Urinary incontinence is loss of normal control of the bladder and involuntary loss of urine.
Individuals with urinary incontinence may experience strong, sudden, urgent and uncontrollable need to urinate, frequent urination and also involuntary loss of urine.
Physiology of normal bladder filling
Normal bladder filling depends on unique elastic properties of the bladder wall that allow it to store urine at low pressure.
Urinary Incontinence may be caused by any of these factors:
Urinary incontinence can be categorized into five basic types depending on the symptoms:
Stress Incontinence : Involuntary leakage of urine with effort or exertion, coughing or sneezing.
Urge Incontinence : Involuntary leakage of urine preceded by urgency, which is defined as a strong desire to void that is difficult to defer.
Sexual incontinence : Occasionally after surgery such as radical prostatectomy patients can leak urine during sex. This can occur during arousal, intercourse or with orgasm.
Overflow Incontinence : Involuntary leakage of urine because of an over full bladder
Functional Incontinence : This refers to urine loss resulting from inability to get to a toilet.
Mixed Incontinence : It is usually the occurrence of stress and urge incontinence together.
Symptoms remain the mainstay of diagnosis and you may be ordered additional tests to identify and confirm the cause for incontinence. These tests include bladder stress test, urine analysis and urine culture, ultrasound diagnosis, cytoscopy and urodynamics.
Treatment depends on the cause and severity of incontinence. Treatment options for male incontinence include medications, behavioural therapy like bladder training and Kegel exercises, surgery, or a combination of these therapies.
Exercising the pelvic floor muscles is an important way to improve your bladder control. When done correctly they can build up and strengthen the muscles that help you hold urine. The pelvic floor is made up of muscles stretched like a hammock from the pubic bone in the front through to the bottom of the backbone. These firm supportive muscles help to hold the bladder and bowel in place and also function to close the bladder outlet and the back passage. Pelvic floor exercises strengthen the muscles that support the pelvic contents and prevent the escape of wind, faeces or urine. Stronger muscles can also enhance sexual satisfaction for both partners.
The aim of bladder retraining is to gradually increase the amount of urine your bladder is able to hold. This can be achieved by timed voiding or deferral of voiding in order to increase the intervals between trips to the toilet.
If conservative measures do not work or you are still bothered by symptoms, then often surgery is indicated.
Different surgical treatments are indicated depending on the type and severity of the incontinence.
Urge Incontinence: For urge incontinence which is refractory to medical treatments, injecting BOTOX into the bladder can be beneficial. This minimally invasive procedure is undertaken as a day case and results can be seen very shortly afterwards.
Sling procedure :
For mild stress incontinence (typically 2 pads per day or less) a simple sling procedure often fixes the problem. In addition, sexual incontinence can also be helped by a sling.
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Artificial urinary sphincter : This is the gold standard treatment for severe stress incontinence (3 or more pads per day). It is an implantable device that helps keep the urethra closed until you’re ready to urinate. It has a very high success rate and usually only requires an overnight stay in hospital.
The artificial sphincter consists of 3 parts:
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