Urinary Incontinence Must You Grin Bear It Dr

Urinary Incontinence : Must You Grin & Bear It? Dr Bim Williams Consultant Gynaecologist February 2016

Urinary Incontinence: Did You Know. . ? • 1 in 3 women suffer with urinary incontinence • 1 in 8 women perceive this as a problem • Number one reason for nursing home admission • Average of 7 years before seeking medical help

Impact of Incontinence • Limitations or cessation of physical activities 1 Physical • Avoidance of sexual contact and intimacy Sexual Psychological • Guilt/depression • Loss of self-esteem • Fear of: – Being a burden – Lack of bladder control – Urine odour Quality of Life • Absence from work • Decreased productivity Social Occupational • Family burden • Requirements for specialised underwear, bedding • Special precautions with clothing Domestic Urinary leakage affects all aspects of quality of life • Reduction in social interaction • Limiting and planning travel around toilet accessibility

What causes Incontinence ? • Age • Family predisposition • Race • Childbirth and pregnancy • Pelvic surgery • Smoking • Obesity • Physical activities

Ageing UK Population UK Office for National Statistics – 2 nd March 2012

Relative Proportions of incontinence by Age Stress urinary incontinence (SUI) Mixed urinary incontinence (MUI) 60 Urge urinary incontinence (UUI) 40 20 Age (y) + 90 9 4 – 8 85 – 8 80 9 4 – 7 75 – 7 70 9 – 6 65 60 – 6 4 9 4 – 5 55 – 5 50 9 4 – 4 45 – 4 40 9 4 – 3 35 – 3 30 9 4 – 2 25 – 2 20 ta l 0 To Percentage of incontinent women (%) 80 n=6876

Lower Urinary Tract Innervation of the lower urinary tract

The Pelvic Floor Set of muscles that spread across the bottom of the pelvic cavity like a hammock.

Pelvic Floor Function • Supports the pelvic organs • Provides sphincter control for the bladder and bowel whilst straining and lifting • Enhances sexual response

Consequences of a Weak Pelvic Floor

What is Stress Urinary Incontinence? “Involuntary leakage of urine with activity such as coughing lifting or exercise”

Case study Alison attends clinic with her 18 month old son (the youngest of 6). She complains of urinary leakage daily, of variable amounts. She reports that she leaks when she laughs and with activities such as lifting and running after her son She feels very self conscious. She doesn’t get much chance to go out with friends these days but when she does she often makes excuses as all the drinking and laughing is a “recipe for disaster”

Stress incontinence: What can you do?

Pelvic Floor: Do Exercises Really Work?

Identifying Pelvic Floor Muscles • Try to stop the flow of urine. Relax completely and allow your bladder to empty. • Insert one finger into the vagina and tighten your pelvic floor by squeezing around your finger. • During intercourse tighten your pelvic floor muscles around your partner’s penis.

Pelvic Floor Exercise : Does it Work? • 70% cure for Stress Incontinence (8 -12 contractions 3 times daily for minimum of 3 months) • ‘The Knack’ Manoeuvre-consciously contracting the pelvic floor muscle prior to a physical stress and maintaining the contraction during the stress

Pelvic Floor Exercise : Does it Work? • Reduces leakage by up to 98% medium and 73% with deep cough within a week • Improve timing of contractions, Pelvic floor muscle strength and stiffness and persists for 10 years

Stress incontinence: What can I do? TVTO Insertion

TVTO Insertion: Benefits • Safe and effective • Up to 90% of patients remain cured 17 years following-surgery • Quick recovery and resumption of normal activity.

TVTO Insertion: Risks • Bleeding • Infection • Injury to nearby structures. • Short-term Difficulty passing urine. • Tape erosion

Stress incontinence: What can I do? Bulkamid Urethral Injection

Bulkamid Urethral Injection: Benefits • Quick procedure • Safe and effective • Quick recovery and resumption of normal activity.

Bulkamid Urethral Injection : Risks • Pain • Blood stained urine • Short-term Difficulty passing urine. • Urine infection

The Next Question. . .

What is Urge Incontinence? “Involuntary leakage of urine due to inability to hold on"

Case Study u. Mrs Pee is a 51 year old lady u. Complains of inability to “hang on” and wets herself when walking her dog u. Her symptoms are getting her down! u

Urge incontinence: What can you do? • Dietary changes/weight loss • Reduction in caffeine intake • Fluid intake management • Bladder re-training

Pelvic Floor Exercise : Does it Work? • ‘Quick Flick’ for urge Incontinence Slow deep breaths while contracting the PFM rapidly 3 -5 times when urge is felt.

Urge incontinence: What can I do? Drug Therapy

Effects of antimuscarinic drugs CNS Iris/ciliary body Lacrimal gland Salivary glands Heart Gallbladder Stomach Safety and tolerability Reduce involuntary bladder contractions Reduce OAB symptoms including: QUALITY OF LIFE Micturition, frequency, nocturia UUI Colon Bladder (detrusor muscle) Andersson KE. Discovery Medicine 2009; 8(42): 118– 24. 30

Urge incontinence: What can I do? Botox Injections

Botox Injections: Benefits • Reduction in Voiding episodes • Reduction in Urgency episodes • Reduction in Leakage episodes

Botox Injections: Risks • Urinary Tract Infection • Voiding problems • Need to Self Catheterise

Differentiating Stress and Urge Urinary Incontinence Stress Incontinence Urge Incontinence Leak with activity Yes No Leak on the way to toilet after urge No Yes Nocturia No Yes Seldom Often Symptoms Sudden strong desire to void

Any Questions?