Urinary incontinence is the involuntary or accidental leakage of urine and is one of the most common chronic health problems affecting women. It has been estimated that 4.2 million Australians aged 15 years and over suffer from urinary incontinence. Although the rates increase with age, incontinence among younger women is also common. Pregnancy, childbirth and ageing are the main causes of urinary incontinence, however there are many other causes.

Many women with bladder problems are reluctant talk about it or may be too embarrassed to acknowledge that they even have a problem. Sometimes women are made to feel that this condition is ‘normal’, especially as they get older. With proper assessment and treatment, incontinence can be treated.

Female urinary incontinence can be grouped in several distinct categories. The most common type of incontinence is ‘stress incontinence’. Women, with this problem, experience urine leakage when there is a rise in abdominal pressure from physical ‘stress’ such as coughing, sneezing and exercising. The next most common type of incontinence is ‘urge incontinence’. This is often referred to as ‘over-active bladder’. It occurs when you cannot hold urine long enough to reach the toilet in time. It is usually associated with a strong impulse to pass urine. If you suffer from a combination of stress and urge incontinence, then you have ‘mixed incontinence’. Often a woman may first experience one kind of leaking and then the other type occurring later. Other causes of urinary incontinence are less common and include overflow incontinence, functional incontinence, fistula and urethral diverticulum.

Bladder Investigations

When establishing the type of incontinence, a 3-day bladder diary is used to record oral fluid intake, frequency of urination, volume of urine voided and any episodes of urinary leakage. A bladder diary is useful in distinguishing between stress incontinence and an overactive bladder and gives useful information about fluid intake and voiding habits.

If the cause of your urinary incontinence is not clear from clinical assessment then urodynamics will usually be recommended. Urodynamic testing is a 20 to 30 minute procedure that evaluates the ability of the bladder to fill and empty and provides a diagnosis of the underlying cause of the urinary incontinence. It can be very helpful in sorting out which parts of the bladder and urethra are functioning correctly, and which parts are not. The test involves the placement of a very small tube in the bladder, and another small tube in the vagina or the rectum. Sterile fluid is then used to fill the bladder to determine how the bladder behaves as it is fills up and how well it empties. The results of urodynamic testing help Dr Carey advise the best treatment for the patient. Cystoscopy (looking inside the bladder with a medical telescope) is often performed with urodynamics.

Non-surgical Treatments for Female Urinary Incontinence

Pelvic floor muscle training is used to strengthen the group of muscles and ligaments that support the urethra, bladder, uterus and lower bowel. The pelvic floor muscles also help to control bladder function such as allowing you to ‘hold on’ until an appropriate time and place. It is recommended that all women exercise their pelvic floor muscles regularly throughout life, to prevent or correct weakness. Exercising weak muscles regularly over a period of 4 to 5 months can strengthen them and make them work effectively again. Many women experience an improvement in stress incontinence with pelvic floor muscle training under the supervision of a physiotherapist or nurse with expertise in managing female incontinence. Pelvic floor muscle training can be used in conjunction with bladder retraining in the management of women with urge incontinence.

Women with urge incontinence often benefit from a range of medications that can relax the bladder muscle. These medications are generally effective in 80% of women and can be prescribed by your general practitioner.  Lifestyle changes such as reducing caffeine and alcohol intake, quitting cigarettes, weight reduction and avoiding constipation can improve bladder function.

Dr Carey will be happy to answer any questions you may have and can give more specific advice. Before deciding to have surgery, you should read carefully all the information about your operation and consider obtaining a second opinion.

If you experience complications after you leave hospital, contact Dr Carey or the nursing staff on 1 West at the Epworth Freemasons Hospital for advice. In an emergency you may attend the Royal Women’s Hospital, Parkville or Epworth Hospital, Richmond emergency department or attend your closest hospital emergency department.