Wakefield Hospital
Florence Street
Newtown
Wellington
New Zealand

Postal Address:
Wakefield Urology & Urodynamics
Private Bag 7909
Wellington South 6021
New Zealand

Urinary incontinence

Urinary incontinence affects some 40% of adult women at some time in their lives, and a smaller percentage of adult men. Most incontinence is primary: it occurs alone without other bladder disease. It is important to identify and exclude those patients whose incontinence is secondary to serious or otherwise treatable disease, simply by history, examination, urine testing, ultrasound and occasionally telescopic bladder examination.

Primary incontinence is treated according to its severity. It is fair to say that nobody dies from incontinence, but it significantly compromises quality of life and is readily treatable with excellent results and low risk. Stress incontinence (SI) is leakage that occurs with activity, cough, sneeze or strain. It results from relative weakness of the valve mechanism, usually secondary to childbirth and aging.

Urge incontinence (UI) occurs with strong desire to void – ‘urgency’ or ‘busting’ – and is associated with frequency and night-time voiding. It results from bladder overactivity and irritability, the reasons for which are usually unknown. Specific investigations may be required to accurately characterise the incontinence, particularly when SI and UI co-exist.

Predominantly SI:

Left untreated, this type of incontinence tends to be progressive and persistent. All patients should attempt pelvic floor exercises and up to 50% are significantly improved when these exercises are supervised by a dedicated physiotherapist.

Most patients will not be cured however, and many will need to proceed with anti-incontinence surgery. There are two types of surgery that have success rates of 80% or greater, and good long-term durability. These are colposuspension and sling procedure. Both support and tighten the bladder outlet and urethra. Colposuspension is performed through the abdomen, from above the pubis, either open or laparoscopically. Sling procedure is predominantly performed from below. One may be more applicable to an individual patient, than the other.

Predominantly UI:

This troublesome incontinence waxes and wanes in severity. As such, our treatment approach is more conservative. Caffeine is a bladder irritant and should be excluded from the diet: decaf coffee substitutes for coffee, herbal infusions for tea, and Coca Cola omitted altogether.

Constipation will worsen bladder function and should be treated with fruit, fibre, fluids and medication if necessary. Again, all patients should attempt a course of pelvic floor exercises and bladder retraining, although the success rate for this is poorer than it is for SI.

There are several medications available that quieten down bladder overactivity. Alas, they all have side-effects of dry mouth, constipation, nausea, and visual disturbance and not all are fully funded. They may be used intermittently or continuously, as tolerated. Some patients without benefit from or unable to oral medications may be suitable for intermittent Botox injections directly into the bladder. This new treatment appears to produce excellent results but requires a telescopic procedure and to be repeated every 9-12 months.

In occasional patients with life-long or persistent UI, surgery is appropriate, to increase bladder capacity and reduce overactivity. This involves either removing a part of the bladder muscle wall, or grafting some other tissue into the bladder. There is the option of a part-laparoscopic approach for this surgery.

Wakefield Hospital, Waikanae, Lower Hutt, Upper Hutt