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Urinary IncontinenceWhat is urinary incontinence?This happens when you are not always in control of your bladder and you have a leak of urine (pass water). This can cause a lot of anxiety especially if it occurs in public and may cause a hygiene problem. Some women may also have a leak of urine during sex or need to get up during the night to pass water.Incontinence happens four times more commonly in women than in men. At least 16% of women experience some incontinence by the age of 75years. It can also occur though in much younger women. All in all incontinence can cause devastating effects on life as a whole and make it much more difficult for sufferers to work, travel and enjoy an active social life. At Marble Arch Private Healthcare we strive to address these problems and make your life more enjoyable. We will fully investigate your problem, listen to how incontinence affects you personally, and guide you with expert advice, as well as prescribing medication or providing surgery to alleviate your incontinence. What happens when I pass urine (pass water)?Urine is produced by the kidneys and collected in the bladder, which expands like a balloon as it fills. When full, the bladder empties to the outside through a narrow tube called the urethra.Most people need to pass water every three to four hours during the day and up to once or twice in the night. Normally, the muscular wall of the bladder has to contract (tighten) at the same time as a valve mechanism at the opening of the bladder relaxes. Most incontinence in adults results from problems with one or other, or a combination, of these processes 
Types of IncontinenceStress incontinenceStress incontinence is much more common in women than men. This is when you accidentally leak urine during every day activities, when there is an increase in pressure from within the abdomen (tummy) such as when coughing, sneezing, laughing or carrying heavy weights. It develops when the normal control mechanism for keeping the outlet of the bladder (urethra) closed is weakened. This can happen when the urethra moves down, out of the normal position (prolapses). This can be brought on by childbirth, hysterectomy and during the menopause, when the pelvic floor muscles are weakened. Urge incontinence/ Over Active Bladder With this type, there is a strong urge to pass frequent, small amounts of urine. This is caused by the muscle of the bladder wall – known as the detrusor muscle - being overactive. This means it contracts to squeeze out urine before the bladder is completely full. Urge incontinence can also be caused by a bladder infection. Diabetes can cause excessive production of urine and very frequent trips to the toilet. Mixed incontinence Some women get both urge and stress incontinence. The two may or may not be linked. Overflow incontinence This happens when urine held by the bladder builds up to the point where the bladder can no longer expand. It can be caused by an obstruction in the urinary tract or damage to the nerves that supply the bladder. Other causes of incontinence:
You can either attend your GP or Marble Arch Private Healthcare, where you will see a Consultant Gynaecologist. These are some important factors to tell the Doctor
The Physical ExaminationYou will also need to be examined when you attend for your consultationYour abdomen (tummy) will be examined to feel the bladder. You will then have an ‘internal’ or vaginal examination to check the vaginal skin and muscle, whether or not there is a prolapse of the front or back of the vaginal walls, check the position of the cervix (neck of the womb), and also to assess the size and the position of the uterus and ovaries
Routine testsA sample of urine (mid-stream urine, or MSU) is examined for signs of infection, bladder stone or other abnormalities.Other investigations A urodynamic assessment may be carried out by a urologist or a urogynaecologist – doctors who specialise in urinary problems. A catheter (fine tube) is passed into the bladder to fill it with sterile fluid. Urodynamic analysis then measures the pressure inside the bladder, the flow and volume of urine passed and the amount of urine left in the bladder. In ambulatory urodynamics, the urinary system is monitored with the person walking around, with catheters connected to a portable computer. Lifestyle Changes You can make some changes to your lifestyle to help reduce urinary incontinence. It is important not to decrease the amount of fluids you drink as this can increase your risk of infection. It is necessary to look at what you drink: drink more water and less drinks that contain caffeine as these can irritate the bladder and make incontinence worse. Drinks containing caffeine include tea, coffee, ‘coke’ and other soft drinks. Alcohol too can make incontinence much worse, this should also be reduced. Smoking can also be an irritant and should be avoided. Try to include lots of fibre, such as fruit, vegetables and whole grain cereals, in the diet to avoid constipation. Cranberry juice is also thought to be of benefit as it can reduce bladder irritation. Drink one large glass per day If you are overweight, you are putting a much greater strain on your pelvic floor muscles; weight loss can greatly improve symptoms of incontinence. Bladder training techniques These are useful for an overactive bladder and urge incontinence. The bladder is emptied at set intervals, and the time between intervals is gradually increased. Pads and clothing Absorbent pads and suitable clothing can help make leaks less embarrassing. Specific products are available from pharmacists. Pelvic floor exercises These are useful for mild to moderate stress and urge incontinence. Exercises involve contracting the muscles that start and stop the urine flow. Biofeedback A variation of pelvic floor exercises, this uses sensors that indicate when the correct pelvic floor muscles are being used. Vaginal cones These can be bought from high street pharmacists. A cone is held in the vagina for increasing periods of time, and helps to strengthen the pelvic floor muscles. As the muscles improve, a heavier cone can be used. Medication There are several drugs in the form of tablets or a patch on your skin that can help incontinence, particularly ‘urge’ or an ‘overactive bladder’. They all work by making the detrusor muscles of the bladder less likely to contract against your control. These drugs have some common but usually mild side-effects, including dry mouth, constipation, blurred vision and drowsiness. Other drugs which are also used for depression are used for urge incontinence and for night-time bedwetting, even for people who are not depressed. Hormone replacement therapy (HRT) may also be useful for women who have been through the menopause and have an overactive bladder or mixed incontinence. Surgery This depends on how it affects you and what you feel you can cope with. Not everyone needs surgery, but if your problems persist, your Gynaecologist may suggest it. Surgery for stress incontinence aims to give you more control over your bladder. It cannot always cure the problem completely. There are a number of possible operations; what is suitable for you will depend on your circumstances. Surgical procedures for stress incontinence are not usually suitable if you still plan to have children, or think you might want to in the future. The aim of surgery is to support the bladder neck and urethra. A number of different procedures are available. You may also need to have vaginal repair surgery +/- a hysterectomy at the same time if you have a prolapse. You may need to stay in hospital for up to 5 days. Less invasive surgery to implant a sling to support the urethra may be suitable for some women. One such procedure uses a tape made of a polypropylene (inert, sterile) mesh, which is inserted with a needle. The procedure is known as tension-free vaginal tape (TVT) and can be done as a day case, or with just a short stay in hospital. This can be arranged at Marble Arch Private Healthcare. Further informationThe Continence Foundation0845 3450165 http://www.continence-foundation.org.uk  |