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

2. Urinary Incontinence: Did You Know..? 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

3. Impact of Incontinence Quality of Life Physical Psychological SocialDomestic Occupational Sexual Avoidance of sexual contact and intimacy Limitations or cessation of physical activities 1 Guilt/depression Loss of self-esteem Fear of: – Being a burden – Lack of bladder control – Urine odour Reduction in social interaction Limiting and planning travel around toilet accessibility Family burden Requirements for specialised underwear, bedding Special precautions with clothing Absence from work Decreased productivity Urinary leakage affects all aspects of quality of life

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

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

6. Relative Proportions of incontinence by Age Percentage of incontinent women (%)

7. Innervation of the lower urinary tract Lower Urinary Tract

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

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

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. Identifying Pelvic Floor Muscles 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.

16. Pelvic Floor Exercise : Does it Work? 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

17. Pelvic Floor Exercise : Does it Work? 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

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

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

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

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

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

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

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

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

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

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

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

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

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

34. Differentiating Stress and Urge Urinary Incontinence Symptoms Stress Incontinence Urge Incontinence Leak with activityYesNo Leak on the way to toilet after urge NoYes NocturiaNoYes Sudden strong desire to void SeldomOften

35. Any Questions?