Urinary incontinence can be divided broadly into the following types but 90% of patients suffer from stress and/or urge incontinence:
Your GP will take a structured, urological history to ascertain what type of incontinence you have and how this affects your day-to-day activities. You may be asked to complete a questionnaire in advance of your appointment to help your GP obtain a more accurate picture. Your past medical and obstetric history are important in any discussion, as are your daily fluid intake, the drugs you are taking, your bowel function, your smoking habits and any other urinary symptoms you may be experiencing.
A full physical examination will be performed, including measuring your blood pressure and assessment of your body mass index (BMI). Particular attention will be paid to the abdomen (to feel for an enlarged bladder) and to vaginal or rectal examination. It is helpful to have a full bladder when you are examined because it may mean that you can reproduce the leakage for your GP. A full neurological examination with an assessment of your reflexes should also be performed.
The actual tests performed will be left to your GP’s discretion. It is usual to measure kidney function and to check the blood cells for anaemia or other problems.
A routine dipstick test will be performed. A urine sample will normally be sent to the laboratory to exclude infection.
Your GP may wish to arrange an ultrasound scan. This is to check your kidneys, to assess your bladder emptying and to find out whether your symptoms are caused by a problem within or close to the bladder. Thereafter, additional tests will only be performed after your GP refers you to a urogynecology clinic.
If you have an enlarged bladder, a mass arising from the pelvis (or urinary tract), blood in your urine or a large, troublesome vaginal prolapse, your GP will arrange your referral to a urologist or uro-gynaecologist. In most patients, however, your initial management will take place under the supervision of your GP.
Simple measures such as reducing caffeine intake, reducing what you drink, losing weight and carrying out pelvic floor exercises may be helpful. You should avoid taking drugs that cause you to make more urine (e.g. diuretics). You should stop smoking. For some patients, using simple pads to catch the leakage may be sufficient. If surgery is not appropriate for any reason, inserting a catheter into the bladder (pictured) or using intermittent self-catheterization may resolve the incontinence.
If the underlying cause of the overflow incontinence can be clearly identified, it should be treated. Men with chronic retention of urine may benefit from TURP. If surgery is not appropriate, a simple urethral catheter can be inserted into the bladder or self-catheterisation started. Permanent urethral catheterisation in women with overflow incontinence can cause significant problems with bladder neck erosion and catheters falling out. Intermittent self-catheterisation is normally better for women.
If there is a fistula causing continuous incontinence, this can be repaired surgically. A urethral catheter or intermittent self-catheterization may be preferred if surgery is not appropriate.
The vast majority of men with post-micturition dribble have no underlying problem apart from a failure of the normal “milk-back” mechanism after passing urine. Simple massaging of the urethra towards the tip of the penis can reduce troublesome dribbling. Thijs helps to expel the last remaining drops of urine. If an underlying cause is identified on ultrasound scanning (e.g. urethral stricture or diverticulum), telescopic surgery may be advised, although this does not always eliminate the dribbling completely.