Ask an expert about…..incontinence 

This one hour web chat took place at:
10.30am - 11.30am on Wednesday 3 September 2014 

It’s estimated that between three and six million people in the UK have some form of incontinence (unintentional passing of urine).  If this affects you or someone you know, we had an expert here for our web chat who answered any questions you may have had.  Miss Daniela Andrich is a consultant reconstructive urological surgeon at University College Hospital and was here to advise on what was causing your incontinence, day-to-day management and possible treatment options.

Read a transcript below.


UCLH: 
Good morning and welcome to our web chat. We will begin at 10.30am but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 10.30am.

Miss Daniela Andrich will be joining us to take your questions on ‘incontinence’ and will try to answer as many questions as possible within the hour long web chat.
 
10:30 Miss Daniela Andrich: 
Welcome to our web chat on the subject of incontinence. My name is Miss Daniela Andrich - Consultant Reconstructive Urological Surgeon at University College Hospital and I am ready and waiting to take your questions.
 
10:30 [Comment From AngieAngie: ] 
I have stress incontinence and an overactive bladder. The stress incontinence has been treated successfully with the insertion of a tape and I take darifenacin (Emselex) for the overactive bladder. This alleviates most of the problem. However I still have some incontinence when I have been lying down and then get up particularly at night. Why does this happen and is there anything I can do to avoid/alleviate this?
 
10:31 Miss Daniela Andrich: 
Hi Angie

Thank for your question. Sounds that you may have a problem filling your bladder too much whilst asleep. You could try cutting down on fluid intake in the evening. May also be useful if your doctor could check with a simple bladder scan that you empty your bladder properly. Sometimes it’s just simply too much caffeine or alcohol which can make your bladder overactivity worse. If you are really often have a problem, you could try taking two Darifenacin tablets if you tolerate them well. Please discuss that with your GP.
 
10:39 [Comment From SallySally: ] 
Why does my husband get up so many times in the night to urinate? He is a fit, healthy 50 year old...
 
10:39 Miss Daniela Andrich: 
Hi Sally

Thanks for your question. I assume that this not an acute onset. He may have problems with bladder overactivity, which can be related to an enlarged prostate. A voiding diary can be actually quite helpful to understand what’s going on. He records the volume and timing of any fluid he is drinking during the day and night and then records the timing and volume voided.
Would also be good for him to check that he is emptying the bladder properly with a simple bladder scan. Cutting out caffeine and reducing fluid intake in the evening may also help.
 
10:44 [Comment From GuestGuest: ] 
Hi, I have spinal stenosis and arachnoiditis. I swing from incontinence to retention. I use catheters but the incontinence is getting so bad. I am soaked all the time. DR did say I could look at a catheter implant. Is this recommended for this and is this the best way to handle this situation. Thank you
 
10:44 Miss Daniela Andrich: 
Hi

You have what we call a neuropathic bladder. When you are incontinent you may have an overfull bladder which overflows. Try increasing the number of catheterisations day and night.
A permanent catheter is always a possibility but it is usually possible to avoid it.
You really though need proper evaluation of your bladder by having a test we call urodynamics. This will tell you what can be done.
 
10:47 [Comment From Mrs MyersMrs Myers: ] 
Hi what are the disadvantages of having a catheter permanently in place above pubic bone. Thank you
 
10:48 Miss Daniela Andrich: 
Hi Mrs Myers

You don’t say why you may need one, but usually they are used as a last resort.
The principle problem with indwelling catheters is that they get colonised with bacteria. This can give you a bladder infection. If the bladder is drained into a urine bag permanently, the bladder capacity will shrink. Sometimes, people also get bladder spasms and pain.
 
10:50 [Comment From Trying to get fitTrying to get fit: ] 
I had a baby years and years ago. Not sure things ever went back to normal. When I go running or have a bad cold with a cough small accidents happen. What can I do???
 
10:50 Miss Daniela Andrich: 
Hi

Have you tried pelvic floor exercise? See a physio and strengthen the muscles of your pelvic floor. For mild stress incontinence after pregnancy that may be all you need to do to get better.
 
11:00 [Comment From HarrietHarriet: ] 
I have had four children and have terrible stress incontinence - leakage when I cough, sneeze etc. I've tried pelvic floor but no use, what are my options....
 
11:00 Miss Daniela Andrich: 
Hi Harriet

Thanks for your question.
In more severe stress incontinence you may need to have surgery. Try first to quantify your incontinence. Do a pad test. Very simple: Use any pads for a 24 hour assessment. When you change a pad, put it into a sealable plastic bag. At the end of 24 hours, weigh the pads in the bag on your kitchen scale and substract the dry weight of the pads used. Very helpful indications how bad things are!
Before deciding on whether or not to offer surgery, I’d like to examine a patient and arrange a urodynamic test. It’s important to understand how badly your bladder neck lost support due to weakening of the pelvic floor as the result of your pregnancies. Also would check during the examination that there is no associated prolapse.
 
11:01 [Comment From GuestGuest: ] 
I have experienced a degree of incontinence for much of my life, but it has worsened over the past few years (i am now 70). I am sweating much less than i used to, so almost all that i drink is excreted, it seems often very soon after drinking - an extra cup of tea can result in several visits to the loo within the next couple of hours. I have resorted to drinking as little as possible, particularly in the afternoon and evening in order to avoid the need to get up 5-6 times a night.
 
11:01 [Comment From RogerRoger: ] 
Sorry, i pressed return expecting to be able to start a new line, but my message has obviously been sent. I was going on to say that if i drink too much i do find that I leak, even before really needing to pee. I am fit, sculling three times a week. I do have an appointment with the urology clinic in December but was hoping to find at least a temporary solution before then. My alcohol intake is generally no more than a glass of wine with my evening meal (no other liquid)
 
11:06 Miss Daniela Andrich: 

Hi Roger and Guest

It sounds as though you have an overactive bladder. You don’t mention whether you have any difficulty passing urine with a slow stream, or sometimes having trouble getting started. The latter two symptoms may point towards an enlarged prostate problem. Sometimes in these cases you may not empty your bladder properly anymore, hence the need to go all the time. You actually really need to see a urologist. He will run a few tests to find a diagnosis of your problem.
 
11:11 [Comment From HarrietHarriet: ] 
Thanks, that's really helpful
 
11:14 [Comment From GuestGuest: ] 
Sometimes after I have urinated, I feel that there's that bit more to go... is this normal?
 
11:17 Miss Daniela Andrich: 
Hi Guest

It depends how much more. Squeezing out just a few more drops is possible for most and that is normal. Question just is whether you really have to bother doing that. I don’t think so.
 
11:17 [Comment From SimonSimon: ] 
Is waking up at 4am every morning desperte for a pee something that just comes as you get older or could there be underlying issues? I have no pain.I am 47 years old.
 
11:24 Miss Daniela Andrich: 
Hi Simon

If you are a typical busy 47 year old, your fluid intake during daylight hours may be rather poor, ..catching up with hydration in the evening? - Well, can’t blame your kidneys producing lots of urine during the night then.
It sounds just too simple, but try doing a input/output voiding diary. It’s amazing bio-feed-back!
 
11:24 [Comment From SueSue: ] 
Can IBS affect bladder control, when I have an attack it seems to affect how much I urinate.
 
11:26 Miss Daniela Andrich: 
Hi Sue

I’m afraid, that is quite common that IBS and bladder oversensitivity are going together.
 
11:26 [Comment From AngieAngie: ] 
Thanks. I was offered botox injections for the overactive bladder but was apprehensive. Have you any comments on this treatment.
 
11:30 Miss Daniela Andrich: 

Hi Angie

I would be very careful with Botox bladder injections as well, particularly in idiopathic bladder overactivity, where no apparent reason for the overactivity could be found (such as a neurological disease).
 
11:31 Miss Daniela Andrich: 
Here are some links that you may find useful:

Badder and Bowel Foundation - www.bladderandbowelfoundati...

Urology at UCLH - http://www.uclh.nhs.uk/OurS...

Urinary incontinence (NHS Choices) - http://www.nhs.uk/condition...

Bowel incontinence (NHS Choices) - http://www.nhs.uk/condition...
 
11:33 Miss Daniela Andrich: 
We haven’t covered bedwetting in children so far.
Most children are dry by the age of 5, although there are quite a number of children who don’t get dry until late adolescence. Usually it’s simply due to a deep sleep pattern. UNLESS these children have problems of urgent and frequent voiding during the day, the management is expectant, supportive and conservative such as setting an alarm clock to wake the child just before it would otherwise wet the bed. Most children will grow out of it!
 
11:33 Miss Daniela Andrich: 
Thank you for joining us today in our live web chats. We hope you found the chat useful and some of your questions have been answered.

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