By Marcus Hudson (Pelvic Floor Specialist)
Anyone who’s ever experienced urinary incontinence knows how embarrassing and life-limiting a lack of bladder control can be. But what is the cause of urinary and stress incontinence?
Urination (peeing) is controlled by the brain and bladder. The bladder sends a message to the brain to signal that it’s full, and the brain controls when the pelvic floor relaxes and the bladder releases urine. In the case of urinary incontinence, the brain, bladder, or pelvic floor stop working together and that’s when bladder leakage can happen.
What Are the Different Types of Urinary Incontinence?
Various types of urinary incontinence happen under different circumstances.
Stress Urinary Incontinence is bladder leakage caused when physical movements, such as lifting heavy objects, coughing, laughing, and sneezing put sudden pressure on the bladder. This pressure results in the bladder releasing a small amount of urine. This can also happen during sexual intercourse, which may interfere with having an active and enjoyable sex life.
Urgency Incontinence is a sudden urge to urinate (pee), making it difficult to hold in your urine. Also known as urge incontinence, this can cause anxiety and make social situations awkward. People will also avoid travelling because they need to know where the nearest toilet is.
Mixed Incontinence is a combination of the symptoms of bladder leakage that occur with stress and urge incontinence.
Overflow Incontinence is urinary incontinence that happens when the bladder is not fully emptied during urination. Also referred to as chronic urinary retention, overflow incontinence causes small trickles of urine to release from the bladder at regular intervals.
Total Incontinence is consistent urinary incontinence, which may also be a constant flow of urine that varies in quantity.
Overactive Bladder syndrome is a condition that may cause symptoms of urge and stress incontinence.
What Are the Causes of Urinary Incontinence?
Urinary incontinence happens for various reasons. Sometimes it’s the result of neurological conditions such as Multiple Sclerosis (MS), or it can occur following brain injuries that disrupt the messages from the brain to the bladder. The most common cause of urinary incontinence is pelvic floor weakness, when the pelvic floor muscles that support the bladder become weak or damaged. Multiple factors can cause pelvic floor weakness, including:
- Pregnancy and childbirth
- Connective tissue disorders
- Natural ageing
- Constipation/straining on the toilet
- Heavy lifting
- Surgery such as hysterectomies, caesareans, and prostate surgeries
- Being overweight
- Chronic coughing due to medical conditions or smoking
- Lower urinary tract infections.
Stress incontinence is not something we have to resign ourselves to as we get older, following surgery, or after pregnancy and childbirth. Practicing pelvic floor exercises, weight loss, and giving up smoking can all dramatically improve or eliminate symptoms of urinary incontinence and bladder leakage.
Even a small amount of bladder leakage can be distressing, so it’s a good idea to talk to your GP as soon as you start experiencing symptoms. Doctors are used to dealing with this issue, so there’s no need to feel embarrassed. The sooner you seek treatment for urinary incontinence, the better your chances of a speedy recovery.
What to Expect When You Speak with a Doctor about Urinary Incontinence
Your doctor may ask you to keep a bladder diary, where you can track any incidents of urinary incontinence and record how many times a day you need to urinate. This helps to identify patterns and triggers. A bladder diary will also help your doctor to work out what type of urinary incontinence you’re experiencing. They may also ask:
- How much do you drink every day?
- How often are you experiencing leakage?
- How much leakage is occurring?
- Do you take part in any sports?
- What happens before you experience each incident of urinary incontinence?
- Is it worse at particular times of the day, when you are doing a physical activity or when you sneeze, laugh or cough?
- Do you use incontinence pads or absorbent underwear?
The first diagnostic test your doctor is likely to send you for is an ultrasound scan to look at the inside of your bladder. This can help identify any blockages, nerve issues, infections, or other physical issues. Your doctor will also review any medications you’re currently taking, prescribed or otherwise, to identify whether your urinary incontinence could be due to a side effect of the medication.
When all obvious underlying issues have been ruled out, you may be referred to a specialist. This could be a urologist, an expert in bladder problems and urinary tract infections, or a neurologist, an expert in the nervous system and neurological issues that can cause urinary incontinence.
Diagnostic tests and Procedures for Urinary Incontinence
A few other common diagnostic tests and procedures may be recommended once an ultrasound has been performed.
A cystoscopy is a surgical, diagnostic procedure involving a tiny camera placed inside the bladder.
Urodynamic studies are tests that observe how efficiently your bladder, urethra, and pelvic muscles work.
Non-Surgical Management of Bladder Leakage
In many cases, treatment is based on the management of bladder-leakage symptoms using urinary incontinence products, such as protective pads and special absorbent underwear. Changing medications, weight loss, and preventing constipation and straining on the toilet may also be recommended to people struggling with symptoms of urinary incontinence.
Non-Surgical Treatments for Urinary Incontinence
The non-surgical treatment options available for urinary incontinence will vary depending on your age, medical history, and the severity and cause of your urinary incontinence.
Bladder Training is a non-invasive way to improve bladder control by limiting when you urinate to help your bladder get used to managing more fluids over time.
Pelvic Floor Training uses pelvic floor exercises that improve the strength of the pelvic floor muscles that support the bladder. Pelvic floor exercises should be performed several times a day, every day. They may be done with a kegel device or without. To build a strong pelvic floor and regain control of your bladder, pelvic floor exercises must be done correctly to ensure the right muscles are targeted.
Biofeedback is a therapy that uses sensors attached to sticky pads placed on the skin near the anus and on the stomach. They are connected to a computer screen. Biofeedback therapy helps the therapist guide you to perform pelvic floor exercises to ensure you are doing them correctly. The recordings also measure the increase in the strength of pelvic floor muscles to check the therapy is working.
Electric Pelvic Floor Stimulation/E-Stim is a form of therapy that can be done by a medical practitioner or with an at-home device often referred to as an E-Stim. Both use electrical currents to activate and strengthen pelvic floor muscles.
Vaginal Pessaries/ Pessary rings — when other forms of non-surgical treatments have not been effective, you may be offered a type of vaginal pessary or a vaginal pessary ring to treat urinary incontinence. They are also used to help treat symptoms of pelvic organ prolapse (POP) and vaginal prolapse, which can contribute to bladder weakness and urinary incontinence.
Botox injections are injections of a neurotoxin (commonly referred to by the brand name Botox) into the bladder.
Collagen injections involve the injection of collagen into the tissues surrounding the urethra to help to make it stronger and more flexible.
Medications for Urinary Incontinence
There are various types of medications used to treat the symptoms of stress incontinence. The type of medication recommended will depend on the type of urinary incontinence, your general physical and mental health, and any other medications you may already need to take for other conditions. All urinary incontinence medications come with a range of possible side effects, including:
- Dry mouth
- Chronic tiredness (fatigue)
- Constipation and digestive issues
- Dry eyes
- Blurred vision and glaucoma
- Urinary tract infections (UTIs)
- Fast or irregular heartbeat and palpitations
- Skin rash
Surgical Treatment of Urinary Incontinence
When all other options have not provided sufficient relief from the symptoms of urinary incontinence, surgical procedures may be recommended. A few surgical options for urinary incontinence include:
Sling Surgery places a sling internally to support the urethra inside the body. Slings can be made from human tissue or surgical mesh. Recently there has been concern over the use of surgical mesh, and significant complications have been reported.
Bladder Neck Suspension involves the placement of internal stitches on either side of the bladder to help to support the muscles and the urethra.
Artificial Sphincter Surgery, also referred to as Artificial Urinary Sphincter Surgery, only works for men. The surgery involves the insertion of three silicone components. A cuff is inserted through the perineum (the skin between the anus and scrotum) and fitted to the urethra. A pump is inserted into the scrotum through an incision made in the groin. And a small liquid-filled balloon is inserted into the abdominal wall. The components work together to control urine flow by compressing the urethra.
But now, there is a safer way to cure urinary incontinence…
The BTL Emsella Chair
The BTL Emsella chair is an FDA-cleared device, providing a revolutionary non-invasive treatment for urinary incontinence. The treatment is suitable for both women and men and can be received fully dressed. All you need to do is relax and sit in our Emsella Chair; you can even read a book during this completely painless treatment. The chair uses a powerful magnet that creates an electromagnetic field to stimulate the pelvic floor muscles and strengthen the pelvic floor. In just one 28-minute session, the equivalent of 11,200 Kegel contractions are created, taking the pelvic floor muscles to a level not possible with traditional Kegel exercises. The contractions created by the Emsella chair build pelvic floor muscles and boost the neuromuscular connections between the bladder and the brain to increase bladder control. Treatment with the Emsella chair also tightens the muscles that support the vaginal canal and the muscles required during erectile function and ejaculation control in men. This quick, effective treatment delivers impressive results, with 95% of patients seeing a huge improvement in urinary incontinence and 84% being completely dry.
If you are ready to find out how this revolutionary treatment can help you, please complete the below form to book an in-depth consultation. During the consultation, we will discuss your condition and the non-surgical and surgical treatment options for urinary incontinence. Following your consultation, you will have the opportunity to try our Emsella chair. The £50 consultation fee is redeemable against any treatment plan.
The Emsella Chair Treatment – Consultation Form
Alternatively, please feel free to call our friendly team of incontinence specialists on 01522 523777.