Bladder weakness and stress incontinence

There are many types of bladder weakness, leakage or incontinence, for instance stress incontinence, urge incontinence, mixed incontinence and neuropathic incontinence with overflow.

A personal assessment is important, which includes a full medical history and finding out when you experience urine loss and under what conditions. A drinks & bladder diary kept for a week is helpful. An examination is frequently very useful. A urine test is sent for culture for bacteria. An ultrasound scan may be helpful. Occasionally an examination of the bladder using a cystoscope is done.

Finally, a simple group of tests that fill the bladder and measure leakage and the effects on the muscle of the bladder [called urodynamic testing], can differentiate those conditions that benefit from surgery from those that don’t.

Stress incontinence is the commonest type of bladder problem causing leakage, and is usually caused by childbirth. If you have completed your family, and you only leak when you cough, strain or do exercise, then try some physiotherapy for the pelvic floor muscles. If these exercises don’t help, then please make an appointment, as an operation called a TVT-O (or alternatively a TVT) can be very helpful.

There are many different terms people use to describe bladder weakness including: sensitive bladder, overactive bladder, leakage, wetness and urine leaks, as well as the medical terms. The symptoms described below should help you start to identify your type.

• Do you leak when coughing, sneezing, laughing or doing heavy lifting

  This is Stress Urinary Incontinence (SUI) or Stress Incontinence. It is the most common type of female bladder weakness. It happens when the pelvic floor muscles that support the bladder have become weakened. Laughing or coughing increases the pressure on the pelvic floor which is unable to tighten enough to keep all the urine in. Usually only small amounts are passed but in some cases it can be more. It is more common during and after pregnancy and after the age of 40, yet it can happen to women of any age. 1 in 4 women experience stress urinary incontinence at some point in their lives. Around 40% of young women experience it when doing sport. Exercises to strengthen the pelvic floor can help. There are surgical options to help, and ring lessaries can be used in those who would like a non-surgical treatment.

• Do you experience sudden urges to urinate

  This is Urge Incontinence, often referred to as an overactive bladder. This is when you experience a sudden urge to urinate and the bladder contracts. There is usually little warning and moderate to large amounts of leakage. If you urinate very frequently, even perhaps waking several times during the night, this could be Urge Incontinence. The exact cause of this type of bladder weakness is not known. The bladder is thought to incorrectly signal the brain indicating that the bladder is fuller than it actually is. In certain cases you can ‘train’ your bladder to improve weakness. There are several medications, most with the side effect of dry mouth to a greater or lesser degree. More advanced options include injections of Botox into the bladder or nerve modulation.

• Could you have mixed symptoms

  Some women experience a combination of Stress Incontinence and Urge Incontinence. If you have both types of bladder weakness you will usually find that one is worse than the other. Patients should focus on these symptoms more, and after achievement of sufficient improvement, can then concentrate on the other symptoms.

• Do you have a physical or mental condition that makes it difficult for you to reach the toilet in time

  Another type of bladder weakness is the inability to reach the toilet in time because of the difficulties caused by a physical or mental illness, which is known as functional Incontinence. Incontinence protection can help make this condition less stressful, and an assessment rules out other causes.

• Do you have a neurological illness or brain injury

  Illnesses such as Alzheimer’s, Parkinson’s disease, Spina Bifida, Multiple Sclerosis or stroke can interfere with the way the bladder and brain communicate leading to an inability to control the bladder or empty it completely. These are known as Neurological Bladder Disorders.