Urinary incontinence is any involuntary leakage of urine. Incontinence is not a condition in itself but a symptom pointing to unwanted changes in the urinary system. It is one of the urological complaints that affects women significantly more often than men, at up to three times the rate. There are several types of incontinence, the most common being stress incontinence and urge incontinence.
Stress incontinence occurs in response to a sudden increase in pressure in the abdominal cavity, causing urine to leak during physical exertion, sudden movement, coughing, sneezing or laughing. Urge incontinence presents as an inability to hold urine in the bladder, with a strong and uncontrollable urge to urinate even when the bladder is nearly empty.
There are many possible causes of incontinence. The most common is a weakening of the support structures around the urethra, including the pelvic floor muscles, the surrounding connective tissue and the vaginal wall. In women, pelvic floor muscles weaken as a result of childbirth and particularly due to falling oestrogen levels during the menopause. Obesity is another contributing factor.
In both women and men, incontinence can be caused by a bladder infection or other pathological changes in the bladder wall. In men, incontinence most commonly relates to prostate problems, such as benign prostatic hyperplasia, and often occurs following prostate removal. Both women and men can also experience overactive bladder syndrome, which may be accompanied by incontinence.
If urine leakage is happening regularly, that is reason enough to see a doctor. Many people affected by incontinence feel embarrassed about their condition, yet it is a very common problem and one that can be treated effectively. An experienced doctor has a wide range of options to help, all approached with full discretion and respect for your dignity.
When making a diagnosis, the most important thing for us is to understand the underlying causes in each individual client. During the consultation, we use the Gaudenz questionnaire, which helps identify the predominant type of symptoms. We carry out a physical examination of the abdomen and pelvis, and in men also of the prostate via rectal examination. To assess the extent of the causes, we rely primarily on ultrasound of the bladder, ureters, kidneys and prostate.
The first line of treatment for incontinence is strengthening the pelvic floor muscles through regular exercise, combined with lifestyle adjustments such as managing fluid intake and reducing caffeine consumption, losing excess weight if relevant, and similar measures. Structural and hormonal changes that contribute to incontinence can also be addressed with medication.
When surgery is needed, we select the approach that is most suitable for each individual client. Options include injecting bulking agents around the urethra, or a sling procedure in which a small mesh tape is placed under the urethra to support it and supplement the function of the sphincter. In suspension procedures, non-absorbable sutures are used to adjust the position of structures in the pelvis, firming the area around the urethra and preventing involuntary leakage.
