Incontinence 

Incontinence is the inability to control urination, leading to accidental leakage of urine. It's a common issue that can affect women of all ages, but it becomes more prevalent with age. It’s also associated with pregnancy and childbirth. About 1 in 3 women who have had a child will have some form of bladder control problem. Urinary incontinence can impact quality of life, but there are effective treatments and management strategies available.

Types of urinary incontinence

1. Stress incontinence: Leakage occurs during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or exercising.
2. Urge incontinence: A sudden, intense urge to urinate followed by an involuntary loss of urine. Often referred to as "overactive bladder."
3. Overflow incontinence: Occurs when the bladder doesn't empty completely, leading to frequent or constant dribbling of urine.
4. Functional incontinence: Urine leakage due to physical or mental impairments that prevent reaching the toilet in time.
5. Mixed incontinence: A combination of stress and urge incontinence.

Risk factors

• Age: Muscle tone diminishes, and bladder capacity reduces with age.
• Pregnancy and childbirth: Physical changes and stress on the bladder from delivery.
• Menopause: Loss of oestrogen can weaken pelvic muscles.
• Obesity: Extra weight increases pressure on the bladder.
• Chronic conditions: Diabetes, neurological conditions, and urinary tract infections.
• Medications: Certain medications can affect bladder control.

Symptoms

• Frequent urination.
• Sudden, strong urge to urinate.
• Leakage with coughing, sneezing, or laughing.
• Waking multiple times at night to urinate.
• Dribbling after urination.

Diagnosis

• Medical history: Includes questions about symptoms, medical conditions, and medications.
• Physical exam: May include a pelvic exam.
• Bladder diary: Tracking urination patterns and leakage episodes.
• Urinalysis: Testing urine for infections or other abnormalities.
• Urodynamic testing: Assessing how well the bladder and urethra are storing and releasing urine.

Treatment and management

Lifestyle changes:

• Bladder training: Scheduling bathroom visits and slowly extending the time between them.
• Diet modifications: Reducing caffeine, alcohol, and acidic foods.
• Weight management: Maintaining a healthy weight to relieve pressure on the bladder.
• Fluid management: Drinking adequate amounts of water but minimising fluids before bedtime.

Pelvic floor exercises:

• Kegel exercises: Strengthening pelvic floor muscles can help control urination.
• femfit® from Junofem: Read this article on menopause and your pelvic floor and how Junofem can help.

Medications:

• Anticholinergics: Reduce bladder spasms to help improve bladder control
• Topical estrogen: Applied directly to vaginal and urethral tissue.

Medical devices:

• Pessaries: A device inserted into the vagina to support the bladder.

Surgery:

• Sling procedure: Uses a strip of material to support the urethra.
• Bladder neck suspension: Improves the support around the urethra and bladder neck.
• Procedures involving surgical mesh implants: The term ‘surgical mesh’ refers to a permanent synthetic implant that's made from a non-absorbable polypropylene (plastic) material. It's known by multiple names including tape, sling, TVT, patch, ribbon, graft or hammock. From August 2023 all surgical mesh procedures have been paused while steps are taken to minimise harm.

Prevention and self-care

• Regular exercise: Strengthen pelvic floor muscles with regular physical activity.
• Healthy diet: Maintain a balanced nutritious diet rich in fibres to prevent constipation, which can stress the bladder.
• Keep to a healthy body weight – it puts less strain on your pelvic floor muscles.
• Avoid smoking: Smoking can lead to coughing, which increases stress incontinence.
• Avoid bladder irritants (eg, alcohol and caffeine-containing beverages) if they irritate your bladder.
• Regular medical check-ups: Monitor and manage chronic conditions like diabetes. Check all of your medicines with your doctor or nurse prescriber – some can affect bladder control. Discuss reducing fluid intake in the evening if going to the toilet at night is a problem.

Resources

• Continence New Zealand: Offers support, information, and resources for managing incontinence.some text
  • Website: Continence New Zealand
  • Phone: 0800 650 659‍
• Pelvic Health Physiotherapists: Specialise in pelvic floor health and can help with exercises and other treatments.