About a third of women around the menopause will have some degree of urinary incontinence, however, many will wait years before they tell their Doctor about it. There are a number of treatments available, which involve changes to lifestyle, medications and surgery. Exactly what treatments are needed depends on the reason why you leak urine.
Types of Urinary incontinence
The two main types of urinary incontinence are ‘Stress urinary incontinence’ and ‘Urge Urinary incontinence’ though it is possible to have both types at once – so called ‘Mixed incontinence’.
1 - Stress incontinence means that women leak urine when they cough or sneeze, pick up something heavy (like a grandchild) or perform exercise or jumping. It is usually due to weakness of the pelvic floor which no longer supports the bladder correctly when you cough or sneeze although more rarely there may be direct damage to the bladder outlet valve itself. Pregnancy and childbirth often contribute to pelvic floor weakness, but a chronic cough or constipation won’t help.
Treatments for Stress Incontinence
Pelvic floor exercises to strengthen the pelvic floor will cure some women’s stress incontinence. There are many leaflets available that will give guidance as to how to do these. However, some women need the guidance of a physiotherapist to ensure they are working the right muscles. It takes time to build up any muscle, so we usually give it at least 3 months before deciding how successful pelvic floor muscle training has been.
Being overweight or obese increases your risk of incontinence, especially stress incontinence. Being obese increases your risk of stress incontinence 3-fold. Conversely weight loss can most definitely cure or improve stress incontinence, or at the very least make you healthier if you end up needing an operation for it.
If non-surgical treatments fail, then there are a number of operations that treat stress incontinence with excellent success rates. The most widely performed operation is the insertion of a mid-urethral tape (a TVT or tension free vaginal tape or urethral sling operation) through a small cut in the vagina. This can be done as a day case or overnight stay and works almost instantly. As with all surgery there are risks and considerations that your surgeon can discuss with you.
2 Urge incontinence / Overactive or Weak Bladder
A normal bladder will relax as it fills with urine until it gets about two-thirds full then it will send increasingly strong messages that it needs to be emptied. However, it will not contract until it is actually a good time to pass urine. Overactive bladders don’t wait for permission and contract when they feel like it. This can be very sudden (urgency) and might result in the leakage of a few drops of urine while you run to the toilet (urge urinary incontinence). Flooding is when the whole contents of the bladder is lost, and can understandably be very upsetting but is actually quite rare. Sometimes bladders will suddenly contract when you stand up or even when you cough. Seeing a toilet, hearing running water, or getting the key in your front door are classic things that trigger urgency. Women who have both stress and urge incontinence usually feel that their urge incontinence is worse because it is so unpredictable.
Treatment for Urge incontinence
In some women there are irritants making the bladder overactive such as urinary infections, and treating these lets the bladder settle down. However, the mainstays of treatment are Bladder training and Fluid Management. Drinking enough of the right sort of fluids and training your bladder to hold urine a little bit longer each day can give you a lot more control. Pelvic floor exercises also help stop the sensation of suddenly needing to go to the toilet. We generally suggest at least six weeks of this before reassessing. Completing a bladder diary can be very informative for the Doctor, and very enlightening for the patient.
Further treatment includes daily drug treatment, and there are now a number of different medications that can be helpful. Again, it is worth trying these for at least two months to give them a chance to work.
Surgical treatments include injecting Botulinum toxin into the bladder using a fine telescope passed through the water pipe. Pinehill Hospital is among few providers of private healthcare offering patients this treatment for overactive bladder.
This is a test that looks at how the bladder relaxes and contracts and the messages it sends. Not everyone will need it, but it can be really useful if early treatments are not working, to identify the type of incontinence and allow the most appropriate treatment to be offered. It is also used in patients with difficulty voiding such as men with enlarged prostates.
It is performed by a Specialist nurse who and takes about 20 minutes. A small tube is passed into the bladder through the water pipe to fill the bladder with salt water, and measure pressures in the bladder. A second fine tube has to be passed into the vagina or back passage to measure the pressure in the abdomen. You have to be awake to tell us what you feel as we fill the bladder during the test. Once you feel full, we might ask you to do things that usually make you leak, like cough or wash your hands so we can pin point exactly what happens when you do. Then we will ask you to pass urine, and all the information is analysed by a computer.