James Ford
Consultant Urologist
People who suffer symptoms of urinary incontinence are encouraged to seek out a range of approaches that could help ease their condition.
Urinary incontinence can be effectively treated, rather than simply managed with incontinence products and pads. Lifestyle changes, physiotherapy, medical interventions and surgical devices are options that can make a significant difference.
Types of urinary incontinence
James Forde, consultant urologist at Beaumont Hospital and Blackrock Clinic in Dublin, says urinary incontinence is a common problem, affecting men and women, with two main types: (1) stress incontinence, where people experience a loss of urine during exertion; and (2) urge incontinence, which is involuntary leakage of urine and associated with an overactive bladder.
Overactive bladder factors
Studies have shown that it affects about 12% of the population; around 350,000 people over the age of 40 in Ireland have overactive bladder symptoms. Forde, who has a specialist interest in voiding dysfunction says: “Overactive bladder is a condition where people experience urinary urgency, which is a compelling need to pass urine and is associated with increased urinary frequency when you void more frequently than normal.
“A lot of patients suffer in silence or are embarrassed and do not like to tell anyone about it. Nocturia, waking up during the night to go to the toilet, is also associated with urinary incontinence.”
Conservative incontinence management
Forde underlines the importance of raising awareness and urges people to talk to their GP or healthcare professional if they suspect a problem. “They may rule out conditions that are making incontinence worse — such as infections or other medical conditions — and, from there, recommend conservative management options that can improve everyday quality of life,” he adds.
Conservative options for an overactive bladder can be as basic as patients detailing their fluid history — such as if they consume a lot of caffeinated drinks, which can be bladder irritants — or physio such as pelvic floor exercises to train their bladder and reduce overactive and urinary incontinence symptoms.
“We ensure patients maximise all conservative options prior to starting them on medication because, in certain cases, conservative management can be more effective than medication,” Forde continues.
Up to 80% of patients report a
significant improvement with botox.
Surgical interventions for incontinence
For those not improving with medication, surgical options such as botulinum toxin (botox) injections into the bladder can be effective at slowing down bladder activity. Up to 80% of patients report a significant improvement with botox. Though, there can be side effects with some patients (around 10%) having trouble emptying their bladder or developing a urinary tract infection.
Another type of surgical treatment that has increased in popularity is sacral neural modulation, developed by companies such as Medtronic, for overactive bladder patients with urge incontinence.
Forde explains: “That involves inserting leads through the lower back, which produce an electrical current that helps modulate or slow down the activity of the bladder and can be a very effective technique. About 70% of patients see an improvement.” The treatment is a long-lasting solution, aided by prolonged battery.
Seek advice to get effective treatment
In cases of stress incontinence, there are also various procedures and surgical interventions that can help. These also start with conservative management techniques and physiotherapy.
Forde’s overarching message to people who have, or fear they have, urinary incontinence issues is that they should not be embarrassed to seek advice and treatment. “There are lots of treatment options available, including very successful conservative management techniques that we build on to try and improve patients’ quality of life,” he says.
With well-established guidelines and pathways with suitable, safe and effective treatments, there are a range of options — beyond continence materials and pads — that can effectively address urinary incontinence.