What is it?
Stress Incontinence is the involuntary loss of urine. Provoking factors typically
include coughing, laughing, running and sneezing. The amount of urine lost will
vary from woman to woman, ranging from a few drops, to soaking clothes and requiring
pads. Too many women adapt by altering their lifestyles so as to avoid embarrassment,
thinking that incontinence is a normal process of ageing. It is diagnosed by your
symptoms and/or special tests on your bladder (“urodynamics” or a “pad test”) and
can be cured.
What causes it?
There may be many causes for stress incontinence. There is normally a supporting
mechanism to the urethra (the outlet pipe leading from the bladder through which
urine passes when urinating, or going to the toilet). If this supporting mechanism
becomes weakened as a result of pregnancy and childbirth, chronic straining (for
example coughing, heavy lifting, constipation), or genetically weak muscles/supporting
tissue, then urinary incontinence may result.
What are the treatments?
There are many treatments for stress incontinence including both surgical and non-surgical
options. Pelvic floor exercises have been shown to be effective for women with stress
incontinence and are advised for most women with this condition. We have a dedicated
team of women’s health physiotherapists who can offer a range of specialist treatments.
In addition, some women find the use of a special vaginal support pessary useful
for controlling their symptoms, although this is rarely a satisfactory and effective
long term solution
The surgical treatments available vary in terms of technique and effectiveness. The
commonest operations involve supporting the urethra (retropubic mid-urethral tape
or trans-obturator mid-urethral tape) or lifting up the bladder neck (colposuspension).
Both these types of surgery offer around a 80-90% chance of significant improvements
in symptoms of stress incontinence (persisting to around 70% after ten years). The
midurethral tape procedures tend to be less painful and have a quicker recovery time
than the longer-standing previous gold standard colposuspension operation. For some
women we still offer a colposuspension, which can be done via keyhole (laparoscopic)
surgery. Occasionally women chose to have an injectable material put in to the urethra
(urethral bulking agent), although this operation tends to only be successful in
around 50% of cases and generally only for up to two years.
All these operations are not designed to treat the problem of “urgency” where women
get a compelling desire to pass urine. The exact choice of operation is likely to
be dependent on the extent of your bladder symptoms, the presence of any additional
vaginal problems and your other medical and surgical history. As with any continence
surgery, it is advisable for a patient who†has not completed her family to do so†before
having surgery so as to reduce the risk of failure.
