There are 4 main types of urinary incontinence
1. Stress urinary incontinence (SUI)
2. Urge incontinence
3. Voiding difficulties and overflow incontinence
4. Urinary fistulae
Stress urinary incontinence– conservative treatment
• Reserved for those cases which are unsuitable or unfit for surgery.
• In younger woman who has not completed her family, further pregnancy may result in a recurrence of
• In patients with mild SUI.
- Pelvic floor exercises/ Kegals exercise
- Use of vaginal cones
- Devices - vagina, Urethra, Electronic
Very effective if regularly carried out. Seven times more likely to cure SUI than those with no treatment. Perform for 3-4 months before determining its success. Three sets of 8-12 slow maximal contractions sustained for 6-8 seconds and repeated 3-4 times per week.
Vaginal cones are useful adjuncts to pelvic floor exercises.
Placed in the vagina. Objective recording of pelvic muscle floor strength can be carried out. Used to aid pelvic floor exercises by enabling the woman to gauge the strength of the contraction generated.
1. Vaginal devices to support the bladder neck.
2. Urethral plug (either at the external meatus or in the urethra).
3. Electronic devices: Stimulation of the pudendal nerve with electrodes placed in the vagina or
Anus, causes pelvic floor contraction and help to teach women which muscle to contract
Urge incontinence – conservative treatment
- Fluid management
- Behavioural therapy - bladder training- biofeedback
- Maximal electrical stimulation
For mild or intermittent symptoms. Amount (reduce intake= 1.5 to 2 lites). Type (avoid caffeine, alcohol).
a) Goals- correct voiding patterns, improve the ability to suppress urge, increase bladder capacity and
continenceb) Includes: pelvic muscle training, scheduled voiding intervals with stepped increases, suppression of urge
with distraction or relaxation techniques
Involves the use of electronic equipment to monitor a normally unconscious physiological process, and to convey this information to the individual so that a change in a particular direction may be brought about. The information is fed back as an audible, tactile, or visual signal.
Most popular method of treatment. Antimuscarinic, calcium channel blocker, tricyclic antidepressants or antidiuretic drugs. Refer to chapter on drugs for details.
Intravaginal or transanal electrode.
Voiding difficulties and overflow incontinence – conservative treatment
2 main causes of voiding difficulties and overflow incontinence;
- Detrusor hypotonia
- Outflow obstruction
Mild cases – no treatment required. Associated with drug therapy eg anticholinergic side effects – withdraw the treatment whenever possible. Double voiding (void a second time after a few minutes of first void).
Change in voiding position (more upright position) in patients where voiding difficulties follow operations for incontinence. Long term prophylactic antibiotics to prevent recurrent UTI.
Detrusor hypotonia – acute
In the presence of acute urinary retention, the bladder will require initial rest – achieved by use of a catheter on free drainage for a few weeks. Teach the women clean intermittent self catheterization (CISC) after each void, measuring the residual on each occasion. Stop once residual < 100 ml.
Detrusor hypotonia – chronic
If main symptom is nocturia – advise to reduce fluid intake in the evening combined with CISC before going to bed. For long standing problem – the only treatment is long term CISC (preferable to indwelling catheter as the incidence of UTI is lower and the lifestyle more normal)
Mainly surgical treatment. Refer to chapter on surgical treatment of urinary incontinence.
Urinary fistula – conservative treatment
Vesico-vaginal fistula; Management depends on the underlying cause and duration of the abnormality.
Urinary fistula secondary to surgical trauma:
If recognized, may be repaired within 24hrs. Most fistulae present between 4 and 21 days when avascular necrosis occurs. Need continuous urethral catheterization since the defect may close spontaneously over a period of 6 weeks with appropriate antibiotic cover.
Urinary fistula secondary to obstetric trauma:
Rarely seen nowadays. Tissue loss following an obstetric slough injury needs bladder drainage and antibiotic treatment. It is essential that tissue loss has ceased and infection is controlled prior to surgery (may delay up to 3 months)
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