Urinary Incontinence
Poor bladder control and leaking urine can be highly embarrassing, affecting your social interactions and general confidence. Urine incontinence is a very common problem, particularly in older women. The good news is that once the underlying cause has been identified, treatment can be very effective.
What is urinary incontinence?
Urinary incontinence is the medical term for involuntary urine leakage from the bladder. There are two main types of urinary incontinence:
- Stress incontinence, when urine leakage occurs due to pressure in your abdomen from actions such as jumping, laughing, sneezing or coughing
- Urgency incontinence, characterised by a need to urinate so sudden and urgent that you’re unable to make it to the bathroom in time.
Many women have mixed incontinence, which is a combination of both stress and urgency incontinence subtypes. Identifying the type of urinary incontinence you have, as well as any co-existing conditions such as a pelvic organ prolapse, is vital for choosing the most effective urinary incontinence treatment.
Both men and women can experience urinary incontinence, but women are twice as likely to be affected than men. This is because certain events that are specific to women – such as pregnancy, childbirth, and menopause – can all increase the risk of incontinence. If not properly treated, urinary incontinence can cause recurrent urinary tract infections (UTIs), and emotional distress from anxiety, embarrassment, and depression.
What causes urinary incontinence?
The bladder is controlled by several muscles and nerves, which must have the strength and coordination to ensure your bladder and urethra (the tube draining urine out from your body) remain closed when you’re not ready to use the toilet despite your bladder containing urine.
When pressure is placed on your bladder or your bladder muscles tighten suddenly or involuntarily, and the muscles keeping the urethra closed are weak, urine can accidentally leak out.
Women are more likely to have urinary incontinence if they:
- Are obese or overweight, which places additional pressure on the bladder
- Often struggle with constipation, as straining on the toilet adds pressure to the bladder and pelvic floor muscles
- Have a weakened pelvic floor from pregnancy and childbirth, particularly a vaginal delivery
- Have a chronic cough, such as from a respiratory condition or cigarette smoking
- Live with a condition such as diabetes or multiple sclerosis, affecting the nerves to the bladder, urethra, or pelvic floor muscles
Women who have been through menopause are also at a higher risk of urinary incontinence, with more than 40% of women over 65 years old being affected by this condition. This is thought to be due to the effects of declining oestrogen levels on the strength of your pelvic floor muscles and urethra.
How is urinary incontinence diagnosed?
A comprehensive consultation with Dr Sam Daniels will identify your type of urinary incontinence and any contributing factors, which will guide his treatment recommendations. During your consultation, he will:
- Discuss your medical history, including whether you are currently taking any medications that may relate to bladder function and control, have ever been pregnant, or if you have any other illnesses such as diabetes
- Discuss your symptoms, such as how often you need to urinate, how often you leak urine and how much, when you first started noticing symptoms
- Perform a pelvic exam with your consent
Dr Sam may also order specific investigations, such as:
- A urine analysis to assess for infections
- Ultrasound, which can reveal abnormalities of your kidney, bladder, and urethra that may be causing incontinence
- Bladder stress test, demonstrating whether actions such as coughing or straining results in stress urinary incontinence
- Cytoscopy, a procedure involving a long, thin scope inserted into your urethra and bladder to look for problems inside these structures
- Urodynamics, which involves filling your bladder with water and assessing the amount of pressure it can withstand
How is urinary incontinence treated?
Depending on your type of urinary incontinence – stress or urgency incontinence – and how severe your symptoms are, Dr Sam may recommend non-surgical management strategies, surgery for urinary incontinence, or a combination of both.
Non-surgical treatments for urinary incontinence
Conservative management is typically reserved for urgency incontinence, but some cases of stress incontinence may also be effectively managed with non-surgical treatments. Some of the more common conservative management approaches are medications, pessaries, and pelvic floor exercises.
Medication
Different types of medications can help by strengthening the muscles of your urethra or by relaxing your bladder muscles, which increases your bladder’s capacity to hold urine before you need to use the toilet. As with all medications, these can come with side effects, which Dr Sam will discuss with you if he believes medication is a suitable incontinence treatment for you.
Vaginal pessary
A vaginal pessary is a small device that supports your pelvic floor when inserted into your vagina. You may choose to wear it constantly or only when you’re about to do an activity that exacerbates urine leakage. This extra support reduces the pressure on your bladder and can help to relieve the symptoms of stress urinary incontinence. To be properly effective, a pessary needs to be well-fitted by a gynaecologist or a pelvic floor physiotherapist with experience in continence. These devices can be removed for cleaning and replacement.
Pelvic floor exercises
Dr Sam may refer you to a pelvic floor physiotherapist to learn how to strengthen and control your pelvic floor muscles through targeted exercises. These are also known as Kegel exercises, and are usually prescribed for stress incontinence.
Surgery for urinary incontinence
It is not uncommon for stress urinary incontinence to require surgery, especially if pelvic floor physiotherapy fails to improve your symptoms. There are a few different surgical approaches to treating urinary incontinence. Dr Sam is particularly experienced in performing an effective, minimally-invasive procedure known as a laparoscopic Burch colposuspension.
A laparoscopic colposuspension is performed under general anaesthesia through keyhole incisions. Dr Sam inserts tiny stitches to stabilise your urethra and lift the vagina, reducing accidental urine leakage. In general, serious complications from urinary incontinence surgery are very rare. More common (but still infrequent) complications from a laparoscopic colposuspension include infection of the incision site, difficulty emptying your bladder, or recurrent symptoms requiring another procedure.
Success rates of Burch colposuspension for stress urinary incontinence
Colposuspension for stress urinary incontinence is highly effective, with great long-term success rates. At one year post-operation, over 80% of women report significantly reduced or entirely eliminated incontinence symptoms. Around 60% of Burch colposuspension operations are still effective 20 years later.
Frequently Asked Questions
The recovery time after surgery for urinary incontinence is highly dependent on the type of operation you had and whether any other procedures were required at the same time (such as pelvic organ prolapse repair). Generally, Dr Sam recommends taking two weeks off work.
A mid-urethral sling is another common form of stress incontinence surgery. The sling can either be made of mesh (a synthetic propylene weave) or of tissue from your own body, and functions like a hammock to provide extra support for your urethra and bladder. Due to the risk of complications associated with the use of vaginal mesh, Dr Sam does not offer the mid-urethral sling procedure.
Dr Sam performs incontinence surgery at Macquarie University Hospital, North Shore Private Hospital, and Northern Beaches Hospital.
Specialist care for women’s health concerns
Comprehensive care with Dr Sam Daniels is available across multiple Sydney locations, including urgent gynaecologist appointments for time-sensitive cases.