Urinary incontinence and bladder disorders can cause considerable discomfort and disruption to your day. Effective treatment options are available to restore your confidence, from lifestyle modifications and physiotherapy to medication and surgery.
Urinary incontinence refers to an inability to hold in your urine or adequately control your bladder, leading to involuntary urine leakage. This condition affects a significant proportion of women, with greater prevalence among older generations, and can be a source of great anxiety and embarrassment. Though urinary incontinence can occur in men, it is more common among women, affecting up to 50% of the female population.
The defining symptom of urinary incontinence is involuntarily wetting yourself, which may include bedwetting at night. Some women may also feel they are unable to completely empty their bladder when on the toilet.
Incontinence can be categorised into different types. The two most common types are urgency incontinence and stress incontinence.
The cause of urinary incontinence is not always clear. The risk of experiencing incontinence increases with age, and is often thought to be due to a weakening of the pelvic floor supporting the bladder. Women are more likely to have incontinence due to the strain of pregnancy and, in later life, the effects of hormonal changes from menopause on the pelvic floor.
Stress incontinence may also be caused by:
Causes of urge incontinence include:
Urinary incontinence is also commonly associated with pelvic organ prolapse, as both are associated with pelvic floor dysfunction.
Bladder disorders in women encompass several conditions that may affect your bladder, kidneys, ureters (the tubes connecting kidney to bladder), and urethra (the tube that drains urine from your body). In addition to urinary incontinence, other common bladder disorders include:
Also known as interstitial cystitis, bladder pain syndrome is a chronic condition involving inflammation of the bladder. Women with interstitial cystitis may have symptoms such as:
The intensity of discomfort or pain can vary between individuals, but many women will feel their bladder pain syndrome symptoms are worse during their menstrual period.
The causes of bladder pain syndrome are not well understood, but are thought to be associated with a fragility of the bladder tissue resulting in ulcers, autoimmune or inappropriate inflammatory responses, or a hypersensitisation of the nerves responsible for detecting bladder sensations.
Diagnosis of urinary incontinence and bladder pain syndrome is predominantly based on your medical history and symptoms. Dr Mayooran may organise targeted investigations such as:
Depending on your presenting signs and symptoms, and medical history, Dr Mayooran may order additional tests to rule out other conditions as required.
Choosing the right treatment option to manage urinary incontinence can depend on a few factors, including the type of incontinence, how your symptoms are affecting your life, and your personal preferences. With a focus on shared decision-making, Dr Mayooran may recommend referral to another healthcare professional for non-surgical intervention, medications, surgery, or a combination of treatments.
Pelvic floor exercises with a pelvic floor physiotherapist helps to strengthen your pelvic floor muscles as well as improve voluntary control of these muscles. You may also benefit from a device known as a vaginal pessary, which is inserted into your vagina and provides immediate support for your pelvic floor and relieves the pressure on your bladder. Some women with stress incontinence may use a pessary only when engaging in particular high-risk activities. A vaginal pessary must be properly fitted by a gynaecologist or pelvic floor physiotherapist.
For women who are suitable for non-surgical incontinence treatment, Dr Mayooran can prescribe medications to improve the coordination of your bladder muscles, or administer BOTOXⓇ therapy, which helps to calm the nerve signals from the bladder in urge incontinence.
If conservative treatments are ineffective, Dr Mayooran can perform surgery for urinary incontinence, which aims to restore the support of your bladder and reduce accidental urine leakage. There are a number of surgical approaches to treating incontinence; one of the most common is known as a Burch colposuspension. Surgery can be achieved either via laparoscopy or robot-assisted surgery.
Unfortunately there is no definitive cure for bladder pain syndrome/interstitial cystitis. Instead, treatment is designed to alleviate your symptoms and restore your quality of life.
Some women will find that certain foods or drinks can trigger bladder pain symptoms. Common triggers include alcohol, caffeine, carbonated beverages, and citrus fruits.
Dr Mayooran may offer referral to a psychologist to learn stress management techniques, as there is evidence that mental stress can exacerbate the symptoms of bladder pain syndrome. Referral to a physiotherapist for techniques such as bladder retraining or pelvic floor relaxation can also often be effective.
Prescription medications for interstitial cystitis include oral medications such as antihistamines, over-the-counter pain relievers, or an immunosuppressant known as cyclosporin. Other drug treatments involve intravesical administration, which means they are delivered directly to your bladder via a catheter.
Other invasive procedures for bladder pain syndrome can include:
