Urinary incontinence refers to the involuntary loss of urine. It can affect both men and women but is far more common in women. Because it is an embarrassing condition, many women delay for years before seeking help from their family doctor. However, incontinence affects at least half of all adult women at some time in their lives – there is no reason whatsoever to feel embarrassed.
The distress that urinary incontinence can cause makes it especially important that women seek professional help from an experienced medical specialist. The team at SHORE FOR WOMEN have a wealth of experience in treating female urinary incontinence in women of all ages.
There are 2 main types of female urinary incontinence:
Female stress urinary incontinence, or simply “stress incontinence”, is a very common problem, affecting up to 1/3 of adult women. Typically, there is involuntary leakage of urine during physical activity. Despite the common misconception, it is not caused by emotional stress but rather activities that “stress” the bladder neck. Classic triggers for stress leakage include coughing, sneezing and laughing. It may also occur during exercise or sporting activity (such as playing golf or tennis) or during sexual intercourse, which can be very distressing for the woman.
Several risk factors can increase a woman’s risk of stress incontinence. Age and number of children play a key role although it is not uncommon for younger women, even in adolescence, to experience stress incontinence. Body weight is another big risk factor and women who are overweight tend to have a higher risk of stress incontinence. Similarly, women who cough chronically, either because of smoking or background lung problems, have an increased risk. Some women will unfortunately develop stress leakage despite having apparently few risk factors.
The most effective treatment for stress incontinence is surgery and the best operation for female stress incontinence is called a “mid-urethral sling” procedure. The team at SHORE FOR WOMEN have considerable experience in treating women affected by stress incontinence and Dr. Colin Walsh has cared for hundreds of women with this condition. He has also published several leading studies examining the best surgical treatment for women with stress incontinence.
Overactive bladder (OAB) is a bladder disorder characterised by a sudden, compelling desire to urinate which is difficult to control (“urgency”). Often, women with this condition also have to get up frequently during the night to urinate (nocturia) and may visit the toilet many times during the day (frequency). The sensation of urgency may be so strong as to cause unwanted leakage of urine before the toilet is reached (urge incontinence). OAB syndrome is extremely common, affecting approximately 25% of adult women worldwide.
Usually, the cause is not known. However, women with recurrent urinary tract infections, previous continence surgery, neurological disease (such as multiple sclerosis) or a history of either bed-wetting in childhood or previous pelvic radiation therapy are at increased risk.
OAB symptoms are due to unwanted bladder “spasms” which can occur randomly throughout the day and night. These bladder cramps or spasms produce the tell-tale symptom of urgency. Some women can identify triggers for their bladder symptoms, such as standing up or when they return home and put the key in the door. However, for many women, there is no obvious trigger and they may leak suddenly while simply sitting on the couch watching television. It is the unpredictable nature of the bladder symptoms and incontinence which makes OAB such a distressing condition.
OAB is diagnosed by an experienced gynaecological specialist when a woman describes the classic OAB symptoms and once other causes (such as cystitis) have been excluded. No special testing is required to make the diagnosis. Occasionally, for women with complicated symptoms or who have previously had bladder surgery, a special test called urodynamics is helpful.
The team at SHORE FOR WOMEN have huge experience in caring for women affected by overactive bladder. Dr Colin Walsh has cared for hundreds of women with OAB, has published extensively on the condition and has a PhD in the treatment of the overactive bladder syndrome.
Unfortunately, for most women with OAB, no “cure” exists. Treatment aims to reduce symptoms and improve quality of life. Simple measures, such as eliminating caffeine intake and modest weight loss, can be very helpful. Post-menopausal women may benefit from regular vaginal oestrogen cream. The mainstay of treatment for OAB syndrome is a combination of bladder retraining and medication designed to reduce the bladder symptoms. There are lots of different medications with different side-effects – Dr. Walsh can discuss this with you in more detail.
A proportion of women with severe OAB may not find medication helpful, or may find it helpful initially but then notice symptoms returning. In recent years, a surgical treatment has emerged for these severe cases. It involves injection of BOTOX® directly into the bladder wall under anaesthetic. This is the same chemical used by women to treat facial wrinkles and it works in a similar fashion in the bladder, eliminating spasms. Although many women find it very effective, the benefit usually last only 9-12 months and the treatment may need to be repeated.