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.