I am Julian Shah,
I'm a consultant urologist and head of female and reconstructive urology
at University College Hospital in London.
Patients who develop incontinence of urine,
their symptoms tend to fall into two different groups.
The first group is the patients with stress incontinence.
In other words, when I cough, I sneeze, I run, jump, laugh,
I make leak a few drops of urine, or even more than that.
On the other side there are patients who have the urge bladder condition.
I go more frequently to pass urine, I may get up at night to pass urine,
or when I want to go I've got to go and if I don't go I may leak.
If we concentrate on the female with incontinence,
it's a very common condition affecting about ten per cent of the population.
One of the principal causes is childbirth.
Having a baby tends to stretch the pelvic floor,
perhaps damage the nerve supply to the pelvic floor,
so it makes the pelvic floor
and the sphincter mechanism that controls the urine weak
and therefore the patient will leak when she coughs and sneezes, etcetera,
as I've described before.
The other condition, urge incontinence, is quite different
and has different causes, age-related.
Some people may be born with a condition
in which the bladder is a bit irritable and can get worse throughout life.
There are neurological conditions such as spinal cord injury,
multiple sclerosis, spina bifida
that can give rise to abnormalities of the bladder,
which give rise to incontinence.
Men tend not to suffer with incontinence as much as women
because they don't have babies.
Usually if a male becomes incontinent
he can become incontinent because his bladder's irritable,
unstable or the overactive bladder,
and that can be an age-related condition.
It also occurs in men who have prostatic obstruction,
so as their prostates enlarge and the bladder becomes obstructed
the bladder can become irritable too,
so not only do they not pee very well,
they also can become urgent and urge-incontinent.
We would normally investigate patients very simply first of all
by doing a urine test,
so we'd dipstick the urine to make sure there's no infection.
We would want them to fill in a chart,
how much they drink when they drink it, how much they pee when they pee it,
because large fluid intake, a common thing these days,
can make people go more frequently.
A patient presenting with incontinence, having talked to the consultants
and the consultants said, "This is the way we should manage your problem,"
we always try to start with conservative measures.
Conservative measures for stress incontinence
would be pelvic floor re-education,
strengthening the sphincter and the pelvic floor
to hold the urine in.
If a patient's got a problem with urgency and frequency,
we try bladder retraining and that's done with a continence advisor.
We may also provide pills at the same time,
so for a patient with a bladder that's urgent and frequent,
or with urge incontinence,
we would start with anticholinergic medication or antimuscarinic medication.
There are a number of drugs on the market that we can use
to try to calm down the bladder spasms that cause incontinence.
If the patient comes back and has had a trial of medication that doesn't work
or has tried pelvic floor exercises that don't work
and the patient is sufficiently distressed and incontinent
to warrant some form of treatment,
then we would offer surgery.
If a patient's with a significant weakness of the pelvic floor or prolapse
we can do an operation called a colposuspension,
which has been around for about 40 years
and is a very good operation to cure incontinence.
If the patient's very bothered by their incontinence,
their unstable bladder urgency incontinence is so troublesome
that they can't cope with it,
we've been lucky in the last few years to have Botox,
which people will associate with wrinkles in the face,
but is very effective when injected into the bladder wall.
It stops the bladder spasms
and it works for about six, nine months, sometimes twelve months,
and will help to cut down those spasms that cause incontinence
and is very, very effective.
There is a small risk with Botox, because you weaken the bladder,
of pushing the patient into retention, in other words they can't pee very well.
Our incidence of that is about ten per cent
and we teach all our patients beforehand to learn how to drain the bladder
so at least if that occurs they know what to do.
For the patient with the very unstable bladder that responds to nothing else,
then we can do more major surgery
in which we enlarge the bladder with a section of the intestine,
which is also a very effective operation and cures about 90 per cent of patients.
Anybody with incontinence tends to find it very embarrassing.
It's a socially restricting condition and yet it's not a disease.
It's not life-threatening, you won't die from it
unless it's due to a neurological condition such as spinal cord injury
where there is a threat to your life,
and most of these patients are managed in spinal injury centres.
If you have a problem with incontinence,
the thing to do is seek medical advice.
The thing to remember is that everybody lives a long time these days
and this condition can go on for a very long time.
The most important thing is to make a diagnosis
and try to offer appropriate treatment
so you don't suffer in the long term with great distress.