Specialised Care For:

Urinary Incontinence

Urinary incontinence is the inability to control the flow of urine (Leakage of Urine).

Studies have shown that 42 per cent of women in the UK will suffer from urinary symptoms at one stage during their lives. One in four men will experience the same.

There are different types of urinary incontinence: the main two groups are stress incontinence and urgency incontinence. Sometime a mixture of both called mixed urinary incontinence.

Stress Urinary Incontinence

Stress incontinence is the most common form of urinary incontinence.

The bladder is shaped like a balloon, with the ‘neck’ at the bottom. Located in this ‘neck’ are the urinary sphincter, which forms the valve and the pelvic floor muscles. Together, they prevent the liquid which is held inside the bladder from leaking.

However, if the urinary sphincter or pelvic floor are damaged and not strong enough, liquid will leak. This is more likely to happen when the bladder is under pressure, such as when you laugh, cough or take exercise.

This type of incontinence affects women more often than men due to pregnancy, menopause, hysterectomy and the structure of the female bladder. Pregnancy and birth put a major strain on the pelvic floor muscles and can cause damage to the sphincter. Problems may not be evident for many years, only becoming apparent during the menopause.

Fortunately there are effective treatments available for stress incontinence in women and men of all ages.

Urgency incontinence and the overactive bladder

A normal bladder expands gently as it fills and sends a message to the brain in plenty of time to find a toilet. The brain sends a signal to the muscles in the bladder wall, known as the detrusor muscles, to contract. A message is also send to the valve, known as the sphincter, to open so that urine can pass.

However some bladders do not work like this and there is a strong urge to frequently pass small amounts of urine.This is a result of the detrusor muscles of the bladder wall being overactive. It contracts to squeeze out urine before the bladder is full.The overactive bladder does not give the brain enough notice, allowing you to reach the toilet before it contracts, causing incontinence.

If you have urge incontinence, or an overactive bladder, you need to pass urine very frequently, perhaps every hour or even less. You are likely to get up several times in the night to pass urine, so your sleep is being affected by your condition.

There are several causes of this type of incontinence. In some cases, it will be triggered by a bladder infection. Diabetes can cause excessive production of urine and very frequent trips to the toilet.

Treating Bladder Problems and Urinary Incontinence

There are many different options for treating bladder problems. The Birmingham and Solihull Bladder Clinic will ensure the best treatment option is found for you – the approach which is appropriate to your condition and meets your personal needs and preferences including the most up-to-date approaches, such as the use of Botox bladder injections.

Using medication to manage your incontinence

Medications can reduce many types of urinary leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage.

TVT® and Vaginal Slings/Tapes

A sling may be offered for women with stress incontinence who have not responded to medications or physiotherapy. This is usually because the muscles and nerves in the urethral area are no longer working properly.

What is a sling and how does it work?

The urethra is the tube through which urine is passed through to the outside of the body. If it is functioning normally, it maintains a tight seal to prevent the sudden loss of urine. If a woman’s pelvic floor muscle is weakened, it is unable to support the urethra in its correct position. A sling is placed beneath the urethra, restoring the urethra to the correct position. When pressure is exerted, such as when the woman coughs or sneezes, the sling provides the support the urethra needs, enabling it to keep its seal.

Synthetic vaginal slings and tapes like the Tension Free Transvaginal Tape (the TVT sling) is an important advancement in this type of treatment, which was first introduced in Sweden in the mid 1990s. There are several types of these tapes.

A Vaginal Sling is a mesh-like tape that is surgically inserted through the vagina to support the bladder neck and urethra. The incisions necessary to do this are very small and the whole procedure takes just 40 minutes. A local or general anesthetic is required. The sling is then adjusted to fit each individual patient to ensure that it works effectively and does not cause problems with urination.

Research shows that this procedure has a cure rate of 86 to 95 per cent.

Urethral Bulking (Zuidex® and Macroplastique®)

Bulking agents are used to reduce stress incontinence. Natural and synthetic materials, such as collagen and silicone are injected into tissues around the bladder neck and urethra to add bulk, reduce the bladder opening and therefore address leakage.

The procedure only takes 30 minutes and is carried out under local or general anesthesia. A special telescope (cystoscope) is used with no cuts involved. Over time, the body slowly ejects the bulking agents, so repeat injections may be necessary. Before you receive an injection at the Birmingham and Solihull Bladder Clinic, a test will be carried out to check whether you are suitable for these injections and decide which will be best for you.