This week (17-23 June 2020) is World Continence Week. The NHS estimates that up to 6 million people in the UK live with urinary incontinence (UI), with 32% of women in this country experiencing symptoms of UI in the past 30 days. That can have a devastating impact on our social lives, sexual relationships, body confidence and everyday life satisfaction.
With that in mind, we teamed up with Bladder & Bowel UK, ERIC and The Urology Foundation to host an online clinic looking at bladder issues.
Our expert panel included consultant urological surgeons Professor Christopher Chappel, Chris Harding, Sachin Made and Rajesh Nair. Below are some of the best questions and answers from the clinic:
I’ve had a hysterectomy and am now struggling with incontinence. What advice do you have?
Mr Malde: I think advice from a continence specialist would be helpful (ask your GP for a referral). Simple things such as reducing caffeine intake may help in the meantime, as well as pelvic floor exercises.
My husband has an overactive bladder following a stroke. He had unsuccessful botox treatment three years ago – should he try it again?
Mr Harding: In a word ‘yes’. Botox is an excellent treatment for overactive bladder symptoms secondary to neurological disease like a stroke. It may be that the original dose could be increased.
What can I do about my overactive bladder? I get up every 3/4 hours during the night.
Mr Harding: The first thing to do is a bladder diary to see how much urine you are producing overnight – this will help rule out a condition called nocturnal polyuria (excessive production of urine overnight). The treatment for this is different to the treatment for overactive bladder. It is essential to make the correct diagnosis first before a treatment plan can be formulated.
I live with symptoms of cystitis but I can’t take ibuprofen – what alternatives do you suggest?
Mr Harding: There are a range of treatments available for your condition. Perhaps you need an appointment with a urologist with an interest in this condition to allow you to decide which treatment you might like to try.
During the day, I urinate every four hours but at night, that doubles. Is this caused by sleeping in a supine position or do I have an overactive bladder?
Professor Chapple: The use of a bladder diary is appropriate. Examples can be accessed online, searching for a ‘bladder frequency volume chart’. A production of urine at night over the age of 50 of more than 1/3 of the 24-hour production constitutes nocturnal diuresis. The actual threshold value is age-dependent and below the age of 20 this maybe 15-20%. There can be multiple reasons why this occurs. If night-time frequency is a problem not resolved by fluid restriction for 3-4 hours beforehand, then review by your doctor would be appropriate, with onward specialist referral as necessary.
Mr Harding: This sounds very much like nocturnal polyuria (a condition where 33% or more of your daily urine output occurs during nighttime hours). If you keep a bladder diary for a few days prior to your next review appointment (marking the times when you go to bed and wake) then your urologist may be able to help with this. Some patients find restricting fluid intake from early evening helps but for others additional treatment is required.
I wet the bed frequently and currently use adult nappies, but they’re very expensive. Is there a cheaper alternative?
Mr Harding: It sounds like you should see a continence advisor who can make an initial assessment, advise on lifestyle measures and if appropriate, organise containment products for you. I have had some success with sacral nerve stimulation for isolated nocturnal enuresis (bedwetting).
My husband has severe bladder weakness due to an enlarged prostate. Can he ask for a prostectomy if he is cancer-free?
Professor Chappel: Bladder weakness can occur spontaneously in the population. It often is exacerbated by enlargement of the prostate and in many cases the exact cause is unknown. Specialist review of the situation is appropriate.
How can I tighten my pelvic floor muscles to improve my labour-induced urine control issues?
Mr Malde: Pelvic floor muscle training with a physiotherapist may make a big difference for you initially instead of medications. I would recommend asking for a referral to your local Continence care services to discuss this further.
I have such an extremely sensitive bladder – everything I eat or drink seems to make it sore. What can I do to make it less sensitive?
Mr Harding: Have you tried to make the urine more alkaline? Commercially available sachets are available from most pharmacies. Other options include taking a medication like Cimetidine which acts on the histamine receptor system – but this will need to be prescribed. If you have tried simple measures, then seek a referral to a urologist.
The antibiotics prescribed for me to help with infections cause diarrhoea. What can I take instead?
Mr Harding: There are a number of non-antibiotic alternatives with varying levels of efficacy and supporting evidence. Examples include methenamine Hippurate, D-mannose, cranberry supplements and vaginal oestrogen. Ask your GP for more details.
You can read more about BBUK, ERIC and The Urology Foundation bladder issues clinic herel sleep and mental health clinic here. Thank you to our experts who so kindly gave their time to answer questions.