Urinary incontinence
Urinary Incontinence is the involuntary leakage of urine
1 in 3 women in the UK will have urinary incontinence at some point in their adult lives. Many put up with the problem, being too embarrassed to seek help. Fortunately, around 80% of women with urinary incontinence can be cured, and the remainder often helped considerably.
Leakage during laughing, sneezing, coughing or exercise is called ‘stress incontinence’. This is due in part to the effects of childbirth, weakening the support to the water tube from the bladder (the urethra). It is very common, and affects all women once in a while. If it becomes a common occurrence, and limits activities, help should be sought. The simplest treatment is with pelvic floor exercises. These are best taught by a physiotherapist or continence advisor, who can help identify and strengthen the correct muscles. The treatment needs to be continued on a long-term basis to have a lasting effect, and 50-60% of women will benefit substantially with this treatment alone, at least in the short term. Medication can help in some cases, as well as alterations to fluid intake.
The surgical treatment of stress incontinence has changed dramatically over the last decade due to the invention of mid-urethral support tapes. The best known of these is the TVT (tension free vaginal tape). If suitable, patients can expect a 90% cure rate. The surgery can usually be performed as a day-case, with a return to work in 2 weeks. Surgery for any prolapse can be carried out at the same time. Mr Smith has inserted over 400 TVT's, and is involved in research into, and the evaluation of, newer variations of this procedure.
An overwhelming urge to regularly pass urine, day and night, is due to a bladder that cannot relax and fill - an ‘overactive’ bladder. This may lead to loss of urine control, and considerable leakage (urge incontinence). Bladder infections have to be ruled out, and attention to fluid intake, and types of drinks, can help. Coffee, coca-cola and orange juice can irritate an overactive bladder, and an excessive intake of fluids, such as bottled water, will worsen the symptoms. As a guide, a urine output of about 1500mls a day is normal, and any more will cause too frequent trips to the toilet. It can be useful to measure the amount of urine passed, and how often, over 2-3 days, to help decide the cause of the bladder problem. A urine test to exclude infection is always essential.
An overactive bladder can be treated with bladder training, pelvic physiotherapy and certain medication. Botox injections into the
bladder can also help in selected cases.
Mr Smith works closely with urological colleagues from the Bristol Urological Institute (BUI) in the management of urinary problems.
Bladder function tests (Urodynamics) performed at the BUI, can often help evaluate the cause of urinary incontinence.
Help is therefore available, and women should be encouraged to seek advice when urinary incontinence becomes a problem.