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Incontinence of urine


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What should I do if I have incontinence of urine?

If you have any involuntary loss of urine which is a social or hygienic problem, you should contact your GP for further advice

Incontinence can be divided broadly into the following types but 90% of patients suffer from stress and/or urge incontinence:

  • Stress incontinence - leakage during periods of abdominal pressure (coughing, sneezing, lifting, straining);
  • Urge incontinence - leakage which follows an irresistible urge to pass urine;
  • Mixed incontinence - combined stress & urge incontinence;
  • Overflow incontinence - inability to empty the bladder with resulting overflow of urine;
  • Functional incontinence - inabilty to use the toilet in time due to poor mobility or brain disorders;
  • Continuous incontinence - constant leakage of urine due to an inherited or acquired abnormality, or damage to the control mechanisms of the bladder (which may be caused by surgery);
  • Post-micturition dribble - leakage from the urethra a few minutes after passing urine (not to be confused with terminal dribbling when it is difficult to shut off the stream immediately after passing urine - usually a sign of prostatic obstruction); and
  • Giggle incontinence - tends only to occur in young girls and normally resolves as the child grows.

What are the facts about incontinence of urine?

  • there may be as many as 3 million people in the UK with urinary incontinence;
  • 60-80% of these patients have never sought medical advice for their condition and 35% view it simply as part of the ageing process;
  • incontinence is caused by bladder abnormalities and/or sphincter (valve) weakness;
  • stress incontinence is due to sphincter weakness for which the commonest causes include childbirth and obesity;
  • urge incontinence is caused by bladder abnormalities for which the commonest cause is an overactive bladder (OAB);
  • conservative treatment can be successful in improving most forms of incontinence; and
  • surgery is effective in incontinence if conservative measures do not work, but there is a late failure rate for all types of surgery.

What should I expect when I visit my GP?

Your GP should work through a recommended scheme of assessment for incontinence of urine. This will normally include one or all of the following:

1. A full history

Your GP will take a structured, urological history to ascertain what type of incontinence you have and how this affects your day-to-day activities. You may be asked to complete a questionnaire in advance of your appointment to help your GP obtain a more accurate picture.

Download a questionnaire about incontinence of urine.

Your past medical and obstetric history are important in any discussion, as are your daily fluid intake, the drugs you are taking, your bowel function, your smoking habits and any other urinary symptoms you may be experiencing.

 

2. A physical examination

A full physical examination will be performed, including measuring your blood pressure and assessment of your body mass index (BMI). Particular attention will be paid to the abdomen (to feel for an enlarged bladder) and to vaginal or rectal examination. It is helpful to have a full bladder when you are examined because it may mean that you can reproduce the leakage for your GP.

A full neurological examination, with assessment of your reflexes, may also be performed, if indicated.

 

3. Additional tests

The usual tests performed are:

a. General blood tests

The actual tests performed will be left to your GP's discretion. It is usual to measure kidney function and to check the blood cells for anaemia or other problems.

b. Urine tests

A routine dipstick test will be performed. A urine sample will normally be sent to the laboratory to exclude infection if the dipstick suggests this is needed, or if you have symptoms of urine infection.

c. Other specific tests

Your GP may wish to arrange an ultrasound scan (pictured), although this is not routinely required. This may be to check your kidneys, to assess your bladder emptying and to find out whether your symptoms are caused by a problem within or close to the bladder. Thereafter, additional tests will only be performed after your GP refers you to a uro-gynaecology clinic. These may include:

 

What could have caused my incontinence?

The causes of incontinence are many and depend on the type of incontinence. In some patients, there is more than one cause and different types of incontinence may also co-exist (e.g. combined urge & stress incontinence)

Stress incontinence

This is usually the result of sphincter weakness cause by childbirth, loss of hormone support due to the menopause, hysterectomy or increasing age. It is also made worse by obesity

Urge incontinence

This is due to bladder muscle overactivity. In most patients, the underlying cause is unknown. Urinary infections, bladder stones, bladder cancer, neurological disease (e.g. stroke, Parkinson's disease) and obstruction (usually prostatic enlargement) can all cause urge incontinence

Overflow incontinence

This is usually due to chronic retention of urine (in men) but may also be caused by a congenital abnormality of the bladder or by spinal cord injury

Continuous incontinence

This is usually due to an inherited problem, injury to the pelvis, a fistula from the bladder to a point below the sphincter or a complication of surgery

Post-micturition dribble

A cause is rarely found for this type of incontinence. In a small proportion of patients, it may be due to to a urethral diverticulum (pictured right) or a stricture of the urethra. These abnormalities can be demonstrated by a special ultrasound scan of the urethra which your urologist may arrange.

What treatment is available for this problem?

There are several reasons why your GP may arrange a referral to a urologist or uro-gynaecologist; these include:

  • an enlarged bladder;
  • blood in your urine;
  • a mass arising from your pelvis or urinary tract;
  • if you are suffering from pain; or
  • you have previously had radiotherapy or surgery to your bladder region.

In most patients, however, your initial management will take place under the supervision of your GP.

1. General measures

Simple measures such as reducing caffeine intake, making sure that you do not drink excessivley, losing weight and carrying out pelvic floor exercises may be helpful. You should talk to your GP if you are taking drugs which cause you to make more urine (e.g. diuretics). You should stop smoking.

For some patients, using simple pads to catch the leakage may be sufficient. If surgery is not appropriate for any reason, inserting a catheter into the bladder (pictured) or using intermittent self-catheterisation may resolve the incontinence.

Download a leaflet on simple catheterisation
Download a leaflet on female intermittent self-catheterisation

 

2. Stress incontinence

Download a summary of treatment options for stress incontinence.

Non-surgical treatment

  • Weight loss - may reduce the incontinence to manageable levels without any further treatment;
  • Physiotherapy - combined with electrical stimulation or the use of vaginal cones can improve many patients with stress incontinence;
  • Oestrogen supplements - may help women with incontinence due to post-menopausal tissue atrophy; and
  • Drugs - there are now some drugs available which can temporarily improve incontinence, although they may not actually cure it.

Surgical treatment

 

3. Urge incontinence

Download a summary of treatment options for overactive bladder.

Non-surgical treatment

Surgery

  • Treat the underlying cause - e.g. prostate obstruction, bladder tumour, bladder stone or urethral stricture;
  • Stretching of the bladder - by overfilling with fluid at the time of telescopic inspection under general anaesthetic;
  • Botox injections - by injecting into the bladder wall using a telescope under local or general anaesthetic;
  • Sacral neuromodulation - implantation of a stimulator & electrodes into the nerves which supply the bladder;
  • Augmentation cystoplasty - enlargement of the bladder using a segment of bowel; or
  • Diversion of urine into a conduit should be regarded as a last resort when all other measures have failed.
 

4. Overflow incontinence

If the underlying cause of the overflow incontinence can be clearly identified, it should be treated. Men with chronic retention of urine may benefit from an operation on the prostate know as TURP. If surgery is not appropriate, a simple urethral catheter can be inserted into the bladder or self-catheterisation (pictured) started.

Download a leaflet on TURP (transurethral resection of the prostate)
Download a leaflet on urethral catheters
Download a leaflet on male intermittent self-catheterisation

Permanent urethral catheterisation in women with overflow incontinence can cause problems with bladder neck erosion and catheters falling out. Intermittent self-catheterisation is normally better for women.

Download a leaflet on female intermittent self-catheterisation

 

5. Continuous incontinence

If there is a fistula between the bladder and vagina or rectum causing continuous incontinence, this can be repaired surgically. An urethral catheter or intermittent self-catheterisation may be preferred if surgery is not appropriate (see above for details).

Download a leaflet on vaginal repair or abdominal repair of a fistula between the bladder and vagina.

 

6. Post-micturition dribble

The vast majority of men with post-micturition dribble have no underlying problem apart from a failure of the normal "milk-back" mechanism after passing urine. Simple massaging of the urethra towards the tip of the penis can reduce troublesome dribbling. Thijs helps to expel the last remaining drops of urine.

If an underlying cause is identified on ultrasound scanning (e.g. urethral stricture or diverticulum), telescopic surgery may be advised, although this does not always eliminate the dribbling completely.

Download a leaflet on telescopic surgery

 

More resources on Incontinence of urine

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