Urinary Incontinence :: Pelvic Organ Prolapse :: Interstitial Cystitis/Bladder Pain Syndrome :: Urinary Tract Infection

Physiology of normal bladder filling

Normal bladder filling depends on unique elastic properties of the bladder wall that allow it to store urine at low pressure. Incontinence refers to involuntary loss of urine when the bladder is not storing urine as it should.

The Types of Urinary Incontinence

Stress Urinary Incontinence: Involuntary leakage of urine with effort or exertion, coughing or sneezing.

Urge Urinary Incontinence: Involuntary leakage of urine preceded by urgency, which is defined as a strong desire to void that is difficult to defer.

Overflow Urinary Incontinence: Involuntary leakage of urine because of an overfull bladder

Mixed Urinary Incontinence: Occurrence of stress and urge urinary incontinence together.

Women experience incontinence more often than men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference.

Treatment

Non-Surgical :: Surgical

Non-Surgical (Conservative)

Pelvic Floor Exercises

Exercising the pelvic floor muscles is an important way to improve your bladder control. When done correctly they can build up and strengthen the muscles to help you hold urine. The pelvic floor is made up of muscles stretched like a hammock from the pubic bone in the front through to the bottom of the backbone. These firm supportive muscles help to hold the bladder, womb and bowel in place and also function to close the bladder outlet and the back passage. Pelvic floor exercises strengthen the muscles that support the pelvic contents and prevent the escape of wind, faeces or urine. Stronger muscles can also enhance sexual satisfaction for both partners.

Bladder Retraining

The aim of bladder retraining is to gradually increase the amount of urine your bladder is able to hold. This can be achieved by timed voiding or deferral of voiding in order to increase the intervals between trips to the toilet.

Pharmacotherapy

Medications to relax the bladder muscle can be useful in patients with overactive bladder symptoms to reduce urinary frequency, urgency and urge urinary incontinence.

Surgical Treatment

Stress Urinary Incontinence

A number of options are available

• Urethral bulking agents
• Midurethral sling (MUS)
• Pubovaginal Fascial Sling
• Bladder suspension procedures eg Burch Colposuspenion
• Artifical Urinary Sphincter – AMS 800

Urge Urinary Incontinence

Second line treatments when symptoms persist after bladder training and pharmacotherapy include:

• Intravesical Botox Injection
• Sacral Neuromodulation
• Percutaneous Tibial Nerve Stimulation