Stress Incontinence

  • Weakness in the urinary sphincter and/ or pelvic floor muscles
  • Urine loss is triggered by activities that cause a rise in intra-abdominal pressure e.g. coughing, sneezing, jumping, lifting, obesity constipation exercise.
  • Hormonal deficiencies such as Menopause Lack of estrogen.
  • Sometimes even standing up from a seated or reclining position can cause enough pressure to cause leakage.
  • To hold urine in the bladder without leakage you need to contract the sphincter. When your sphincter and pelvic muscles are weak it is more difficult to contract these muscles eg post-childbirth, constipation or pelvic surgery

Management and/or treatment of stress incontinence

  • Pelvic floor rehabilitation with exercises to strengthen the pelvic floor, preferably under the supervision of a pelvic floor physiotherapist; to find one in your area, visit the Continence Foundation of Australia website.
  • Vaginal pessary: a device that is placed high in the vagina to hold up the bladder neck and any prolapse that is present. It may be shaped like a ring, but can be a number of other shapes, including a mushroom-like pessary. The size and shape will be determined by your doctor. The pessary requires cleaning every 3-6 months and can be done by either yourself or your doctor. If the size and position are right, then you will be unable to feel it.
  • A sub-urethral sling, of which there are many types, is the recommended surgical procedure for stress incontinence. A common method used is the retropubic mid-urethral sling (tension-free vaginal tape), which is inserted through the vagina, up behind the pubic bone and out through the abdominal wall, avoiding the bladder. Cure rates are high in more than 90% of women.

Urge incontinence 

  • Detrusor overactivity: i.e. a bladder muscle that contracts or spasms out of the person’s control usually at low bladder volumes and with little warning
  • The loss of urine is preceded by a sudden and severe desire to pass urine with loss of urine typically occurring on the way to the toilet.
  • Triggers for urine loss include arriving at the front door (“key in the door”), running water, hand washing, cold weather.
  • Amount of urine loss is variable, ranging from a few drops to flooding
  • Other common causes: UTIs, Bladder diseases such as tumors or stones.
  • Constipation, enlarged prostate that presses on the bladder or urethra and restricting urine flow.
  • Often related to diseases such as MS and Parkinsons

Medications that can calm down an overactive bladder:

  • Oxybutynin (Ditropa)
  • Darifenacin (Enable)
  • Solifenacin (Vesicar)
  • Mirabegron (Betmig) – may also increase bladder capacity
  • Topical/vaginal estrogen cream, pessary or tablet

Botox injections into the bladder wall under general anesthetic by a specialist, if all other treatments have failed

Overactive Bladder
OAB is defined as the urgent desire to urinate (with or without urge urinary incontinence) which is usually associated with frequent urination as well as excessive urination at night.
About 1/3 of people who suffer from OAB experience urinary incontinence, known as “OAB wet”, with the remaining 2/3 of people having “OAB dry”.
It is important to ensure that other conditions causing irritation to the bladder lining are not mistaken for OAB, e.g. urinary tract infections, bladder stones, and bladder tumours.

Fistula

A fistula is an abnormal connection between the urinary tract and other organs e.g. between the bladder and vagina in women -“vesicovaginal fistula”. This is not common in developed countries but can happen post-surgery.

  • A vesicovaginal fistula is usually associated with urinary incontinence leakage of urine into the vagina which can be quite severe.
  • Continuous insensible (not felt) urine loss from the vagina, usually of large volume
  • Other fistulas relating to continence
  • Vesicouterine fistula occurs between the bladder and the uterus
  • Urethrovaginal fistula is between the urethra and the Vagina

Mixed incontinence is a combination of stress and urge incontinence symptoms. 

Treatment/management for incontinence

  • Lifestyle changes such as losing weight, quitting smoking, eating more fibre, drinking more water or lifting less.
  • Medication to help relax the bladder muscles, which play an important role in urge incontinence.
  • Physiotherapy to strengthen the pelvic floor, which supports your bladder. A physiotherapist can design a special pelvic exercise program for you.
  • Surgery to support or ‘hold up’ your bladder or urethra (the tube that links your bladder to the outside of your body). Surgery is usually only considered if medication or physiotherapy have not been successful.
  • The success of treatment can vary. While treatment may not ‘cure’ your incontinence, it can still help you live more comfortably with it.

You may consider surgery, or your doctor may recommend it  if you:

  • Have ongoing severe stress incontinence
  • Made lifestyle changes and/or tried physiotherapy without success
  • Need surgery for another pelvic condition (e.g. prolapse).

There are four main operations used to treat stress incontinence for women.

  • Mid-urethral sling procedure installs a U-shaped mesh tape under your urethra to give it support. This usually involves small cuts to your vagina and belly (key-hole surgery). This procedure is sometimes called a tension-free or transvaginal tape (TVT) operation.
  • Colposuspension uses stitches to lift up the neck of the bladder and attach it to the pubic bone. This can involve small cuts to your belly (key-hole surgery) or a longer cut along your belly.
  • Rectus fascial sling takes a small amount of the tough, thin tissue that covers your belly muscles and puts it under your urethra where it works as a supportive sling.
  • Urethral bulking agents involves injecting substances into the neck of your bladder that makes it tighter and stronger. You will be sedated or given an anesthetic for this procedure.

 types of womens incontinence