Urinary incontinence is common. It is a great nuisance to patients lifestyle
It has significant effects of self awareness and carries a stigma.
Urinary incontinence is usually divided into:
- Urinary urge incontinence (Neurologic cause).
- Urinary stress incontinence (Anatomic cause).
Urinary Urgency and Urge Incontinence Melbourne
Urinary urgency is the result of an “unstable bladder”.
Urgency occurs because the bladder is neurologically triggered to react when it is not particularly full.
This results in urinary frequency during the day and also nocturia.
The unstable bladder will ultimately trigger involuntary voiding resulting in urinary urge incontinence.
Urinary stress incontinence results from a disturbance of bladder anatomy.
It often occurs with:
- Bladder prolapse.
- Loss of the urethro vesical angle where the bladder joins the urethra.
- Urethral atrophy (loss of the urethral closing pressure after menopause).
- Nerve damage.
It is important to record the following using a Urinary diary:
- Urinary frequency.
- Circumstances where incontinence occurs (coughing, lifting etc.).
It is common to have a combination of both urinary urge and also urinary stress incontinence. Urodynamics can be performed to measure urinary flow rates and record a range of pressures in the bladder to determine the type and severity of bladder dysfunction.
Physiotherapy is useful in retraining the bladder to function normally and is particularly helpful with urinary urgency.
Various bladder relaxant medications and even Botox can relax the bladder and allow the bladder to retain larger volumes of urine before sending a signal to the brain of bladder fullness. This can be used to control urinary frequency. These drugs are always used as part of the bladder-retraining program.
Plastic vaginal pessaries
In older women who have various other medical problems it may be considered more appropriate to insert a vaginal pessary. This can elevate parts of the vagina and may give some incontinence relief.
Urinary stress incontinence is primarily a problem of vaginal wall weakness and bladder prolapse. Anterior vaginal repair to elevate the bladder has always been one of the best treatment options. If vaginal prolapse is more extensive this operation may be extended to include repair of the front, back and vault of the vagina.
Sub urethral sling operation
Some women may have a very localised area of prolapse. The loss of the urethro vesical angle can be corrected through the use of a sub urethral sling. This operation involves the insertion of a synthetic tape inserted through a small incision placed underneath the urethra. It can be used to elevate the urethra and reconstruct the normal urethro vesical angle. There are a number of sling operations and my preference is the Monarch sub urethral sling procedure.
Indications for Involvement of a Urogynaecologist in Melbourne
Some women may have complex bladder problems and may have had previous treatments, including surgery, which have failed. These women are best referred to an Urogynaecologist who is a subspecialist dealing with complex bladder problems.