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Incontinence

Incontinence is the loss of bladder control and can involve a leakage of urine, wind or faeces. It is a common and uncomfortable problem. As little as a cough or sneeze can trigger the need to urinate, causing embarrassment for those who suffer from it.

Urinary incontinence is a very distressing condition that women generally develop later in life though it can occur at any age. Giving birth by natural labour can increase the chances of developing urinary incontinence. There are several types of urinary incontinence – stress urinary incontinence, urge urinary incontinence or overactive bladder and mixed urinary incontinence

Urine is made by the kidneys and stored in the bladder. The bladder muscles tighten when you need to urinate. Urine is then forced out of the bladder through the urethra. While this occurs the sphincter muscles around the urethra relax to allow the urine to be released.

Incontinence occurs when the bladder muscles tighten on their own or/and the sphincter muscles cannot hold the urethra shut. The strong urge to urinate cannot be controlled. It’s sometimes a small amount of urine that leaks or a lot of urine can be released all at once.

Twice as many women than men experience urine incontinence. Things such as childbirth, pregnancy and menopause can affect the bladder, making women more susceptible to the condition. Urinary incontinence can develop in a woman of any age and it is more common as you get older.

Stress urinary incontinence. This occurs when pressure is exerted on the bladder often caused by sneezing, coughing, laughing, lifting something heavy or sometimes just standing up. This is the most common type of incontinence in younger women.
Urge incontinence due to an overactive bladder. Leaking urine accidently when there is a strong urge to pass urine, usually treated with tablets.
Overflow incontinence due to either poor bladder contraction or blockage of the urethra
Functional incontinence due to medications or health problems making it difficult to reach the bathroom

Stress urinary incontinence occurs if you leak urine when you run, cough, sneeze, jump. Stress urinary incontinence it causes an increase in intra-abdominal pressure (with cough/laugh/ increased weight etc) and weakened pelvic floor muscle, bladder muscle, urethral sphincter.

  • A urinary infection (UTI or bladder infection) especially if you started leaking urine recently. A simple urine test can diagnose urinary infection.
  • Weight gain and being overweight
  • Chronic cough (having a flu and coughing will almost certainly make stress urinary incontinence worse, some medications prescribed for high blood pressure cause cough and may lead to stress urinary incontinence
  • Ageing can cause stress urinary incontinence because vaginal wall supporting urethra loses collagen and becomes weaker, low oestrogen level in menopause leads to vaginal dryness and it can also result in urinary incontinence
  • Pregnancy and childbirth can also lead to stress urinary incontinence becomes of relaxing effect of progesterone on the vaginal wall, weakening of the vaginal wall
  • The treatment of stress urinary incontinence includes pelvic floor exercise (or Kegel exercise). Patients who take up pilates also find improvement in stress urinary incontinence. Studies have shown that pelvic floor exercises are effective in the treatment of incontinence but only if performed under the supervision of a physiotherapist. It is very difficult to perform pelvic floor exercises regularly and maintain the correct intensity.
  • A new, revolutionary pelvic floor trainer, the Emsella Chair uses a high-intensity electromagnetic field to activate motor neurons located in the pelvic floor. A single 28-minute session results in 11,200 pelvic floor muscle contractions which have the effect of performing the same number of Kegel exercises! Emsella results in supramaximal muscle contraction. One cannot achieve such contraction doing Kegel exercises as Emsella stimulates contractions which are stronger and last longer. Emsella chair treats all types of incontinence. It helps women with mild and moderate incontinence and lessens the symptoms of severe incontinence. To find out more about the Emsella click here.
  • The surgical method available to patients who require a more invasive treatment is sling procedure ( performed under anaesthesia) which treats urinary incontinence. You can read about sling procedure here
  • Vaginal laser treatment or avginal readiofrequency is a non-surgical procedure performed in the doctor’s office without any anaesthesia works very well for mild and moderate stress urinary incontinence. Laser and radiofrequency are also very effective in treatment of vaginal dryness (called atrophic vaginitis) that women develop in menopause. More information about vaginal treatments can be found here.
Urge incontinence is sometimes called an overactive bladder. Generally, urine leakage happens after a strong sudden urge to urinate but before you can make it to the bathroom. Women who experience this sometimes make it to the toilet on time but feel the urge to urinate more than eight times a day.
Urge incontinence or overactive bladder are caused by bladder muscle contracting all the time. Urge incontinence is caused in menopausal women by thinning of vaginal skin, bladder lining resulting in irritation in the area.
Traditional treatment of urge urinary incontinence includes the use of various tablets that relax the bladder wall. If tablets do not provide relief, we can inject botulinum toxin into the bladder wall (usually performed in an operating room under anaesthesia). Unfortunately, the effects of botulinum toxin only last for 4 months and treatment must be repeated.

Emsella chair and vaginal laser and radiofrequency are also helpful in treatment of urge urinary incontinence.

Overflow incontinence is when your bladder doesn’t completely empty itself when you urinate you experience constant dribbling of urine. This is caused by a blockage or weak bladder muscles that do not allow the bladder from fully emptying or from informing it that it is full.
Functional Incontinence often this occurs when a person is not aware, they need to urinate because of mental or physical impairments. Maybe they cannot make it to the bathroom on time or they cannot unbutton their pants on time due to some illness such as severe arthritis. It can be caused by neurological conditions and even diabetes because it impairs nerve supply to the bladder and as a result normal bladder contractions/function. The treatment of this type of incontinence is directed at its cause.
If you have a combination of types of incontinence a doctor will assess your situation and will suggest treatment options for you.

When urine incontinence starts affecting your way of living such as not being able to visit family or friends because you are scared you may have a leak; it is time to consult with a doctor who specialises in the treatment of incontinence (urogynecologist, urologist, gynaecologist). There are ways for you to help treat incontinence.

Overall, a healthy life-style, good drinking habits,  healthy vaginal skin, strong pelvic floor muscles and healthy bladder wall are all essential to manage incontinence throughout your life. Your treatment options will depend on type and severity of incontinence and whatever area you need to address.

If you have any questions, you may book a consultation at Dr. Novikova for advice.