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Urinary Incontinence

The Types of Urinary Incontinence

Stress Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).

Urge Leakage of large amounts of urine at unexpected times, including during sleep. Functional Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.

Overflow Unexpected leakage of small amounts of urine because of a full bladder.

Mixed Usually the occurrence of stress and urge incontinence together. Transient Leakage that occurs temporarily because of a condition that will pass (infection, medication).

Physiology of normal bladder filling

Normal bladder filling depends on unique elastic properties of the bladder wall that allow it to increase in volume at a pressure lower than that of the bladder neck and urethra (otherwise incontinence would occur). Despite provocative maneuvers such as coughing, voluntary bladder contractions do not occur. Emptying is dependent on the integrity of a complex neuromuscular network that causes relaxation of the urethral sphincter a few milliseconds before the onset of the detrusor (bladder muscle) contraction. With normal, sustained detrusor contraction, the bladder empties completely.

Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.

The level of incontinence differs for each person and depends upon the treatments that they have had, however for some people the phenomena may be short lived while for a few it may be permanent.

There has however been a lot of progress in dealing with continence issues and there are a wide variety of aids and equipment for collecting urine, preventing infection and protecting the skin and surrounding area. There are also a number of exercises that can be done to strengthen the urinary sphincter muscle that controls the opening and closing of the bladder.

Treatment

Non-surgical (Conservative)

Exercising the Pelvic Floor

Pelvic floor exercises are an important and relatively easy way to improve your bladder control. When done correctly they can build up and strengthen the muscles that help you hold urine. The pelvic floor is made up of muscles stretched like a hammock from the pubic bone in the front through to the bottom of the backbone. These firm supportive muscles help to hold the bladder, womb and bowel in place and also function to close the bladder outlet and the back passage. Pelvic floor exercises strengthen the muscles that support the pelvic contents and prevent the escape of wind, faeces or urine. Stronger muscles can also enhance sexual satisfaction for both partners.

Electrical Stimulation

Electrical stimulation is the application of an electrical current to stimulate the pelvic muscles or their nerve supply. The aim of electrical stimulation is to directly improve pelvic muscle strength and so to assist in bladder control. This is achieved by inserting a vaginal device into the vagina. This device generates electrical stimuli. Electrical stimulation may also be used to inhibit the overactive bladder.

Vaginal Cones

Other equipment may be employed to enhance muscle awareness or muscle training. Vaginal cones are available and come in a variety of weights, shapes and sizes. The aim is to “hold” the device in the vagina for a specific time period to improve muscle control.

Bladder Retraining

The aim of bladder retraining is to overcome urgency and stretch out the intervals between trips to the toilet.

Surgical treatment

Today surgery for stress incontinence has become quite minimally invasive and can often be performed either as a day stay or overnight procedure.

Sub-Urethral Sling (TVT)  is the most common

© Pelvic Floor Clinic 2014