Incontinence

Urinary incontinence is a widespread condition that ranges in severity from “just a few drops” to complete loss of bladder control. Although leaking is the main symptom associated with incontinence, there are a number of symptoms that may occur before you develop any leaking or when you only have the occasional leak. These include;

  • Feeling your bladder isn’t completely emptied
  • Having to rush to the toilet
  • Having to rush to the toilet
  • Frequent waking during the night to go to the bathroom
There are different types of incontinence with a number of different possible causes. The types are often described as:
  • stress incontinence,
  • urge incontinence, and
  • mixed incontinence.

Dr Budden will start with a detailed history about what happens when you leak, how much you leak and the events surrounding the times you leak. He will also take a detailed history of the fluids you drink during the average day including type of fluid and volume. While some questions may seem odd, they will help Dr Budden to make an assessment of the likely underlying cause and tailor a management plan for you.

Stress Incontinence

Stress urinary incontinence classically occurs during a sneeze or cough or when picking up something heavy. It usually only involves a small amount of leaking but there can be large amounts when stress incontinence occurs together with urge incontinence. The underlying causes for stress incontinence include thinning of the cells lining the urethra (tube from bladder to the outside) and weakness of the pelvic floor muscles. More than 50% of women in the early stages of leaking can be cured with pelvic floor physiotherapy and oestrogen cream. If these treatments are not effective for you, Dr Budden will discuss the use of an incontinence pessary or surgery and the advantages and disadvantages of each these treatment options.

Surgery for Stress Incontinence

If Dr Budden recommends surgery to help with your symptoms, he will ensure you understand the proposed procedure and allow plenty of time to ask questions. There are two main approaches for this type of surgery:
  • Placement of mesh underneath the urethra, inserted from a vaginal approach although there will be two small incisions above your pubic bone.
  • Placement of mesh underneath the urethra, inserted from a vaginal approach although there will be two small incisions above your pubic bone.
Both procedures are performed to reduce the mobility of the urethra rather than pull it up. There are pros and cons of these approaches and Dr Budden will ensure you understand these before organising any procedure.

Urge Incontinence

Urge urinary incontinence is often due to overactivity of the bladder muscle. There are a number of causes of an overactive bladder including drinking too much fluid or excessive alcohol or caffeine consumption. Urge incontinence also commonly occurs if someone is worried about leaking and therefore goes to the bathroom more frequently than needed. Over time, the bladder loses its ability to stretch and becomes unable to tolerate the little contractions that tell us it is time to go to the bathroom. If your symptoms are suggestive of urgency or overactivity, Dr Budden will discuss a tailored bladder retraining program and assess areas to reduce the risks of overactivity (like decreasing caffeine). If no improvement is seen after following these simple measures, Dr Budden will discuss the other options available.