Incontinence...Stress or Urge

A problem not many women want to complain about and keep to themselves. It often comes out only on routine questioning of a patient or if there is an associated problem such as prolapse. Unfortunately it is a very common problem especially in older women who have had many or difficult vaginal deliveries. With age the collagen tissues that support the bladder neck become weak and cannot hold the urine when she coughs, sneezes or does physical activity such as jogging. This is pure stress incontinence. I recently had a patient who had stress incontinence but was too embarrassed to bring up this problem even though it had affected her lifestyle so that she had to give up her favourite excercise of jogging. Each time she went out she had to wear pads and was always aware that there was a smell of urine about her.
Urge incontinence presents differently. The patient will feel the urge to constantly go to toilet but very often will not be able to get there in time and will leak urine. After voiding she may feel the urge to go again. This is not due to a weakened bladder neck but an overly sensitive bladder.
Both urge and stress incontinence may co-exist to complicate matters as in my recent patient.
It was my job to firstly determine which of the two was the predominant symptom that was causing her more distress and then to deal with the problem.
In my patients case it was the stress incontinence that needed attention. She was counselled about the various methods of treating stress incontinence and eventually opted for a sling operation. To date she has been free of her stress incontinence and has happily resumed her favourite excercise of jogging!