Urinary Incontinence
Assessment and treatment of bladder leakage in Johannesburg — for women and men.
What is urinary incontinence?
Urinary incontinence means leaking urine when you don’t mean to. It is very common — especially in women after childbirth and around menopause, and in men after prostate surgery — but it is not something you simply have to live with. Most people can be helped significantly.
The first step is working out which type of leakage you have, because the treatments are completely different:
- Stress incontinence — leaking with effort or pressure on the bladder: coughing, sneezing, laughing, lifting, running or jumping. The problem is weak support of the urethra (the tube that drains the bladder) or of its sphincter muscle.
- Urgency incontinence — a sudden, strong urge to pass urine that you can’t hold off, sometimes leaking on the way to the toilet. The problem is an overactive bladder muscle that contracts when it shouldn’t.
- Mixed incontinence — a combination of both. We usually treat whichever is more bothersome first.
At your first visit I will take a careful history, examine you and test your urine. I may ask you to keep a bladder diary for a few days and check how well your bladder empties with an ultrasound scan. Some patients need more detailed bladder pressure studies (urodynamics), particularly before surgery.
Stress incontinence — treatment options
I follow international guidelines: pelvic floor training comes first. If leaking is still bothersome, there are two procedures to choose from — not steps on a ladder, but options we choose between together, based on how much you leak, your preferences and your plans (for example, future pregnancy).
- First — Pelvic floor muscle training: a structured programme, ideally supervised by a pelvic-floor physiotherapist, usually for at least three months. Together with simple measures such as weight loss and treating a chronic cough or constipation, this helps many women enough to avoid a procedure
- Option — Urethral bulking: a gel is injected into the wall of the urethra through a small telescope to help it close. A short day procedure with a quick recovery and no mesh or incisions. Success rates are lower than with a sling and it may need repeating, but many women prefer it as the less invasive choice
- Option — TOT sling (transobturator tape): a narrow strip of synthetic mesh placed under the middle of the urethra through a small vaginal incision, with two tiny cuts in the groin creases. It is the most widely studied operation for stress incontinence, with high success rates and a quick recovery
- Before any procedure, we will discuss the benefits and risks openly — for a sling these include groin pain, difficulty emptying the bladder, new urgency and mesh exposure — so that you can make an informed choice
Urgency incontinence and overactive bladder
Urgency incontinence is part of overactive bladder. Surgery for stress incontinence does not help it — and can sometimes make urgency worse — which is why getting the diagnosis right matters.
- First-line: bladder training, sensible fluid intake and cutting down on caffeine and alcohol
- Medication to calm the bladder muscle, if lifestyle measures are not enough
- When medication doesn’t work or isn’t tolerated (refractory overactive bladder), I offer two advanced treatments: bladder Botox injections, or sacral neuromodulation — a small implanted device, tested first with a trial period. Read more about sacral neuromodulation →
Incontinence in men
Men can also leak — most often after prostate surgery. Pelvic floor exercises, ideally guided by a pelvic floor physiotherapist, help most men recover over the first months. If leaking persists and is bothersome, I offer surgical treatment with a male sling or an artificial urinary sphincter, placed together with a specialist implant surgeon at our hospital. Which one suits you depends mainly on how much you leak.
To discuss bladder leakage, call 011 794 3549 or email appointment@urology.joburg. No referral is needed.
This information is general in nature and is not a substitute for a consultation.