When bladder issues start to impact daily activities, it’s time to think about doing something. In our clinics, we see a lot of women who experience Urinary Incontinence, and who have started to lose confidence and limit activities. Some have delayed getting help and have suffered unnecessarily. As awareness is increasing, however, we find that women are more comfortable raising these common problems and they are relieved to discover there are more treatment options than ever before.

Dr Rita Galimberti and Dr Suzanne O’Sullivan.

EXPERT ADVICE AND HELP

In order to treat Urinary Incontinence, it’s important to understand the cause in order to get the correct treatment. It is a problem that can creep up over time, and is common across all age groups. An expert in the field of Urinary Incontinence is long time colleague Dr Suzanne O’Sullivan, leading Consultant in Obstetrics and Gynaecology in Cork University Hospital and a subspecialist in Urogynaecology. She defines Urinary Incontinence as “an involuntary or unintentional loss of urine, which equates to leakage or incontinence episodes, often referred to as accidents”. Dr O’Sullivan explains there are two main types of Urinary Incontinence in women: “Stretching of the ligaments supporting the bladder neck causes Stress Incontinence, and abnormal firing of the nerves in the bladder wall causes Urge Incontinence but many women have mixed symptoms and they may have other problems like prolapse or infection. Accurate diagnosis is crucial as the treatments are completely different”.

WHICH TYPE? STRESS OR URGE INCONTINENCE

Stress Incontinence involves involuntary or unintentional loss of urine on effort or exertion. Leaks can happen with sneezing, coughing, jumping, exercising, or even with a laugh. It’s a very common problem, and is seen more in younger women especially after pregnancy and childbirth. “Urge Incontinence,” explains Dr O’Sullivan, “is associated with a sudden strong urge to urinate that results in leakage or an accident, and while it is more common among post-menopausal women, it can happen at any age. This problem is often associated with needing to go very frequently and often at night, and finding it difficult to delay the act of urination.”

GETTING A DIAGNOSIS

How do women know which type of Urinary Incontinence they suffer from? A specialist physiotherapist or doctor will take a clinical history and do a pelvic exam which is very important as it helps to rule out a pelvic mass or prolapse. A urine specimen is important to rule out infection or blood in the urine, and there are other specific tests, like urodynamics, which can also help us achieve a diagnosis but most of the time, a history and clinical examination will be sufficient.

STRESS INCONTINENCE TREATMENTS

“The first line treatment for Stress Incontinence is specialist physiotherapy,” says Dr O’Sullivan. If physiotherapy does not work, surgery is also an option. “As with all surgery, there are benefits, but also risks. There are different surgical options and women are more aware of recent controversies in relation to vaginal mesh and sling surgery.” Vaginal Erbium Laser works on the connective tissue supporting the bladder neck and recent good quality studies have confirmed it to be very effective and extremely safe, with high levels of patient satisfaction for women with mild to moderate stress incontinence. “Incontilase treatment must be administered by a qualified specialist, using a non-ablative Erbium Laser with specific energy settings and a timed programme of treatments. While there are some situations where it doesn’t work, overall results are extremely promising for a safe, walk-in, walk-out intervention with no anaesthetic or downtime” says Dr O’Sullivan.

URGE INCONTINENCE TREATMENTS

Urge Incontinence is treated differently to Stress Incontinence because it has a different cause, says Dr O’Sullivan. “Urge Incontinence is caused when the bladder contracts out of the blue. We start with bladder retraining where the cycle of continuously emptying the bladder is broken. The bladder is designed as a storage organ and should do just that.” Fluid management is also important. “Caffeinated drinks, alcohol, citrus juices and fizzy drinks are all bladder irritants so cutting them out may help.”

However, if you are leaking repeatedly, the mainstay of treatment is medication.“There are families of drugs that are safe and very effective. We try different preparations and combinations to get the best results and the problem is sorted 70%-80% of the time. If they don’t work, Botox injections into the bladder wall using a small camera can be used, but this is not permanent and requires repeat treatments.”

DON’T SUFFER IN SILENCE

While incontinence may be common, it is not normal. “I hate seeing advertisements that promote incontinence pads in women as there is so much that can be done. No woman should be incontinent as help is available, and the embarrassment, shame and lifestyle limitations are avoidable.” Dr O’Sullivan encourages women of all ages to come forward for specialist advice to their GP, physiotherapist or specialist clinic if they suffer from Urinary Incontinence. “Many older women do not realise that suffering from untreated Urinary Incontinence doubles their chance of requiring long-term residential care, and while we can’t guarantee to make everybody completely dry, there are there are very few situations when bladder problems cannot be made a lot better.”

For information on Femalase and Renovalase visit www.femalase.com. If you do have Urinary Incontinence, please contact us for advice and help.