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What is Urinary Incontinence?

Urinary incontinence is a common condition characterised by unintentional loss of urine. It impacts women of all ages, but it’s especially prevalent in postpartum and older women.

There are several types of incontinence, including:

  • Stress Incontinence – occurs when urine leaks due to physical exertion like coughing, laughing, or sneezing.
  • Urge Incontinence – involves a sudden and intense need to pass urine, which is often uncontrollable. People with this type of incontinence usually need to urinate frequently.
  • Mixed Incontinence – characterised by having both stress and urge incontinence.

Symptoms of urinary incontinence can include:

  • Unintentional loss of urine
  • Leaking urine during physical exertion such as coughing, laughing, or sneezing
  • A sudden, intense urge to urinate followed by an involuntary loss of urine
  • Frequent need to urinate
  • Inability to hold urine long enough to get to a restroom

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What Can You Do To Treat Urinary Incontinence?

Urinary Incontinence can be treated non-surgically and with minimally invasive procedures.

Non-surgical treatments include lifestyle changes such as managing fluid intake, bladder training, and pelvic floor exercises, which strengthen the muscles that help control urination. Medication may also be prescribed to manage symptoms.

For more severe cases, your GP will advise you to undergo minimally invasive procedures or surgery. These include mid-urethral sling procedures, urethral bulking, colposuspension surgery, or BoNT to the bladder. These treatments aim to provide support to the urethra or increase the amount of urine the bladder can hold.

It’s important to note that the treatment choice depends on the type of incontinence, its severity, and your overall health and lifestyle.

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Why Choose London Women’s Centre for Treatment for Urinary Incontinence?

At London Women’s Centre, we pride ourselves on our holistic and multi-disciplinary approach to treating urinary incontinence and pelvic floor problems. Our team comprises expert urogynaecologists, nurses, and women’s health physiotherapists, all working together to provide a comprehensive care package tailored for each patient.

We believe in empowering women by offering a range of treatment options, from conservative management and physiotherapy to medication and surgery.

Our team’s extensive experience and state-of-the-art facilities enable us to provide a high standard of care. Whether you are dealing with stress incontinence, urge incontinence, or mixed incontinence, we are ready to provide the appropriate treatment that fits your age, condition, and the severity of your symptoms.

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Stress & Urinary Incontinence Treatment Options

Should other strategies for managing urinary incontinence symptoms fall short, surgical treatment could be the next step. There are numerous surgical treatment options available, and all are designed to be minimally invasive.

Mid-urethral sling procedure

A mid-urethral sling procedure is a minimally invasive surgery that is primarily used to treat stress incontinence.

In this procedure, a small sling is placed under the urethra, which is the tube that carries urine from the bladder out of the body. This sling acts like a hammock to support the urethra and keep it closed, especially when you cough or sneeze, preventing leaks.

The procedure is usually done under general or local anaesthesia and it takes about 30 minutes. Most women can go home the same day, although full recovery can take a few weeks.

Currently, although recommended as a gold standard first line procedure to treat stress incontinence, synthetic mid-urethral slings are paused in their use in the U.K. This means that we do not offer this procedure at the current time.

It is expected that we will be able to offer this procedure in due course pending a national review, but until this time we still offer the procedure using a sling fashioned from a patient’s own tissue, called the Autologous Fascial Sling.

This is inserted in a similar fashion to the mid-urethral tape but requires a slightly larger incision over the patient’s abdomen to allow a sling to be fashioned from the muscle sheath.

Urethral Bulking Agents

This procedure involves injecting a substance into the urethral walls, around the bladder neck. The procedure aims to increase the size of the urethral walls to allow the urethra to stay closed more strongly.

Bulking procedures are often recommended for women experiencing stress incontinence or those having trouble with bladder emptying. It’s also applicable to more complex scenarios, such as women who’ve undergone prior continence operations.

This is a relatively quick procedure performed under general anaesthesia, and it doesn’t require any surgical incisions or stitches.

Some risks of urethral bulking agents may include:

  • Burning or bleeding when passing urine, though this usually stops shortly after treatment
  • Difficulty emptying the bladder
  • Urethral pain
  • Urinary tract infection

Urethral bulking agent treatment is more suitable as a secondary treatment, as it has a lower success rate and durability compared to mid-urethral tape or colposuspension. As bulking agents tend to wear off over time, repeated injections may be necessary.

Colposuspension Surgery

Colposuspension is effective for women who haven’t found relief from non-surgical treatments or less invasive surgeries.

Colposuspension has the same risks as the mid-urethral tape, as well as some additional risks associated with it being a more significant procedure, including:

  • Difficulty emptying the bladder fully
  • Recurring or chronic UTIs
  • Painful sex

There are no risks associated with vaginal healing since the procedure is not carried out through the vagina.

During a colposuspension procedure, the surgeon lifts the neck of the bladder and secures it with stitches to a stable structure within the pelvis, like the pubic bone. This repositioning of the bladder neck provides additional support, helping to prevent leakage when pressure is placed on the bladder.

The procedure is performed under general anaesthesia and can take 45-60 minutes. Hospital stay is usually 3 to 4 nights, and full recovery can take up to 6 weeks. The longer recovery times and resulting scarring, similar to a caesarean section scar, make this procedure less common in modern times. A newer and more popular treatment option is the mid-urethral tape procedure. This procedure offers shorter operating times, faster recovery, and minimal scarring.

BoNT to the Bladder

BoNT to the bladder is a treatment for urinary incontinence that involves injecting BoNT into the bladder muscle. This procedure can help relax the bladder, increasing its storage capacity and reducing episodes of urinary incontinence.

This procedure is brief and non-invasive, involving no cuts or stitches. BoNT is administered into the bladder wall through a camera device called a cystoscope. You’re set to return home the same day, after passing urine.

While the long-term effects of this treatment are still somewhat unknown, some known risks may include:

  • Urinary tract infection
  • Difficulties emptying the bladder

The impact of BoNT typically endures between 3-12 months, and the treatment can be repeated if proven beneficial.

Recovery and aftercare

Post-Treatment Care

Following any of the treatment options for urinary incontinence, you will receive exceptional care and support from our dedicated team at the London Women’s Centre.

After your procedure, our team will provide you with specific aftercare instructions tailored to your treatment. This may include advice on activity levels, dietary recommendations, and managing any potential side effects.

For non-surgical treatments such as medication and physiotherapy, the recovery period is minimal, and you can return to your normal activities almost immediately.

Surgical treatments may involve a recovery period ranging from a few days to several weeks, depending on the procedure.

Colposuspension Surgery Aftercare

Following a colposuspension surgery, you may experience discomfort and pain, which can be managed with pain relievers. It’s important to avoid heavy lifting and strenuous activities for at least six weeks to allow your body to heal.

You might also experience changes in your urinary habits such as frequent urination or difficulty emptying your bladder. These symptoms usually improve over time.

Our team at the London Women’s Centre will provide detailed aftercare instructions and support to ensure you recover smoothly. You will also have follow-up appointments to monitor your progress and address any concerns you may have.

Why see a Subspecialist Urogynaecologist?

An accredited subspecialist urogynaecologist is trained to manage women with urinary problems, to the highest level of expertise. They work at centres where patients with complex problems are referred from other units, such as women who have previously been operated on or treated for urinary incontinence or prolapse, but without success.

They also deal with women who have more than one type of incontinence or have incontinence as well as other pelvic floor problems, such as prolapse of the vagina and uterus.  Subspecialists are usually involved with the training of surgeons and the research and development of new techniques. This is, therefore, the highest level of care that you can receive.

Mr Demetri Panayi – Expert in Bladder and Urinary Incontinence Treatment ✓

Mr Panayi is a highly accomplished gynaecologist and subspecialist urogynaecologist with extensive experience in both the NHS and private sectors. Holding various senior positions and being a respected leader in his field, he is a sought-after speaker at national and international meetings and a dedicated mentor, researcher, and trainer for the next generation of consultants.

Mr Panayi has been a consultant for thirteen years and specialises in treating women with bladder and urinary incontinence problems, as well as chronic and recurrent UTIs and ongoing bladder pain.

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FAQs

Can Stress Incontinence get worse?

Yes, stress incontinence can worsen over time, especially if the underlying causes are not addressed. Factors such as ageing, obesity, and childbirth can weaken the pelvic floor muscles and cause the condition to deteriorate. High-impact exercises and heavy lifting can also exacerbate symptoms. Therefore, it’s important to seek medical advice and treatment as early as possible to manage the condition effectively.

What is the difference between stress incontinence and urge incontinence?

Stress incontinence is when urine leaks due to physical exertion such as coughing, laughing, or sneezing. It often happens when the muscles that support the bladder and regulate the release of urine (the pelvic floor muscles and the urethral sphincter) become weak.

On the other hand, urge incontinence involves a sudden and intense need to pass urine, which is often uncontrollable. It is usually caused by overactivity of the bladder muscles.

What causes Urinary Incontinence?

Urinary incontinence is caused by issues with the muscles and nerves that help to hold or release urine. This can include damage to the pelvic floor muscles and nerves that may be caused by childbirth, surgery, or ageing. Other factors may include certain medical conditions like diabetes or neurological disorders, menopause, chronic coughing, obesity, and physical inactivity.

How common is stress and urinary incontinence?

Stress and urinary incontinence are quite common, especially among women. Approximately 1 in 3 women will experience some form of urinary incontinence in their lifetime, and stress incontinence is the most common type.

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