgical options like urethral bulking, colposuspension, and autologous fascial slings can be effective for stress incontinence, while advanced treatments like bladder Botox injections and sacral neuromodulation can help manage urgency incontinence. It's important to discuss the various options with your doctor in order to determine the best course of action that meet your specific needs. With the right treatment, many women find significant relief from their symptoms, improving their quality of life.

Arrange a consultation with Dr Revicky via his Top Doctors profile.