LUCANUS GYNAECOLOGY

URINARY INCONTINENCE

Urinary incontinence or involuntary leakage of urine from the bladder is common. Many women, even those under the age of 25 years, will at times have noted urinary leakage on coughing, laughing, sneezing or jumping.

Twenty five percent of women between the ages of 35 and 50, and fifty percent of women over 75 suffer embarrassing urinary loss.

While an occasional problem for most women, it can worsen with time, and for some, seriously affects lifestyle. The incidence of urinary incontinence increases with age, pregnancy and childbirth, and the onset of menopause. All of these factors may operate to produce laxity of support of the vagina and associated organs by damage to or atrophy of supporting ligaments and fascia.

Causes of incontinence

There are many possible causes of urinary incontinence, including some arising from pathological growths or post-operative damage, but most cases are a result of degenerative changes, or intrinsic bladder dysfunction.

The two major causes are:

Weakness of the pelvic ligaments supporting the uterus and vagina, which results in laxity of support of the bladder outlet (prolapse) causing stress urinary incontinence.
Bladder over-activity arising from premature activation of the stretch receptors in the bladder wall. This is also a result of damaged supporting ligaments and fascia, and acts to produce urinary frequency, urgency, and nocturnal need to urinate (FUN). When severe it can result in urgency incontinence or reflex emptying of the bladder.

Less commonly urinary retention, bladder infection, hormone deficiency, fistula (an abnormal opening of the bladder which sometimes follows complicated childbirth or surgery), and certain drugs or neurological disorders may cause wetting problems.

Diagnosis

There are a number of steps we will take in establishing the cause of urinary incontinence:

A full medical history will be taken and a physical examination performed. Urine infection will be excluded by a laboratory test.
A 24 hour urinary diary and home pad test will be requested These tests record times and volumes of fluid intake and urination, and leakage of urine during exercise.
We may advise you for performance of urodynamic assessment.

Urodynamic assessment

This is an investigation which measures the functions of the bladder and urethra during filling and emptying. It provides information about the urine flow rate, bladder capacity and muscular and nervous control, which enables a more specific diagnosis of the cause of incontinence.

Urodynamic assessment takes about 30 minutes to perform and does not require use of anaesthetic drugs. It is not painful although some discomfort may be experienced. The test involves the passage of fine catheters which measure pressure in the bladder and vagina. There is a small risk (about 1%) of urinary tract infection.

Click here for the Kvinno Clinic management including urodynamic assessment.

Treatment

There are various kinds of treatment of urinary incontinence, depending on the cause of the problem.

Antibiotics to treat any urinary tract infection.
Hormone replacement treatment to treat menopausal symptoms.
'Bladder training' to increase bladder capacity by reducing the number of times urine is passed.
Drugs to improve urinary control and frequency.
Pelvic muscle exercises to strengthen the bladder outlet.
The insertion of an intra-vaginal device to improve pelvic support, in cases of stress incontinence or vaginal prolapse.
Surgery to correct damaged fascial supports, to repair vaginal prolapse causing both stress incontinence or FUN. Click on Kvinno Operations to check treatments according to the Integral Theory of Professor Petros.

In many cases urinary incontinence can be successfully treated by non-surgical methods although, if necessary, surgery can be curative.

Urinary incontinence is a common problem. Application of the Kvinno principles and careful diagnosis allows precision in the design of appropriate treatment, and for most women, the problem can be solved or markedly improved.