(how much urine it holds) is reduced and your
bladder feels full at lower volumes than normal
(e.g. 250ml instead of 400 to 500ml).
Bladder retraining teaches your bladder to
gradually hold on to larger volumes of urine,
so that you don’t need to void so often. It
goes hand-in-hand with urge deferral, that is,
techniques to calm the urgent feeling before you
go to the loo. Voiding and defecatory dynamics
optimise your bladder and bowel emptying.
Together with pelvic floor muscle training, these
interventions improve incontinence in up to 50
percent of women.
Several medications are available for treatment
of an overactive bladder.
They aim to reduce the frequency and strength
of bladder spasms, reducing the urgency and
frequency. Some medications aren’t funded on
the Pharmaceutical Benefits Scheme (PBS) so
may come at a higher cost to you.
All medications have side-effects or may interact
with your other medications – hence they are
considered second line options if your symptoms
remain bothersome after lifestyle modification
and physiotherapy.
Third line options include injections of Botox
into the bladder wall – done via a small telescope
inserted through the urethra. It temporarily
paralyses parts of the bladder muscle, calming
the spasms. There is a small risk of needing
to empty your bladder with catheters if the
injections work too well. Sacral neuromodulators
are leads implanted in the back, stimulating
bladder and bowel nerves through a battery
pack. It works well for incontinence of both
bladder and bowels but involves an anaesthetic
to place the implant and the battery pack needs
replacement every 8 to 10 years. These options
are only considered where the leakage is very
severe and disabling.
For stress incontinence, a continence pessary
(vaginal support device) may help to control
the leakage. It offers the freedom of self-management,
but it is important to have the right
size fitted initially.
The next step in management involves surgery.
There are various options available, depending
on your age, findings at urodynamic studies (a
special bladder test) and personal preferences.
For years, the mid-urethral sling (a small mesh
support sling) has been the surgical treatment
of choice. With the recent Senate Enquiry into
mesh complications, more emphasis is placed
on how we council women on this procedure,
as well as the alternative options including
a colposuspension and a pubo-vaginal sling.
Discussing the merits of these operations is
beyond the scope of this article, but the message
is clear – women do not need to suffer unduly
from this condition with the number of highly
successful surgical options available.
I encourage you to see a doctor if you recognise
your own symptoms in any of these descriptions.
pindaramagazine.com.au Pindara Magazine 43