Bladder Problems

Bladder problems, such as incontinence, are thought to affect up to 65% of women at some point in their lives. 

Symptoms include:

• Increased urgency to pass urine
• Increased frequency in passing urine
• Passing urine in the night
• Recurrent urinary tract infections 

 Incontinence is very common and affects many people.  Women are more commonly affected than men and the two main reasons for experiencing problems within the bladder are:

• ​Childbirth; especially in women who have multiple pregnancies, larger babies or a difficult labour
• A drop in hormones due to a medical condition or advancing age which results in a weakening of the ligaments within the pelvic floor

There are two main types of incontinence and you may suffer from either one of these or a combination of the two. 

These are:

• Stress incontinence – This is when you suffer a sudden loss of urine after sneezing, coughing or laughing for example
• Urge incontinence – This is when urine leaks with either little or no warning and you may also need to empty your bladder more often 

Urine is produced in the kidneys and passes through tubes called the ureters, into the bladder.  As the bladder fills, it expands and the muscles around it, called the detrusor muscles, stay relaxed.  The urethra is a tube that runs from the neck of the bladder to the outside of your body and it has a valve, called a urinary sphincter that keeps the opening at the bottom of the bladder tightly closed.  The thick, spongy walls of the urethra help to form a watertight seal when compressed by the sphincter. When you need to empty your bladder the detrusor muscles contract to help force the urine out of your body and the sphincter opens to allow the urine to pass through.

The sphincter, bladder, bladder neck and urethra must be in the correct position in order to work properly. They are held in the correct position by the pelvic muscles and other support structures.  If the pelvic floor muscles are not strong enough to support a full bladder it will allow the sphincter to open and for urine to leak out.  Therefore, with the added pressure of coughing, sneezing or lifting for example, leakage may occur. 

 If physiotherapy is not an option, then surgery may be required. Previously, colposuspension was the most commonly performed procedure in the treatment of stress incontinence.  However, in recent years the urethral tape suspension procedure has become increasingly popular and is usually the preferred choice of treatment. A urethral support sling is a narrow strip of material placed in your body to create support for your bladder neck and urethra. The sling acts as a hammock that cradles the bladder neck and urethra so that your bladder is well supported and your urethra has a solid point to rest and press against, thus allowing the sphincter to close more effectively. This procedure is performed under general anaesthetic.