A B C D E F G H I J K L M N O P R S T U V W

STRESS INCONTINENCE - URGENCY INCONTINENCE

What is Stress Incontinence and Urgency Incontinence ?

STRESS INCONTINENCE is when a little urine escapes on straining or "stress". Straining includes coughing, sneezing and physical exercise. In bad cases, urine may be lost on walking and getting up from the sitting position. However, only a little urine is lost at any one time. It is most important to distinguish stress incontinence from another problem called urge incontinence URGENCY INCONTINENCE only occurs when you want top pass urine or feel the urge to do so. This is due to a problem with the bladder muscle. The two conditions may occur together, but their treatment is different.

How do they occur ?

Urine is voided from the bladder through the urethra. The urethra is about 3 cm long and is very close indeed to the front wall of the vagina. Urine is kept in the bladder by a ring of muscle around where the urethra opens into the bladder (the bladder neck). Continence is also dependent on the muscle support of the bladder by the pelvic floor. When the pressure inside the abdomen is increased by coughing or sneezing this also increases the pressure inside the bladder forcing urine out. Normally this does not cause a leakage of urine because the top of the urethra / bladder neck is also squeezed by the same pressure and this helps to keep it closed. When the bladder fills up to a certain pressure, a signal tells the brain to empty the bladder. One then relaxes the urethra muscle and pelvic diaphragm. At the same time the muscle in the bladder wall contracts and so urine is passed. Stress incontinence happens when the muscles of the bladder neck and pelvic floor are weak. If the neck of the bladder prolapses below the pelvic diaphragm it will no longer be squeezed when there is an increase in pressure on the bladder by a cough or sneeze and will be less able to prevent urine leaking out of the bladder. Urgency incontinence is when the bladder muscle contracts even when the bladder is not full. It is quite common for women to have a mixture of both types of incontinence.

Why do they occur ?

Stress incontinence occurs because weakness in the pelvic floor muscles. It is often associated with prolapse. Urgency incontinence is associated with a loss of bladder discipline and training. Women (particularly the elderly) who drink a lot of tea or coffee find themselves passing urine more often. This then becomes a habit which is difficult to break. They are also often given drugs called diuretics to make them pass more urine. These drugs are usually used in heart disease. They may change a woman from good to very poor urinary control.

Treatment Involved for Stress Incontinence and Urgency Incontinence

It may be necessary to do special tests to distinguish between stress and urgency incontinence. It is important to be sure about which type of incontinence a woman has as this will determine the right sort of treatment. You may be asked to keep a record of how much you drink and how often you pass urine. Samples of urine will always be checked for infection. If there is an infection this will be treated and symptoms will often improve a lot. The doctor might arrange for you to have bladder pressure studies at the hospital. These involve putting a catheter (tube) into the bladder and into the rectum (back passage) and testing pressure readings while passing urine. X-rays may also be taken.

STRESS INCONTINENCE Non-surgical treatment includes exercises from the physiotherapist. Pessaries may be used. Urinary infections must always be treated, as must causes of chronic straining like constipation and chronic bronchitis. Surgery: An operation may be done through the vagina as in a prolapse. This is only effective for urinary symptoms in about 40% of cases and is generally only used if treatment is also required for other symptoms of prolapse. Alternatively the muscle support of the bladder can be strengthened by an operation called a colposuspension. Stitches are placed close to the top of your vagina, which pulls it forwards. This means that the vagina itself is used to give extra support to the bladder. This can be done through a cut on the abdomen, as a laparoscopic (keyhole) operation or by passing a stitch or special tape up through the vagina. Some of these operations can be done under local anaesthetic which allows the surgeon to adjust the tension on the tape or stitch to control the symptoms. They do not affect intercourse.

URGENCY INCONTINENCE A cystoscopy may be done to ensure there is nothing else wrong inside the bladder. There are various treatments which may be tried separately or combined. Bladder training: You will be asked to empty your bladder regularly after a certain length of time, perhaps one hour. This needs to be continued for some days and then increases the time by 15 or 20 minutes for a further few days. This time is increased gradually until reasonable control is achieved. Drugs: There are drugs which reduce the activity of the bladder. These may cause a dry mouth and constipation and should be avoided. It is important the doctor knows about heart conditions or if you suffer from glaucoma (raised pressure inside the eyeball). Sometimes stretching the urethra (dilatation) under anaesthetic may help.

During Treatment for Stress Incontinence and Urgency Incontinence

The non-surgical management of both types of incontinence progresses slowly. The results of surgery should be apparent immediately but there are risks of the anaesthetic, bleeding and damage to the bladder or urethra. Serious complications are rare but difficulty passing urine initially afterwards is quite common. For this reason a catheter is necessary after surgery. This is a small plastic tube which may be placed in the bladder through the abdominal wall at the operation. A catheter through the abdomen allows one to pass urine naturally if possible. If this is difficult to start with, the bladder can still be emptied by the catheter.

After Treatment

If there are also symptoms of needing pass urine frequently these may get worse after surgery for stress incontinence. Stress incontinence may continue even after surgery. The best operations have a success rate of 70-80%. Urgency incontinence tends to recur if treatment is stopped. Cystitis must be treated promptly with antibiotics.

If Stress Incontinence is left untreated

Stress incontinence tends to get slowly worse. Those with long-term prolapse and stress incontinence may get chronic urinary infections.

Effects on the family of Stress Incontinence and Urgency Incontinence

Urinary incontinence is very embarrassing. Family should be sympathetic to this. Women with stress incontinence should be protected from too much physical exertion.