The two most common types of urinary incontinence are:
1. Stress incontinence Urinary leakage with any form of physical exertion. (see above)
2. Urgency incontinence Urinary leakage associated with urgency or the inability to delay passing urine.
Investigation
In general stress incontinence is caused by weakness of the muscles of the pelvic floor and urethral sphincter (the urethra is the tube leading from the bladder). Urgency incontinence is most commonly caused by overactivity of the bladder. Unfortunately, the symptoms associated with incontinence are not always a reliable guide to the cause of the leakage. After examination of the urine to detect infection Urodynamics are tests performed on the bladder to determine the cause of urinary leakage and are performed in the out-patient setting.
Treatment
- Stress incontinence Stress incontinence is usually managed by pelvic floor physiotherapy in the first instance. If this fails the drug duloxetine may be tried. If this does not help surgery may be employed. There are a number of different surgical procedures available but currently the most popular is the Tension free Vaginal Tape (TVT). The tape is inserted through a small vaginal incision and two very small (5mm) incisions below the pubic hair line. It has a high success rate but can fail or produce difficulty emptying the bladder.
- Urgency incontinence Overactivity of the bladder leading to urgency and urgency incontinence may be caused by bladder pathology or unknown causes. When a woman presents with symptoms suggestive of bladder overactivity it is firstly important to determine whether any treatable disease is present. Urinary infection is the commonest cause of bladder overactivity but other conditions such as bladder tumour must also be excluded. Laboratory examination of the urine and on some occasions insertion of a camera into the bladder (cystoscopy) may be necessary. If no treatable cause for the bladder overactivity is found there are two main treatment options;
Firstly bladder retraining, where a routine of bladder emptying is established and the interval between bladder emptying gradually increased. This is usually supervised by a specialist nurse.
Secondly, there are drugs which may be used which make the bladder less active reducing the urinary frequency, urgency and urgency incontinence.
If drug treatment fails to improve symptoms Botulinum toxin may be injected into the bladder. This is only available at a few specialist centres.