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Mrs Jane E Simpson
Mrs Simpson is the Continence specialist at The London Clinic, and the author of The Pelvic Floor Bible.
Urinary incontinence can be an uncomfortable and upsetting problem. Many people think that it is an inevitable part of ageing, but there are several forms of effective treatment, and although some women will need surgery, we initially encourage lifestyle changes and pelvic floor exercises, working up to medical interventions.
However, many women with severe urine incontinence are surprised to find their condition can be treated simply and effectively, without needing to think about surgery.
Pelvic floor exercises
Your pelvic floor muscles are the muscles you use to control the flow of urine as you urinate. They surround the bladder and urethra (the tube that carries urine from the bladder to outside the body).
Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often one of the first treatments recommended, whether you have stress, urge or mixed incontinence.
Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life. Studies from around the world show that, with proper supervision, conservative treatment such as pelvic floor muscle training can improve stress or mixed urinary incontinence in women by two-thirds.
We also teach these exercises using biofeedback equipment; the patient is given a pelvic floor educator to practise with at home. We also use vaginal weights and electrical stimulation to help the pelvic floor contract, thereby becoming stronger.
- Lifestyle advice is also very important when it comes to urine incontinence.
- If you’re overweight or obese, we would encourage you to lose the excess weight. Eating a healthy, balanced diet and engaging in moderate exercise of at least 30 minutes per day would be beneficial.
- Limit caffeine intake, or have decaffeinated coffee or tea instead and try emptying your bladder frequently to avoid having a full bladder, thereby avoiding the sudden urge, or incontinence.
- Wear absorbent pads to absorb any leaks – these are widely available from the pharmacy or supermarkets.
- Something simple like drinking too much water may also be a problem; you may need to drink more or less water, your doctor may advice as appropriate.
Medical therapy: what’s new?
Another option for urge incontinence is treatment with drugs that block the release of messages from the nerves that control the bladder’s contractions. This can be successful in 60-70 % of men and women with urge incontinence. The drugs can be difficult to use in the long-term as they can cause side effects including dry mouth and constipation.
More recently a new procedure using Botulinum A toxin (Botox®) has been used to treat patients who have not had successful treatment with drug therapy. This treatment involves injections into the bladder under a local anaesthetic and the effects last an average of 12 months.
Surgical treatment options
If pelvic floor exercises fail to improve or cure stress urinary incontinence there is a range of surgical options available. These include sling procedures in which a synthetic material, TVT (tension-free vaginal tape), is inserted into the vagina through a small incision to help support the urethra.
As with every surgery, there are some risks associated. Your doctor would be able to advice on the most appropriate treatment option for your condition.
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