Urinary Incontinence 

Urinary incontinence – the sudden unintentional release of urine - is one of those things that nobody wants to talk about. It can affect your life to such an extent that you end up limiting or avoiding social activities, physical exercise, and travelling. The reduction in quality of life can have a huge impact on your emotional and psychological well - being. But there are a variety of ways to control the problem and overcome it altogether.

The problem is much more common in women and it is estimated that 75% will experience bothersome urinary leakage at some time during their life.

Urinary incontinence can broadly be divided into the following categories:

1. Stress Incontinence is leakage of urine on exertion (coughing and sneezing, straining, lifting heavy loads or exercising). It is common in women who have had children. Pregnancy and childbirth can result in weakness in the pelvic floor muscles which support the bladder and womb and also the muscle within the pelvic floor (the sphincter) which closes the the urethra (water pipe).
2. Urge Incontinence is leakage of urine associated with an urgent and frequent need to rush to the toilet.  This is caused by an overactive bladder.  It can often occur on its own without underlying disease, but it is also commonly associated with spinal injuries and neurological conditions such as multiple sclerosis.
3. Mixed Incontinence is the term given for a combination of stress and urge leakage.

Urinary incontinence in men

Although far less common, men can also experience this problem.  The prostate gland which lies directly beneath the bladder commonly becomes enlarged in men over 60 years of age, obstructing the outlet from the bladder.  Urinary leakage can occur due to overactivity of the bladder muscle as it tries to push the urine out against resistance.  The obstruction can also lead to the bladder overflowing involuntarily, if it is not emptying effectively, and to a condition known as post micturition dribble (leakage of urine shortly after urination has finished).  These problems are usually resolved once the enlarged prostate has been treated. Men may also suffer from temporary urinary incontinence following certain types of surgery to the bladder or prostate.  However, this is uncommon following minor operations. 

Other factors that increase the risk of incontinence are ageing, being overweight, straining to pass a bowel motion, and indirectly, smoking (chronic coughing puts pressure on the pelvic floor and increases the risk of urinary leakage).

Whatever the cause of the incontinence, there are many things that can help from lifestyle changes, pelvic floor exercises and medication to surgery. 

Some investigations and treatments available at Salisbury District Hospital that may be suggested to you:

1. Urine Flow Test followed by Bladder Ultrasound Scanning: This combined investigation shows how well the bladder empties and if there is a significant volume of urine left behind.  It involves passing urine into a flow machine in the privacy of the toilet, shortly followed by the ultrasound scan.  You will be shown into another room where the ultrasound probe is passed gently over the lower abdomen).
2. Videourodynamics investigates the function of the bladder – what happens as it fills and empties – it shows whether your incontinence is caused by an overactive bladder (urge incontinence) or a weak pelvic floor (stress incontinence).  It is important to distinguish between the two so the right treatment can be planned.  The test is performed in the Salisbury Spinal X-ray department and involves the passing of very small tubes into the bladder and back passage under local anaesthetic,  and slowly filling the bladder with fluid while the pressures in your bladder are measured.  Once your bladder is full you are asked to pass the fluid out around the tube).
3. Botulinum Toxin Injection (Botox):  You may be more familiar with this in relation to cosmetic surgery, but Botulinum Toxin (Botox) works well in the bladder for patients with an overactive bladder who have not responded well to lifestyle changes or medication.  In the same way as the muscles in the face become inactive, so do the bladder muscles.  The procedure is usually performed in the Day Surgery Unit at Salisbury, under general anaesthetic.  A cystoscope (telescope) is passed into the bladder via the urethra (water pipe) and several injections given into the wall of the bladder.  The procedure usually needs to be repeated every 6 – 8 months)).
4. Tapes/Slings
   
   TVT (tension free, trans-vaginal tape):  For women, this is a minor operation under general anaesthetic to treat stress incontinence, usually performed in the Day Surgery Unit.  The tape acts as a sling to support the urethra (water-pipe) and is put in place via a small incision in the vagina and two small incisions in lower abdomen.
   
   TOT(transobturator tape) is similar to the TVT but positioned slightly differently. Your surgeon will discuss with you what is best for you.
   
   Tapes for Men: Occasionally men suffer on-going urinary incontinence following major bladder or prostate surgery.  Insertion of a male tape can bring about return of continence.  All patients undergoing tape surgery are usually in hospital for one day and one night.


5. Colposuspension: This is an operation for stress incontinence in women.  It is a bigger operation than the tape insertion described above, but is very successful - providing relief for patients when their bladder has dropped too low in the pelvis for tape surgery to be effective.  The procedure is done through a small incision in the lower abdomen and involves lifting the bladder with a vaginal sling.
   
   
6. Artificial Urinary Sphincter

This operation is suitable for men and women who cannot regain continence after every other course of action has been tried and failed.  The operation involves inserting a cuff around the urethra (water-pipe) which can be inflated from a small reservoir placed in the groin and controlled by a small button in labia in women and scrotum in men. Diagram of artificial sphincter mechanism showing cuff around waterpipe and control button NB:  It is important to note that artificial urinary sphincters are very expensive and require funding approval from your GP.  If your consultant recommends this treatment an application will be made on your behalf.