Brisbane Urology Clinic

Urinary Incontinence

Urinary incontinence is the inability to control the flow of urine and is a common side effect of a number of Uro-oncology treatments, including surgery on the prostate and bladder as well as Radiation therapy.

Physiology of normal bladder filling

Normal bladder filling depends on unique elastic properties of the bladder wall that allow it to increase in volume at a pressure lower than that of the bladder neck and urethra (otherwise incontinence would occur). Despite provocative manoeuvres such as coughing, voluntary bladder contractions do not occur. Emptying is dependent on the integrity of a complex neuromuscular network that causes relaxation of the urethral sphincter a few milliseconds before the onset of the detrusor (bladder muscle) contraction. With normal, sustained detrusor contraction, the bladder empties completely.

The Types of Urinary Incontinence

Stress

Leakage of small amounts of urine during physical movement (coughing, sneezing, and exercising)

Urge

Leakage of large amounts of urine at unexpected times, including during sleep. 

Functional Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevents a person from reaching the toilet. 

Overflow

Unexpected leakage of small amounts of urine because of a full bladder

Mixed

Usually the occurrence of stress and urge incontinence together causes mixed incontinence.  It may also be due to transient leakage that occurs temporarily because of infection or medication.

Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.

The level of incontinence differs for each person and depends on the treatments that they have had, however for some people the phenomena may be short lived while for a few it may be permanent.

There has however been a lot of progress in dealing with continence issues and there are a wide variety of aids and equipment for collecting urine, preventing infection and protecting the skin and surrounding area. A number of exercises can be done to strengthen the urinary sphincter muscle to control the opening and closing of the bladder.

Treatment

Non-surgical (Conservative)

Pelvic Floor Exercises

Pelvic floor exercises are an important and relatively easy 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, womb 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.

Bladder Retraining

The aim of bladder retraining is to overcome urgency and stretch out the intervals between trips to the toilet.

Surgical treatment

Today surgery for stress incontinence has become quite minimally invasive and can often be performed either as a day stay or overnight procedure. Of all the methods there are two that have become very popular;

  • Sub-Urethral Sling (TVT)
  • Laparoscopic Burch