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 caused by weakness of the pelvic floor muscles.  This can occur due to pregnancy and childbirth (especially following a forceps or vacuum delivery) or chronic constipation.  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 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.

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.

Urge Incontinence

Urge Incontinence happens when you don’t get to the toilet on time when you have the strong urges from the overactive bladder.  The leak is usually quite large (compared to the small leak that usually happens with stress incontinence).

Bowel Incontinence

This can include staining or incontinence of wind and can be very distressing.  Weakness of the pelvic floor is the main cause although damage to the sphincter during surgery or childbirth can be present.  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.

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.  Diet and hydration are also very important.  Treatment consists of pelvic floor rehabilitation, biofeedback therapy to train the muscles to work properly.

Prolapse

A prolapse usually happens due to weakness of the walls of the vagina 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.

Post-prostatectomy

Prostate surgery is one of the major causes of urinary incontinence in men.  Symptoms can include leaking on activities such as coughing, terminal dribbling, frequency and urgency.  Physiotherapy to help train the pelvic floor muscles, and sometimes real-time ultrasound, biofeedback or electrical stimulation may be used to improve the pelvic floor muscles and sphincter.  Advice can also be given on erectile dysfuntion post-prostatectomy.