BLADDER DYSFUNCTION

INTRODUCTION

Lower urinary tract (bladder/urethra) dysfunction can manifest in a number of ways. One of these is urinary incontinence which is defined as ‘the complaint of any involuntary leakage of urine’. Sometimes bladder problems may be a ‘symptom’ of other illnesses e.g. diabetes mellitus, cardiac disease or may simply be due to lifestyle issues such as excessive fluid/caffeine intake.

Bladder problems have historically been viewed as an unavoidable part of the ageing process, but this isn’t necessarily the case. There are a number of treatments and interventions which can significantly improve the quality of life of women with urinary difficulties.

• Urinary incontinence is a common symptom that can affect women of all ages, with a wide range of severity and nature. While rarely life‑threatening, incontinence may seriously influence the physical, sexual, psychological and social wellbeing of affected individuals. The impact on the families and carers of women with urinary incontinence may be profound.
• Another common bladder problem is ‘Overactive Bladder Syndrome’. This is characterised by urinary urgency, an overwhelming compelling desire to pass urine which is difficult to resist. Women usually pass urine frequently during the day (urinary frequency) and/or night (nocturia), with small volumes voided each time. Leakage of urine may occur if women are unable to access a toilet in time.
• Voiding difficulty: Some women may find it difficult initiating urination (hesitancy), have a slow or intermittent urinary stream and prolonged voiding times. They may have a sensation of incomplete bladder emptying or need to use additional techniques such as ‘double-voiding’ to ensure their bladder is empty.
• Women may have a range of other bladder-related concerns such as recurrent infections, altered sensation and pain/discomfort in the bladder region.

TYPES OF URINARY INCONTINENCE (UI)

Leakage of urine can occur for a variety of reasons. However, most women with urinary incontinence fall into one of three categories:

• Stress UI is involuntary urine leakage on effort or exertion or on sneezing or coughing.
• Urgency UI is involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay).
• Mixed UI is involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing.

WHAT TREATMENT IS RIGHT FOR ME?

There is no single best treatment for all patients. Treatment needs to be individualised and will depend on many factors including your history, symptoms, your doctor’s experience and your own personal preference.

Some of the more common investigations performed to better understand the underlying problem include:

• Bladder diaries,
• Urinalysis to assess for urinary tract infection,
• Urodynamic testing,
• Cystoscopy and bladder biopsy.

Not all women need surgery. In fact, for some women, it may be that making simple lifestyle changes such as modifying fluid intake or weight loss is all that is required. Conservative strategies such as bladder re-training and/or pelvic floor exercises, supervised by a pelvic floor physiotherapist, can be beneficial.

There are a range of medications which can improve symptoms, particularly in women with overactive bladder.

Surgical management of urinary incontinence is often effective and can be considered should the various conservative strategies be ineffective or unsuitable. Most surgical techniques are performed in a minimally invasive way with a short hospital stay and a quick recovery time.