Most women with stress urinary incontinence have weak pelvic muscles. These are the muscles that support the bladder, bladder neck and the urethra (the urinary passage). Pregnancy, childbirth and prior pelvic surgery are among the reasons for weakened pelvic muscles.
Another possible cause for stress incontinence in women is a weakened urethral sphincter muscle itself. Both of these, weak pelvic muscles and a weakened urethral sphincter muscle, may co-exist in the same patient.
Urge Incontinence: Urge incontinence is the inability to hold urine long enough to reach a toilet. In this type of incontinence, an overactive bladder contracts without you wanting it to do so. You may feel as if you can’t wait to reach a toilet. There is the sudden strong urge to urinate, with an uncontrollable rush of urine. It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson’s disease and multiple sclerosis. It can also be a warning sign of early bladder cancer. In men, it is often a sign of an enlarged prostate. It can, however, occur in otherwise healthy, older people.
Overflow Incontinence: Overflow incontinence is the leakage of small amounts of urine from a bladder that is always full. It results when the bladder is allowed to become so full that it overflows.In this form of incontinence, the bladder never completely empties, and the urine stream is weak, with a frequent or constant dribble. Overflow incontinence can occur when the flow of urine from the bladder is blocked as in the case of a blocked urethra, when there is loss of normal bladder function in some people with diabetes, or due to bladder muscle weakness.
Functional Incontinence: Functional incontinence occurs in many older people who have normal urine control but who have difficulty reaching a toilet in time because of arthritis or other crippling disorders.
Total Incontinence: Total incontinence occurs when there is a complete loss of bladder control, usually occurring after some form of surgery to the lower urinary tract.
Mixed Incontinence: is a combination of urge and stress incontinence.
For Both Men & Women
Incontinence may be brought on by an illness accompanied by fatigue, confusion or hospital admission. Incontinence is sometimes the first and only symptom of a urinary tract infection. Curing the illness will usually relieve or clear up the incontinence.
Diseases and disorders involving the nerves and/or the muscle
A blocked urethra due to an enlarged prostate
Weakness of the pelvic floor muscles
Effects of medication
Urinalysis: A sample of your urine will be tested for the presence of infection, blood or other abnormalities.
Uroflowmetry (Urine Flow Test): Uroflowmetry (urine flow test) is the simplest of the urodynamic tests. [Urodynamics are special outpatient tests used to assess the normal and abnormal function of the urinary tract, especially the bladder and the urethra (the ‘water-pipe’ leading from the bladder to the outside of the body). These range from the simple to the more sophisticated depending upon the complexity of your problem].
This test measures the rate of urine flow as well as the amount of urine passed. You will have to come to the clinic with a reasonably full bladder (as per what feels comfortable to you), sit on a modified toilet seat (called a micturition chair) and, in private, pass urine in the usual way, into a flow meter.
Residual Urine Measurement: This test is performed to find out whether any urine remains after you have attempted to empty your bladder. Immediately after your uroflowmetry, we will measure the amount of urine left in your bladder (residual urine) in order to detect how well you have emptied your bladder. Residual urine is measured by placing a bladder scanner over your bladder – a painless procedure lasting only for a few seconds.
If your uroflowmetry and/or residual urine are abnormal, you will then require a voiding cystometry to determine the cause of your difficulty in passing urine.
Filling and Voiding Cystometry (CMG): Filling cystometry will tell us about the sensation of your bladder, how much it can hold, how ‘elastic’ it is, the pressure changes when it is being filled up, when you are changing posture, standing up and coughing, and whether you have any urge or stress incontinence of urine. In this way, it can help us make a diagnosis of whether your bladder is stable(normal) or unstable (detrusor instability), whether you have genuine stress incontinence of urine (stable bladder with stress incontinence of urine demonstrated) or both the latter two conditions.
Voiding cystometry is performed immediately after the filling cystometry; it is used to differentiate as to whether you have an obstruction of the urethra (‘water pipe’), or an under-active bladder as a cause of your difficulty in passing urine.
When you arrive for these two tests, you will have to empty your bladder completely, in the usual way, in the toilet. We will then make you lie down on an examination couch, clean you down below using sterile cotton swabs and an antiseptic lotion before inserting a fine tube into your bladder to measure your residual urine. Your bladder will then be gradually filled through this tube with sterile 0.9% salt solution to mimic urine. Another finer tube will also be inserted into your bladder together with the first tube, for the purpose of measuring the pressure changes in your bladder through a computer in the urodynamic machine. We will also have to insert a fine catheter into your back passage for measuring pressure changes in your’tummy’ (abdomen) at the same time. This is to ensure that the computer will automatically calculate the true pressure changes within your bladder (detrusor pressure). Otherwise, any pressure changes in your abdomen, such as changing posture, standing and coughing, will show a false rise in pressure in your bladder.
During the filling cystometry we will make you sit up on a modified toilet seat and fill your bladder until you finally feel like passing urine. We will then remove the filling tube, make you to stand up and cough 10 times on a pre-weighed incontinence sheet to determine the absence or presence, and severity of stress incontinence of urine.
After this you will have to sit down on the modified toilet seat again, to empty your bladder completely into the flow meter, in order to complete the voiding cystometry.
Urethral Pressure Profile (UPP): UPP will only be performed in some of those patients who have had previous failed surgery for incontinence. As this test is not commonly undergone, your doctor will explain how it is performed in the case you are required to take it.
Video-Cystourethrography(VCU): VCU will only be performed in some of those patients who have had previous failed surgery for incontinence. As this test is not commonly undergone, your doctor will explain how it is performed in the case you are required to take it.
Stress Test: While your bladder is full, you may be asked to cough, stand and perform other activities to find out whether these stresses on the bladder cause leakage.
Ultrasound: This technique can be used to determine the size and shape of the kidneys, the bladder and the prostate.
Cystoscopy: A thin telescope-like instrument called a cystoscope is inserted into the bladder through the urethra. This test allows the physician
For Both Men & Women
Treatment of urinary incontinence should be tailored to each patient’s needs. The many options include:
Certain Behavioural Techniques: Certain behavioural techniques including pelvic muscle exercises, biofeedback and bladder training are helpful in controlling urination. These help a person to sense the filling of the bladder and delay voiding (the passing of urine) until he or she can reach a toilet.
Medical Treatment: A number of medications can be used to treat incontinence. However, they must be used carefully under a doctor’s supervision.
Surgery: Several types of surgery can improve or even cure incontinence that is related to a structural problem such as an abnormally positioned bladder, or blockage due to an enlarged prostate. Devices that replace or aid the muscles controlling urine flow have been tried in people with incontinence. Many of these devices require surgical implantation.
Specially Designed Absorbent Underclothing: Specially designed absorbent underclothing is available. Many of these garments are no more bulkier than normal underwear and can be worn easily under everyday clothing.
Catheterisation: Incontinence may be managed by inserting a flexible tube known as a catheter into the urethra and collecting the urine in a container. However, long-term catheterisation – although sometimes necessary – creates many problems, including urinary tract infections. In men, an alternative to the in-dwelling catheter is an external collecting device. This is fitted over the penis and connected to a drainage bag.
Pelvic Floor Exercises: The floor of the pelvis is made up of layers of muscle and other tissues – these are called the pelvic floor muscles. These layers stretch like a hammock from the tailbone at the back to the pubic bone in front. A woman’s pelvic floor supports the bladder, the womb (uterus) and the bowel. The urethra (front passage), the vagina (birth canal) and the rectum (back passage) pass through the pelvic muscles. The pelvic floor muscle has an important role in bladder and bowel control, and sexual sensation.
We have control over the pelvic muscles. Like other muscles in the body, exercise strengthens them when they are weak.
Pregnancy and childbirth
Continual straining to empty your bowels (constipation)
Persistent heavy lifting
A chronic cough (such as smoker’s cough or chronic bronchitis and asthma)
Changes in hormone levels at menopause (change of life)
Lack of general fitness
Medical Treatment: Medications that are used to treat incontinence must be used carefully under a doctor’s supervision. Stress incontinence can be treated non-surgically by means of medications.
Surgery: Presently, there are many simple surgical procedures that have a high degree of success and also provide long-term relief. All the surgical procedures create support for the urethra and the bladder neck in order to prevent urine leakage during physical activity. Stress incontinence that can be treated surgically. With respect to the possible complications from surgery for urinary incontinence, serious complications such as death are very rare. The likelihood of blood transfusion is less than 5%. Less serious complications, such as infection, may occur, but are usually easily treated. Retention of urine is a possible complication, but is temporary in most cases. During this period, the urine is drained either with a catheter left in the bladder, or by self-catheterisation. The time spent in the hospital normally ranges from 1 to 5 days, depending upon the type of procedure.
Injection of Bulking Agent: Another type of treatment is injecting a bulking agent into or around the urethra to help the ceiling mechanism. The effectiveness of this, however, decreases over a period of time, requiring re-injection over a six month to a one-year period. The various sling and suspension procedures are performed through very small incisions in the lower abdomen or in the vagina, permitting an early return to activity.