Urinary Incontinence

In general, lifestyle modifications such as weight control in obese patients and reduction of caffeine intake may help to reduce symptoms of stress, urge or mixed urinary incontinence.

1. Stress urinary incontinence

Non-surgical options

• Pelvic floor exercises
• Commonly known as Kegel exercises, these help to strengthen the pelvic floor muscles and if done correctly and consistently, it can improve the quality of life of 60 percent of women with stress incontinence.
• A trial of supervised pelvic floor exercises for a minimum of three months remains the first-line treatment for women with stress or mixed urinary incontinence (NICE guideline).

Surgical options
Surgery is the mainstay of treatment for stress incontinence when conservative management has failed. Your childbearing wishes also have to be considered before surgery. The following surgical procedures have high success rates of up to 80 to 90 percent but also have risks including but not limited to bladder, vaginal wall and bowel injuries, urinary retention and infection. They should only be undertaken by a trained and accredited surgeon.

• Synthetic mid-urethral tape
• Slings of man-made mesh are used to support the urethra. The most common type in use is tension-free vaginal tape (TVT). Other versions of slings used include TVT-O, TVT-exact and TVT-abbrevo.
  
• Open colposuspension
• Most commonly known as Burch colposuspension, where surgical sutures are used to support the bladder neck.
  
• Autologous rectus fascial sling
• Newly added recommendation by NICE guideline 171, 2013.

Other options such as vaginal devices, collagen injections and artificial urinary sphincter are not recommended as first-or secondline treatment strategies.

2. Urge incontinence and overactive bladder

Lifestyle modifications

• Reduction of coffee and tea intake may help to reduce symptoms.

Medications

• First-line treatment drugs are anticholinergics. They act to block the nerve signals which cause frequent urination and urgency, and bladder spasms. Your doctor will initially start with the lowest recommended dose and review you after a month. The main side effect is mouth and throat dryness. They are contraindicated in women with glaucoma.
• Second-line medications may be recommended if you are unable to tolerate the side effects of anticholinergics.
• Intravaginal oestrogens may be prescribed for postmenopausal women with vaginal atrophy.

Other options
These treatment modalities may only be considered for those who have failed the above medical treatments.

• Injections of botulinum toxin A into bladder wall
• Neuromodulation – percutaneous sacral nerve stimulation
• Augmentation cystoplasty
• Urinary diversion

3. Mixed incontinence

Treatment should be directed towards the predominant symptom, but may involve a combination of approaches.

• Pelvic floor exercises and bladder training, as above, are first-line treatments.
• Anticholinergics such as oxybutynin can be started if the above are not effective.
• Regular review and follow up should be undertaken.

4. Overflow incontinence

• Relieve or treat the cause of bladder outlet obstruction
• Intermittent self-catheterisation or long-term indwelling catheterisation (either urethral or suprapubic) may be required

Ladies, do not suffer in silence. Please seek medical help early to improve your quality of life.