Urinary Incontinence

 What Urinary Incontinence?

Urinary incontinence has a huge impact on quality of life. Menopause and vulvovaginal atrophy create the perfect storm for weakening the support around the urethra. Without estrogen to keep the surrounding tissue strong, the urethra can flex and people can have stress urinary incontinence. This occurs when there is increased intra-abdominal pressure [from coughing, laughing, sneezing and running] and this pressure is transmitted through the bladder. As a result, the urethra is overcome by the pressure, causing leakage.

There is another kind of incontinence that is quite common, called urge urinary incontinence. Common symptoms include an inability to make it to the bathroom on time, loss of bladder control on the way to the bathroom, and frequent visits to the bathroom every hour to minimize leakage.

Diagnosis

We take a careful history to determine which kind of urinary incontinence the patient is suffering from. We also send patients for urodynamics studies at the Ambulatory Care Unit at the hospital for pressure studies to measure what exactly is happening with the bladder when it is full. This helps determine whether medical or surgical management is appropriate.

Treatment

Stress urinary incontinence responds to weight loss, pelvic floor muscle exercises, pessary (hyper link), or surgical management with a bladder sling.

Lifestyle

Urge urinary incontinence responds to lifestyle modification, pelvic floor muscle exercises, weight loss, and overactive bladder medications. You should also limit your caffeine intake and attempt to lose weight if your BMI is overweight. Another modification that is helpful is bladder training, which entails scheduling a void every hour to minimize leakage episodes.

There are two locations with access to pelvic floor physiotherapy in Prince George which may also be helpful. Patients can be referred, but can also self-refer if this is something they want to explore.

Medication

Overactive bladder medications—medications that inhibit nerve impulses responsible for various bodily functions–are helpful, and the ones being made now have a much better side-effect profile than the older drugs we previously had in our arsenal. We often try to give patients a four-week sample to trial and report back on symptom control and any side-effects. The most common medications I prescribe are Mirabegron, Toviaz, and Vesicare.

Surgery

The most common bladder sling surgery that I perform is a tension-free vaginal tape procedure using Gynecare mesh. This surgery has had safety data and excellent performance over a 20 year span. People have a 30% risk of recurrence of their incontinence after five years. There is a 10% chance of de novo urinary urgency. There is also a small risk of bladder perforation while the mesh is being positioned. For lots of people, this procedure can be performed as a day procedure. However, I recommend patients take six weeks off work, particularly if your job involves lifting or prolonged standing.