INCONTINENCE

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Introduction

Urinary incontinence is a common condition affecting many women. For many this is an occasional issue that is more of an irritation. For a small number the leakage is considerably more than an occasional or small leak and as such causes major issues with disruption to life, embarrassment and loss of confidence, so much so that the thought of symptoms is often enough to impact on lifestyle e.g. avoiding doing physical activity or visiting an unfamiliar place. Around 2% of the population have clinically significant, socially bothersome symptoms. As a rough guide that’s 50 patients for every GP in the country.

What is incontinence?

Urinary incontinence is extremely complex. Whilst symptoms are often categorised as “stress incontinence” (leakage with physical exertion) or “Urgency incontinence” (where there is a sudden compelling need to urinate) the truth is that symptoms are often multiple and interrelated. Stress incontinence is most often treated in women in the 10 years after childbirth (although sometimes a lot later than this). The occurrence of Urgency incontinence can be at any age. It may be a symptom in childhood that recovers, and broadly speaking it increases with increasing age. If you want to know more about Urgency incontinence you may consider buying the book I have written on it, OAB minimising symptoms maximising life, which explains the causes and treatment options including self help.

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How do you know if you suffer from incontinence?

Incontinence may be something as simple as leaking with coughing and sneezing (stress incontinence) or may be part of a more compelx process such as overactive bladder syndrome (OAB) where urgency to go to the toilet dominates.

Other symptoms involve bed wetting (enuresis) and bladder pain.

Rarer causes are fistulae (false communication between the bladder and outside the body) or overflow due to the bladder not emptying and becoming over full.

Treating incontinence

Treatment depends on the exact cause, although often there are simple things such as lifestyle changes which can dramatically help. Weight loss, stopping smoking, avoiding bladder stimulants such as caffeine and alcohol may be effective. With stress incontinence physiotherapy will help up to 70% of women.

In some cases drug therapy may be helpful and in certain cases surgery may be appropriate.

What to expect at your first appointment

At your first appointment your symptoms will be assessed and an examination undertaken to check for any other pelvic problems. Pelvic floor symptoms are often complex and interrelated and as such careful evaluation required.

You will be asked to complete a bladder diary and a quality of life questionnaire (ePAQ). Often simple treatments may be tried first off but it is possible that you may require some investigation such as an ultrasound or Urodynamics. The management options will be outlined and you will receive an individualised letter outlining the discussion to help you decide what is best for you.

Surgery for incontinence is about improving the patient’s life and as such you will be central to the decision about what treatment.

Currently many women are worried about the use of mesh in surgery. You can be reassured that there are alternatives to mesh and all options will be discussed. No mesh implant can be used without your explicit consent after discussing all the risks, benefits and alternatives before surgery.