Specialist Care for Bladder and Prostate Problems

Male & Female Incontinence

Urinary incontinence is the inability to control the flow of urine. Studies have shown that forty two 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. The majority of female and male patients with urinary incontinence usually suffer from embarrassment and consequently delay in visiting their GP. With an increasingly ageing population, the problem is an expanding one.

The causes of urinary incontinence, urgency incontinence, stress incontinence and overflow incontinence affects both sexes. Sometimes a combination can occur 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 sent 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. For further details on Overactive Bladder and treatments available visit the Overactive Bladder page.

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 Botulinum toxins 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.

Female Incontinence

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 are 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

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 called a 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.

Male Incontinence

Incontinence amongst men can occur after ungergoing surgery on the prostate to treat prostate cancer (Post Radical Prostatectomy Incontinence).

Incontinence initially is commonplace after a radical prostatectomy (an operation to remove the prostate due to prostate cancer), but this usually stops within a few months. After their operation some men will notice they may leak urine and need to urinate much more frequently and may have to wear pads in their underwear to keep themselves dry.

Incontinence can occur but is less common after surgery to treat an enlarged prostate (benign prostatic hyperplasia). Factors that can affect incontinence following prostate surgery include age, general health and the amount of prostate and surrounding tissue removed during surgery.

Regular pelvic floor exercise following radical prostatectomy is a very important way for patients to speed up the recovery of their continence. Formal pelvic floor rehabilitation programmes and bio-feed back techniques can further accelerate the process of regaining bladder control. Prescribed medicines are generally not that effective in this condition.

If incontinence hasn’t stopped within a few months of undergoing surgery, then there are revolutionary surgical methods available which the Birmingham and Solihull Bladder Clinic specialise in:

Male Sling

Male slings are a relatively new treatment option for male incontinence and their advantage is they are less invasive than the Artificial Urinary Sphincter procedure detailed in the next section. They are suitable for men with less severe stress incontinence, usually following an operation to remove the prostate. A male sling is a sling made of synthetic mesh which are placed through a perineal incision to support the siphincter (control mechanism) and restore continence. They are relatively recent procedures with promising initial results, however, long term results and randomised trials are still lacking. Mr Zaki Almallah, Consultant Urologist at the Birmingham and Solihull Bladder Clinic has special expertise in performing this operation. (For more information please click here). To read Mr Carlin’s experience of having a male sling inserted click here.

Artificial Urinary Sphincter

A normal sphincter muscle will prevent urine from leaking out but when the sphincter fails, urine is not stopped completely and therefore you become incontinent.
For those patients where incontinence persists as a result of surgery, further investigations will have indicated that the best option is to be offered an Artificial Urinary Sphincter (AUS).

To follow a patients journey of having an AUS fitted, please click the following link where you will be able to read a summary or watch an extract from the popular Channel 4 TV programme, Embarrassing Bodies. This addressed the issue of male urinary incontinence and followed Mr Zaki Almallah, Consultant Urologist while operating on Peter, aged 66 to correct his urinary incontinence following surgery for prostate cancer.
http://www.youtube.com/watch?v=eSfZ6cIJFDA

To see how this revolutionary surgery has benefited the patient’s life six months following his surgery to have the AUS devise fitted, please follow the link below
http://www.youtube.com/watch?v=fpgayrK3kVg

What is an Artificial Urinary Sphincter (AUS)?

An AUS is a device for men who have urinary incontinence, it takes the place of the damaged sphincter to restore continence. It is a fluid filled device that opens and closes the urethra to offer urinary control.

The device consists of a cuff, a pump and a pressure regulating balloon and the following stages explain how it is fitted and activated:

  1. An artificial urinary sphincter cuff is fitted around the urethra
  2. Once fitted it inflates and squeezes across the urethra to close it
  3. The cuff is connected to a balloon, placed underneath the powerful abdominal wall called the rectus muscle
  4. The Consultant then takes a push button pump which is gently pushed into the scrotum before joining all of the pipes together before tucking them in
  5. The patient then has to wait for six weeks before the Consultant can activate the pump, which will then enable him to be able to turn his water on and off himself by pressing a button when he feels the need to urinate, enabling him to return to a normal life, without the worry of leaking and having to wear pads.

To follow a patients journey of having an AUS fitted, please click the following link where you will be able to read a summary or watch an extract from the popular Channel 4 TV programme, Embarrassing Bodies. This addressed the issue of male urinary incontinence and followed Mr Zaki Almallah, Consultant Urologist while operating on Peter, aged 66 to correct his urinary incontinence following surgery for prostate cancer.

Incontience due to an enalrged prostate (benign prostate hyperplasia)

For treatment for incontinence due to an enlarged prostate, please see the GreenLight Laser section on the website, and also read Mr Ted Ilsley’s story for undergoing this treatment. Click here for testimonials.

As Seen on TV

Mr Zaki Almallah performing the Male Sling operation on Phil for urine incontinence after prostate cancer treatment. Extract from the popular Channel 4 programme Embarrassing Bodies

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