Incontinence

What is urinary incontinence?

Urinary incontinence is the loss of bladder control leading to leakage of urine. It is a regular and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.

Types of urinary incontinence include:

Stress incontinence: Urine leaks when you exert force on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress urinary incontinence is usually reason by weakness of the pelvic floor muscles which is frequently related to childbirth or previous prostatic surgery.

Urge incontinence: A sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Most of the time, this is caused by over activity of the bladder detrusor muscle and there is no underlying cause (Idiopathic detrusor over activity), but it may sometimes be reason by serious conditions such as urine infection, bladder cancer, prostatic obstruction, bladder stones or neurological disorders.

Overflow incontinence: Frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

Mixed incontinence: More than one type of incontinence

What are the tests for incontinence?

Your doctor wills likely order tests to further assess incontinence.

Urine tests: A sample of the urine is tested for infection, blood in the urine and cancer cells.

Bladder diary: For several days you record how much you drink, when you urinate, the quantity of urine you produce, whether you had an urge to urinate and the number of incontinence episodes.

Pad weight: The severity of urine leakage is measure by weighing the continence pads before and after use over a 24 hour period.

Urodynamics study: A catheter is inserted into your bladder to fill your bladder with water. Meanwhile a force monitor measures and records the pressure within your bladder. A small catheter is also be inserted into your rectum to measure abdominal force. This test helps measure your bladder strength and urinary sphincter health, it is a important tool for distinguishing the different type of incontinence you may have.

What are the possible treatment options?

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause.Some general behavioural techniques may improve continence:

Scheduled toilet trips: Urinate every two to four hours to keep the bladder empty
Fluid and diet management Ignoring caffeine, spicy foods and alcohol which may stimulate the bladder. Reducing excessive fluid consumption, weight loss and enlarged physical activity can also ease the problem.Pelvic floor exercises.The pelvic floor muscles control urinary and bowel continence. Exercises can strength these muscles and improve control.Exercises involve tightening the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds.Progressively work up to holding the contractions for 10 seconds at a time.Aim for three sets of 10 repetitions each day.To help you identify and contract the right muscles, your doctor may advise you work with a continence therapist or try biofeedback techniques.

What is the treatment for urge incontinence?

Apart from the general behavioural changes, there are medications that dampen and inhibit involuntary contractions of the bladder detrusor muscle. There are several groups of these medications that act on the sympathetic or parasympathetic nervous supply of the bladder to relax the bladder. Possible medications available in Australia include Ditropan, Oxytrol patches, Enablex, Vesicare and Betmiga. Injections of Botox into the bladder muscle may benefit people who have an overactive bladder that does not respond to other first line medications. Botox last between 3-9 months, and repeat injections is necessary