Urinary Incontinence : Must You Grin & Bear It?

1. Dr Bim Williams Consultant Gynaecologist February 2016 Urinary Incontinence :Must You Grin & Bear It?

2. 1 in 3 women suffer with urinary incontinence 1 in 8 women perceive this as a problem Number one reason for nursing home admission Average of 7 years before seeking medical help Urinary Incontinence: Did You Know..?

3. Limitations or cessation of physical activities1 • Guilt/depression • Loss of self-esteem • Fear of: • Being a burden • Lack of bladder control • Urine odour • Avoidance of sexual contact and intimacy Impact of Incontinence • Absence from work • Decreased productivity • Reduction in social interaction • Limiting and planning travel around toilet accessibility • Family burden • Requirements for specialised underwear, bedding • Special precautions with clothing Urinary leakage affects all aspects of quality of life

4. Age Family predisposition Race Childbirth and pregnancy Pelvic surgery Smoking Obesity Physical activities What causes Incontinence ?

5. Ageing UK Population UK Office for National Statistics – 2nd March 2012

6. 80 S t r e s s u r i n a r y i n c o n t i n e n c e ( S U I ) Mixed urinary incontinence (MUI) 60 Urge urinary incontinence (UUI) 40 20 0 29 39 49 59 69 79 89 84 24 34 44 54 64 74 90+ Total – – – – – – – – – – – – – – 25 35 45 55 65 85 75 60 20 30 40 50 70 80 Age (y) n=6876 Relative Proportions of incontinence by Age Percentage of incontinent women (%)

7. Lower Urinary Tract Innervation of the lower urinary tract

8. The Pelvic Floor Set of muscles that spread across the bottom of the pelvic cavity like a hammock.

9. Supports the pelvic organs Provides sphincter control for the bladder and bowel whilst straining and lifting Enhances sexual response Pelvic Floor Function

10. Consequences of a Weak Pelvic Floor

11. What is Stress Urinary Incontinence? “Involuntary leakage of urine with activity such as coughing lifting or exercise”

12. Case study Alison attends clinic with her 18 month old son (the youngest of 6). She complains of urinary leakage daily, of variable amounts. She reports that she leaks when she laughs and with activities such as lifting and running after her son She feels very self conscious. She doesn’t get much chance to go out with friends these days but when she does she often makes excuses as all the drinking and laughing is a “recipe for disaster”

13. Stress incontinence: What can you do?

14. Pelvic Floor: Do Exercises Really Work?

15. Try to stop the flow of urine. Relax completely and allow your bladder to empty. Insert one finger into the vagina and tighten your pelvic floor by squeezing around your finger. During intercourse tighten your pelvic floor muscles around your partner’s penis. Identifying Pelvic Floor Muscles

16. 70% cure for Stress Incontinence (8-12 contractions 3 times daily for minimum of 3 months) ‘The Knack’ Manoeuvre-consciously contracting the pelvic floor muscle prior to a physical stress and maintaining the contraction during the stress Pelvic Floor Exercise : Does it Work?

17. Reduces leakage by up to 98% medium and 73% with deep cough within a week Improve timing of contractions, Pelvic floor muscle strength and stiffness and persists for 10 years Pelvic Floor Exercise : Does it Work?

18. Stress incontinence: What can I do? TVTO Insertion

19. Safe and effective Up to 90% of patients remain cured 17 years following-surgery Quick recovery and resumption of normal activity. TVTO Insertion: Benefits

20. Bleeding Infection Injury to nearby structures. Short-term Difficulty passing urine. Tape erosion TVTO Insertion: Risks

21. Stress incontinence: What can I do? Bulkamid Urethral Injection

22. Quick procedure Safe and effective Quick recovery and resumption of normal activity. Bulkamid Urethral Injection: Benefits

23. Pain Blood stained urine Short-term Difficulty passing urine. Urine infection Bulkamid Urethral Injection : Risks

24. The Next Question......

25. What is Urge Incontinence? “Involuntary leakage of urine due to inability to hold on"

26. Case Study • Mrs Pee is a 51 year old lady • Complains of inability to “hang on” and wets herself when walking her dog • Her symptoms are getting her down!

27. Dietary changes/weight loss Reduction in caffeine intake Fluid intake management Bladder re-training Urge incontinence: What can you do?

28. ‘Quick Flick’ for urge Incontinence Slow deep breaths while contracting the PFM rapidly 3-5 times when urge is felt. Pelvic Floor Exercise : Does it Work?

29. Urge incontinence: What can I do? Drug Therapy

30. Effects of antimuscarinic drugs • CNS • Iris/ciliary body • Lacrimal gland • Salivary glands • Heart • Gallbladder • Stomach • Colon • Safetyandtolerability • Reduce involuntary bladder contractions • Reduce OAB symptoms including: • Micturition, frequency, • nocturia • UUI • QUALITY OF LIFE • Bladder (detrusor muscle) Andersson KE. Discovery Medicine 2009; 8(42): 118–24.

31. Urge incontinence: What can I do? Botox Injections

32. Reduction in Voiding episodes Reduction in Urgency episodes Reduction in Leakage episodes Botox Injections:Benefits

33. Urinary Tract Infection Voiding problems Need to Self Catheterise Botox Injections:Risks

34. Differentiating Stress and Urge Urinary Incontinence

35. Any Questions?