I am Julian Shah,

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.