This week's gynaecological feature spotlights a pressing issue relevant to women: urinary incontinence. To help us to better understanding this health issue, we interview Urogynaecology specialist Professor Zeelha Abdool, MMED (O&G) FCOG (SA) PhD.
What is urinary incontinence?
Urinary incontinence is the complaint of involuntary loss of urine. When this occurs during periods of raised intra-abdominal pressure, such as coughing, sneezing or jumping on a trampoline, it's referred to as stress urinary incontinence (SUI). Urinary incontinence that's associated with the need to urgently empty your bladder, awake several times from deep sleep to void and frequency are symptoms suggestive of overactive bladder, referred to as OAB syndrome. This diagnosis is only valid when other medical conditions have been excluded. The estimated prevalence for UI ranges between 10-40% with higher figures in older women. Currently, there are no statistics for South African women suffering with UI.
What are the major causes of UI in women?
The major risk factors for the development of UI is vaginal childbirth, ageing, menopause, obesity, genetic inheritance of weak connective tissue and previous hysterectomy. Previous injury/surgery to the bladder or lower back and neurological conditions such as stroke, Parkinsons disease and Multiple sclerosis can also cause UI. In addition diabetic patients may complain of UI especially when poorly controlled. Other factors that lead to severe UI in older age is a condition called Intrinsic sphincter deficiency. Women typically complain of significant urine leakage when standing from a sitting or lying position. This is as a result of poor anatomical functioning of the lining of the urethra and the sphincter muscle around the urethra, and is more challenging to manage.
I have urinary incontinence. What next?
Take note of your complaints and consult your gynaecologist, preferably those who have a special interest in Urogynaecology (a sub-specialty of Gynaecology that focusses on pelvic floor dysfunction) or local gynaecology clinic. After a detailed history your gynaecologist will assess your vagina and pelvic floor muscles. An ultrasound scan will be performed to provide more information of the bladder and pelvic floor muscles. You will be requested to complete a bladder diary, and some basic tests such as urine culture (to test for infection) and diabetic testing will be recommended. In some cases, we recommend a specialized test called urodynamic studies to assist in further understanding bladder function.
What are the treatment options?
In cases of mild stress UI, pelvic floor muscle exercises with electrical stimulation performed by a trained physiotherapist is advised. In moderate to severe cases of SUI, a sling procedure (surgical procedure) still remains the gold standard. In cases of OAB, bladder rehabilitation (such as timed voiding) and medical treatment with specific pills will be prescribed. When there is poor response to medical treatment more specialized treatment such as Botox and neuromodulation (device that coordinates the nerve supply to the bladder) may be advised.
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