Urinary Incontinence
Urinary Tract Infection :: Haematuria :: Erectile dysfunction :: Urinary Incontinence
Urinary stones :: Vescico ureteral reflux :: Benign Prostatic Hyperplasia :: Cancer
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 maneuvers 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, exercising)
- Urge
Leakage of large amounts of urine at unexpected times, including during sleep. Functional untimely urination because of physical disability, external obstacles, problems in thinking or communicating that prevent a person from reaching a toilet
- Overflow
Unexpected leakage of small amounts of urine because of a full bladder
- Mixed
Usually the occurrence of stress and urge incontinence together. Transient leakage that occurs temporarily because of a condition that will pass (infection or medication)
A person can also become incontinent due to neurologic injury, birth defects, strokes, multiple sclerosis, or physical problems associated with aging.
The level of incontinence differs for each person and depends upon
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. There are also a number of exercises that can be done to strengthen
the urinary sphincter muscle that controls the opening and closing
of the bladder.
Treatment
Non-Surgical :: Surgical
Non-Surgical (Conservative)
Exercising the Pelvic Floor
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 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.
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
Technically they both achieve the same result but they are done
differently.
Below are charts, instructions, forms related to Incontinence
care. All of them are PDF documents which will open in a new window.
Click on the desired handouts to open them in a new browser window.
Talk to the incontinence nurse at your local hospital
or to your medical team for advice about the options management
of your continence and the options available to you.
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