Stress Urinary Incontinence

This is a common problem that affects women more than men.  It is leaking of urine when you cough, sneeze, run or laugh or any activity that increases the abdominal pressure and therefore, puts pressure on the bladder.  It is mainly caused by weakness of the pelvic floor muscles.  This can occur due to pregnancy and childbirth (especially following a forceps or vacuum delivery), chronic constipation, a chronic cough and post-prostatectomy.  In women, it often starts or gets worse around menopause. Treatment is aimed at strengthening the pelvic floor muscles and we would first assess that you can do a pelvic floor contraction and relax them correctly (50% of women can’t) and then would tailor an exercise programme to suit your muscles.  We can also use biofeedback and muscle stimulation if the muscles are particularly weak and real-time ultrasound to help see the pelvic floor movement. Make an appointment to see Tara (women only), Linda or Alan (post-prostatectomy only).

Overactive Bladder

Previously known as urgency, this occurs when the bladder muscles squeezes even if the bladder is not that full and you get a strong urge to go to the toilet.  It is often associated with frequency (going to the toilet more that seven times a day).  People with an overactive bladder will usually not stray too far from a toilet so it can restrict activities. Initially, we will get you to fill out a chart so that we can ascertain the degree of the problem and whether it is associated with drinking habits (for example, too much caffeine can exacerbate the problem) or a small bladder size. Treatment consists of a bladder and pelvic floor training problem. Make an appointment to see Tara.

Urge Incontinence

Urge Incontinence happens when you have strong urges from an overactive bladder but don’t get to the toilet on time.  The leak is usually quite large (compared to the small leak that usually happens with stress incontinence) and you often have to change clothes. Bladder training is the main initial treatment for this although we may liaise with your GP regarding medications. Make an appointment with Tara.

Bowel Incontinence

This can include leakage of stool, gas or mucous from the bowel or staining and can be very distressing.  Weakness of the pelvic floor specifically the anal sphincter muscle is the main cause and damage to the sphincter during surgery or childbirth can be present.  Chronic straining due to poor defecation mechanics can play a part as the bowel may not be emptying completely. Treatment of the pelvic floor muscle is a very important part of therapy although dietary issues may also need to be addressed.  Advice is also given on correct bowel habits.  Biofeedback therapy may be used. Make an appointment to see Tara (women only) or Linda.

Constipation

There are many reasons for constipation but poor bowel mechanics can be a major cause in chronic constipation.  If there is poor muscle co-ordination between the abdominal and pelvic floor muscles, this can cause a difficulty in emptying the bowels.  The pelvic floor muscles may be contracting when they should be relaxing to open the sphincter (anismus). Diet and hydration is also very important.  Treatment consists of muscle relaxation and/or biofeedback therapy to train the muscles to work properly. Make an appointment to see Tara (women only) or Linda.

Prolapse

A prolapse usually happens due to weakness of the vaginal wall although there are other types.  It is called a cystocoele if it is the front wall and a rectocoele if it is the back wall that prolapses. Pelvic floor strengthening is very important as it helps to support the walls.  Prolapses of the rectum can also happen. Treatment consists of advice on avoiding straining the pelvic floor, strengthening using an exercise programme or sometime biofeedback or muscle stimulation. Make an appointment to see Tara.

Post-prostatectomy

Prostate surgery is one of the major causes of urinary incontinence in men. Symptoms can include leaking on activities such as coughing or getting up from a chair, terminal dribbling, frequency and urgency.  Physiotherapy to help train both the strength and endurance of the pelvic floor muscles and sometimes biofeedback or electrical stimulation may be used. We can use real-time ultrasound to help assess the muscles in certain cases. Ideally, we like to assess the muscle strength pre-operatively to check that a correct contraction can be initiated and to work on a home programme to strengthen as much as possible before surgery. We can also give advice on erectile dysfunction which is a common side effect post-surgery. Make an appointment to see Alan or Linda.