The bladder is a hollow sac of smooth muscle which fills and stores urine made by the kidneys. When we feel the time is right, it empties, by contracting the smooth muscle wall, and relaxing the pelvic floor muscles.
The urine in the bladder is directly affected by what we eat and drink and some hormones. The bladder smooth muscle is not like muscle in our arms and legs which can contract when we want to – the bladder smooth muscle can’t be contracted on demand; it works under its own control!
The muscles of the pelvic floor however are under voluntary control, so we can contract them and relax them when we want to, to interrupt flow for example.
Before having children, urine infections (cystitis, Urine tract infection, UTI) often after intercourse, are a frequent and distressing problem.
Leaking with gym workout, jogging, or even just walking downstairs with a full bladder is called “stress incontinence”. Pregnancy and childbirth is often the starting point for this problem.
Leaking on the way to the bathroom, because you can’t get there in time, is called urge incontinence. A particular type of this is called “latch key” when it happens as you put the key in the front door!
Finding it difficult to pass urine is not a common symptom in women, but it can occur if the front wall of the vagina has lost all its support and is dropping down a long way (cystocele).
Caffeine (coffee, tea, green tea, cola and chocolate), alters the balance of urine production, making the kidneys produce more urine faster, so making urgency worse. Reducing the caffeine in your diet can be a great help. If getting up at night is a problem, try stopping all fluids three hours before bed.
There are some excellent medicines to help when urge incontinence is the main problem, and if medicines don’t help, injections of botox into the bladder wall under local anaesthetic is very effective.
Pilates and Pelvic floor exercise when taught well can be very beneficial, but not for everyone. If for example the muscles are no longer attached where they should be after having children, exercise is less likely to help.
Leaking when doing sport can sometimes be reduced by putting a tampon in the vagina – which gives extra support under the bladder neck. Some supportive vaginal pessaries can also help.
For urge urinary incontinence, injections of Botox A into the bladder under local anaesthetic can give a substantial improvement – around 90% of women in studies.
For stress incontinence, if none of the non-surgical interventions work well enough for you to lead your normal life then surgical options include:
Colposuspension – an operation done through appx 8 – 10 cm bikini incision or laparoscopically, lifting the tissues either side of the bladder neck. In hospital for 48 hrs and take it easy for 4 weeks. Success at resolving the stress leak is around 80%.
Injection of bulkamid at the bladder neck – overnight stay, and no incision, but less good (30% – 60%) at stopping the leak. It generally lasts for fewer years than colposuspesion
The Tension-free Vaginal Tape (TVT) operation using mesh is not permitted in the UK at the moment, whilst there is a UK enquiry into the short and long term post-operative complications.
It has been shown that the symptoms return if the exercises are discontinued
No – studies at different age groups show the symptoms of leaking with jumping and coughing can improve for some.
Yes, some of the vaginal rings might help, and there are new products being introduced all the time