Treatments & Diagnosis
Incontinence
Diagnosis and treatment for stress, urge, overflow, and mixed urinary incontinence, including pelvic floor therapy, medication, and surgical options.
Treatments & Diagnosis for Incontinence
Stress Incontinence: This means leaking urine during physical activity, exercise, coughing, sneezing, laughing, or anything that puts pressure on the bladder. "Stress" here refers to physical pressure, not emotional stress, and the leakage is usually brief.
It's the most common type of incontinence and generally responds well to treatment. The usual cause is weakened pelvic floor muscles, which support the bladder, bladder neck, and urethra, often due to pregnancy, childbirth, or previous pelvic surgery. A weakened urethral sphincter can also contribute, and it's common for both factors to be present together.
Problems Treated
Other Types of Incontinence
Urge Incontinence: Not being able to hold urine long enough to reach a toilet, caused by an overactive bladder contracting involuntarily. It's common in people with diabetes, stroke, Parkinson's disease, or multiple sclerosis, and in men it's often linked to an enlarged prostate. It can also affect otherwise healthy older adults. Persistent urgency is usually caused by something other than cancer, but it's occasionally an early sign of bladder cancer, so it's worth having evaluated rather than assumed away, particularly if it doesn't respond to standard treatment.
Overflow Incontinence: Small amounts of urine leaking because the bladder becomes too full, often due to a blocked urethra or weakened bladder muscles, which can occur in some patients with diabetes.
Functional Incontinence: Occurs when bladder function is normal but a mobility issue, from arthritis or another disabling condition, makes it hard to reach the toilet in time.
Total Incontinence: Complete loss of bladder control, often following surgery on the lower urinary tract.
Mixed Incontinence: A combination of urge and stress incontinence.
Treatment for Incontinence
- Treatment for Stress Incontinence: Mid-urethral slings, such as Trans Obturator Tape (TOT) and Tension-Free Vaginal Tape (TVT), are common surgical procedures.
- Treatment for Urge Incontinence: Usually starts with behaviour changes, reduced fluid intake, timed voiding, and pelvic floor (Kegel) exercises. Anticholinergic medications (bladder relaxants) are often effective. For more severe cases, bladder augmentation using a segment of the small intestine may be needed, though this may require intermittent self-catheterisation afterward. Botox injections into the bladder are an option for patients who don't respond to or can't tolerate medication.
Tests to Evaluate Incontinence
Urinalysis: A urine sample tested for infection, blood, or other abnormalities.
Uroflowmetry (Urine Flow Test): Measures urine flow rate and volume by passing urine into a flow meter while seated on a modified toilet seat.
Residual Urine Measurement: A bladder scanner checks for remaining urine after urination. Quick and painless.
We run uroflowmetry and residual urine measurement as separate tests, since doing them together can give inaccurate results if the bladder refills during the scan.
If these tests show abnormalities, urodynamics (voiding cystometry) may be needed to pin down the underlying cause.
Urodynamics: Specialised tests that evaluate how well the bladder and urethra are functioning, ranging from simple to more detailed depending on what's being investigated.
Incontinence Treatment for Both Men & Women
Incontinence can be triggered by illness, fatigue, confusion, or a hospital stay, and it's sometimes the first noticeable sign of a urinary tract infection (UTI), which often resolves the incontinence once treated.
Common Causes of Incontinence
Diseases and Disorders: Conditions affecting the nerves or muscles involved in bladder control.
Pelvic Floor Muscle Weakness: A common contributor to urinary incontinence.
Medication Effects: Some medications can cause or worsen incontinence as a side effect.
Constipation: Pressure from a full bowel can affect the bladder and contribute to urinary issues.
Diagnostic Tests for Incontinence
Urethral Pressure Profile (UPP): Usually recommended for patients with a history of failed incontinence surgery. Your doctor will walk you through it if it's needed.
Video-Cystourethrography (VCU): Sometimes used after a previous failed surgery to assess bladder function in more detail.
Stress Test: The bladder is filled, then activities like coughing and standing are performed to check whether they trigger leakage.
Ultrasound: Imaging to check the size and shape of the kidneys, bladder, and prostate for abnormalities.
Cystoscopy: A thin, telescope-like instrument passed through the urethra for a direct look inside the bladder.