Urinary issues

Over a third of women will experience urinary incontinence which can occur after pregnancy or as a natural part of the ageing process. The good news is there are simple interventions that can provide long term relief from the discomfort.

What is urinary incontinence?

Put simply, urinary incontinence is when you lose some control of your bladder.

This can vary from experiencing a sudden desperate need to pee but not being able to make it in time, known as urge incontinence, to spontaneous leakage of small amounts when physically active or when coughing or sneezing, known as stress incontinence. Another issue is an underactive bladder, which is when you have trouble emptying your bladder. Urinary incontinence can also be due to any combination of the above.

The most common cause of bladder control problems is the rigours of pregnancy and childbirth, which can damage or weaken the muscles near your vagina and surrounding organs. However, bladder control problems can also be caused by health issues which place strain on the bladder, such as:

Constipation
Chronic coughing
Urinary infections
Diabetes
Obesity
Diseases that damage your nervous system and affect muscle control

Some medicines can affect bladder control, including some antihistamines and antidepressants. Menopause and the reduction in hormones associated with this natural phase of life can also cause some incontinence.

As part of the initial consultation, a urogynaecologist will want to hear a full and complete history of your bladder issues. From there, they will complete a physical examination of the pelvic region and often run urodynamics – a test of bladder function. If further investigation is required, it will be ordered.

Most incontinence can be managed conservatively, but if incontinence is affecting quality of life, a surgical solution may be offered.

Conservative management of incontinence

Before looking at surgical treatments, there are often lifestyle changes that can be made to alleviate these issues. These include weight loss and changes to liquid intake and the nutritional quality of your diet. Your gynaecologist can advise on these as a first step or to support surgical intervention.

Many patients have a high success rate using pelvic floor physiotherapy to resolve incontinence problems. COGA works with a number of talented specialists in this area as part of our cross-discipline approach.

For some women who are perimenopausal or have been through menopause, vaginal oestrogen cream may help with urinary incontinence issues. These are often effective in combination with a pessary.

A continence pessary is a removable device inserted in the vagina to support the urethra and prevent bladder leakage. Made from silicone, they come in a range of shapes and sizes. Fitted by our gynaecologists, some pessaries are worn continuously for weeks, months or years with appropriate maintenance, while others are inserted as needed.

Surgical Treatment for Incontinence

This operation involves placing sutures (stitches) in the vagina on either side of the urethra (the pipe through which urine is released) and tying these sutures to supportive ligaments to elevate the vagina. With the vagina elevated and the urethra more supported, leakage stops or is reduced.

Colposuspension can be performed using an abdominal incision – a horizontal cut in the bikini-line, or laparoscopically (keyhole surgery). Usually patients will spend two to three nights in hospital after this procedure.

This surgical technique involves reconstructing the bladder neck to form a ring of muscle using the existing muscle and soft tissue. This ring acts like a sphincter and helps by holding more urine in the bladder to create a stronger stream of urine when weeing.