What is incontinence?

Incontinence is the word used to describe the involuntary loss of urine and there are different types of leakage such as stress, urge and overflow.

Stress urinary incontinence in females is the involuntary loss of urine because of an increase in abdominal pressure. This can occur with activities such as coughing, sneezing, straining, lifting or running. In males, urinary incontinence can occur for many reasons such as an enlarged prostate, prostate surgery, or a neurological condition like Parkinson's disease.

Causes

Stress urinary leakage happens because the muscles of the pelvic floor are not strong enough to stop urine leaking out when the bladder is under pressure.

In women, pregnancy, childbirth via the vagina, vaginal hysterectomy and being postmenopausal all increase the risk of stress urinary incontinence. Unfortunately, the more children you have, the more likely you are to have stress urinary incontinence. In men, leakage of urine can occur after surgery for prostate cancer as the urinary sphincter muscle is always damaged to some extent during surgery (the amount of or lack of damage depends on your anatomy and the skill of your surgeon).

Diagnosis and treatment

A urine test will be carried out to check for blood in the urine or infections. Sometimes, a flow test and bladder scan are also used to diagnose incontinence.

There are three treatments available for urinary incontinence: pads, pelvic floor physiotherapy and surgery. Pads for urine leakage are designed to take away the water, so you stay dry - however, it is really important to use the correct product or pad. Pads for menstrual loss in women are not good for urine as the amount of water a menstrual pad can hold is quite small. For men, triangle-shaped pads, which surround the penis are available - these come in different absorbencies.

The best initial treatment is pelvic floor physiotherapy, which is a series of exercises (often called Kegel exercises) designed to strengthen the pelvic floor and reduce urine leakage. If this fails, surgical options can be explored, though you will need to have a test called urodynamics before surgery is offered. This is designed to test how the bladder is working and why it is leaking urine. It helps us decide what operation (there are many types, with different options for men and women) or medication can be used to treat incontinence. At Urology Waikato, the usual form of urodynamics is called video-urodynamics, which are carried out in the x-ray department at Waikato hospital.