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Bladder Management and Incontinence

Incontinence is an involuntary leakage of urine. It is a common problem in males and females – up to 37% of women and around 13% of men experience urinary incontinence. The condition can have a significant impact on a person’s quality of life, but because of embarrassment, many people do not seek medical help. This is unfortunate, because there are effective treatments for the management of incontinence in men and women.

Stress incontinence is the result of abdominal straining, such as coughing or lifting.
It is usually the result of weakness of the urinary sphincter muscle. Initial treatment for both men and women generally involves a set of exercises to strengthen the pelvic floor muscles. Surgical treatments include the injection of urethral bulking agents to prevent leakage by increasing pressure on the urethra; or the surgical placement of a ‘sling’ to support the urethra.

Urge incontinence follows the feeling of a sudden and strong need to pass urine. Treatment options for men and women include pelvic floor exercises in conjunction with behavioural techniques to ‘retrain’ the bladder;  and medications that reduce the sensitivity of the bladder and decrease its ability to contract.

Surgery may be an option for patients who do not respond to these less complex treatments for urge incontinence. Sacral neuromodulation is a recently available surgical procedure that can be effective in the management of overactive bladder and urinary retention. It involves implanting an electrode next to the third sacral nerve at the very base of the spine. The electrode is connected to a small external device similar to a pacemaker, which sends a very low pulse to stimulate the nerve and change the function of the bladder.