Incontinence treatments

Step 1: Behavioural therapy

We will support you to make behavioural changes, such as changing what you drink and how to manage fluids throughout the day.

Step 2: Pelvic floor exercises

This involves exercises to strengthen the pelvic floor – the muscles activated when you prevent yourself from passing water.

Pelvic floor rehabilitation

We offer biofeedback, an effective approach which is popular with patients. This involves using a small probe to measure muscle movement and the results are projected onto a computer screen. Patients can see how their muscles work and exactly how much harder they need to work in order to gain full control. Muscles are re-trained, initially using the computer guidance and then without guidance.

Bladder retraining

Bladder retraining is the method of gradually increasing the time between your visits to the toilet, so that your bladder is able to hold larger quantities of urine comfortably.

Step 3: Medication

Medication can be effective in the treatment of incontinence. Different types of drugs are used for specific types of incontinence, with anticholinegic medications used for urgency and a different group of medication for mild to modest stress incontinence. We can advise people on best treatment for their individual needs.

Step 4: Acupuncture and percutaneous nerve stimulation (PTENS)

We have an advanced nurse practitioner who specialises in the use of acupuncture for the overactive bladder, as well as bladder/pelvic pain syndromes. Studies show acupuncture can be effective in terms of increasing bladder capacity and reducing discomfort. Percutaneous nerve stimulation can be effective in terms of strengthening the muscles required to achieve better bladder control and inhibiting the nerve impulses that cause unwanted bladder contraction, resulting in urgency.

Step 5: Minimally invasive techniques

Sacral nerve stimulation

This new technique (also known as sacral neuromodulation) is based on the stimulation of the nerves that control the bladder in the sacral part of the lower spine. A test stimulation is performed for a three week period, to which two thirds of patients respond. If patients succesfully respond to the temporary stimulator, a permanent bladder pacemaker is implanted, with battery life up to seven years. This new technique has minimal risk of requiring catheters.

Step 6: Surgery

Surgery is normally only considered for women with significant stress incontinence. Women with an overactive bladder are likely to have found a solution in the first five steps of treatment. Women who continue to experience problems with stress incontinence following the first five steps of treatment may have structural problems which need to be addressed by surgery.

Bladder surgery has rapidly developed during the past ten years and while surgical options need to be very carefully considered, success rates are over 80 per cent.

The main types of surgery for stress incontinence are:

• Urethral bulking agents or implants
• Tension-free vaginal tape (TVT)
• Vaginal sling
• Bladder neck suspension by colposuspension
• Artificial urinary sphincter

For those patients with the most severe urge incontinence surgery involves clam cystoplasty where a small segment of your bowel is used to augment your bladder and prevent bladder spasm.

Each patient is given incontinence treatments which are appropriate for their condition, with an emphasis upon minimally invasive approaches, although the full spectrum of more complex solutions are available for those with severe difficulties.