What is urinary incontinence (UI)?
Urinary incontinence is the involuntary loss of urine. When it occurs during times of increased abdominal or bladder pressure – for example when you cough, sneeze or exercise, it is referred to as Stress Urinary Incontinence (SUI). If it occurs when you have the urge to void it is referred to as Urgency Urinary Incontinence (UUI). It is also possible to suffer from both conditions – which is known as Mixed Urinary Incontinence (MUI).
Urgency urinary incontinence
This can be due to an overactive bladder. It can also sometimes be secondary to bladder outflow obstruction (in men this usually due to an enlarged prostate). In this case you may need surgery (eg. TURP) to deal with the obstruction to the passage of urine before your UUI can be addressed.
Stress urinary incontinence
This can occur in both men and women. Typically, in women it occurs following pregnancy and childbirth. In men it occurs almost exclusively post radical prostatectomy.
How is SUI treated?
Treatment for SUI begins with more conservative, non-surgical measures such as:
- Pelvic floor exercises – are best performed under supervision of a continence advisor or physiotherapist
- Weight loss and giving up smoking
- Incontinence pads or a penile sheath – may be used if your symptoms are not a bother to you or if you choose to do nothing
- Penile clamp
If you experience ongoing stress urinary incontinence which is bothersome there are surgical options. These are very different for men and women.
Treatment options for men
- Insertion of a polypropylene mesh urethral sling
- This is designed to provide additional support to the urethra so it can withstand the extra pressure during coughing or exercising and therefore prevent urine leak during those times
- Slings are generally recommended for mild to moderate incontinence
- Once a male sling has been inserted there is no need for further patient input in the day-to-day functioning of the device
- Insertion of an adjustable transobturator male sling (ATOMS)nsertion of a polypropylene mesh urethral sling
- This device comprises of an adjustable silicone “cushion” which is held in place against the urethra by two mesh arms that pass around the pelvic bone
- The silicon cushion is filled with sterile saline and the volume can be adjusted to achieve continence
- Insertion of an artificial urinary sphincter (AUS)
- This device has multiple components inserted through 2 incisions
- It is completely concealed and essentially replaces the body’s natural sphincter mechanism
- It is reserved for more severe incontinence
- This device requires activation by the patient, so it is important to have a good understanding of its functioning
- It is also important to recognise that inserting a catheter after this device can cause damage if not done correctly
Treatment options for women
- Urethral bulking
- This is a minimally invasive procedure for milder levels of incontinence
- It involves injecting material into urethra to improve its closure or coaptation
- Rectus Fascial Sling
- This procedure involves harvesting a string of connective tissue (fascia) from your lower abdominal wall and using it as a tissue sling under the urethra at the bladder neck to help support it
- This requires an overnight admission