| Introduction | The healthy bladder | What can go wrong | Stress | Urge | Mixed |
| Overflow | Night time | Prostate | Pelvic floor | Bowel |
What can go wrong with the Urinary system
Many Types of Possible Problem
With so complex a system, problems can arise in many ways. The symptoms can be confusing: even doctors and nurses can sometimes be puzzled and need to do special tests to sort out a diagnosis. But here is a simplified explanation of the main types of incontinence.
Female
Male
Diagrams reproduced with permission from "Bladder Disorders" in the "Patient Pictures" series, published by Health Press Ltd, Oxford
If the sphincter muscles or the pelvic floor muscles (see diagrams) become weak and the pressure of urine in the bladder gets too great for them to hold it in, you may leak urine - this will happen especially when you cough or laugh or strain, because these actions cause a sudden increase of pressure inside your abdomen. This is called stress incontinence
If the bladder wall muscles, instead of relaxing as the bladder fills, start contracting prematurely, you will feel an urgent need to pass water and sometimes may fail to get to a lavatory in time - suffering urge incontinence as a result.
You may have both these problems at once - mixed incontinence.
You may develop an obstruction that makes it difficult to pass water. This is common in middle-aged men, when the prostate gland often swells and obstructs the urethra, but it can happen in women and at any age. Obstruction may lead to incomplete emptying of the bladder but as the bladder refills and pressure overcomes the obstruction you can get repeated small leakages. Misleadingly, this is usually known as overflow incontinence.
With the whole system depending on a complex system of monitoring by the brain, any accidental damage to the nerves involved or any degenerative disease affecting the brain or nervous system (such as multiple sclerosis or the like) can produce problems. The term used for this is neurogenic incontinence.
And sometimes people have problems at night: needing to get up to go to the lavatory several times a night - nocturia- or wetting the bed - nocturnal enuresis.
Your symptoms may point clearly to one of these types of incontinence, and you can then read more about that condition by clicking on it.
But we would always advise you to seek advice from your GP or practice nurse - or from the local Continence Service which will be staffed by specialist nurses (and sometimes a specialist physiotherapist) who spend all their time helping people with bladder and bowel control problems.
When you see one of these people, they will assess your condition a lot more thoroughly than you can by reading this website. They will probably want a urine sample to test and will probably want to examine you. Mainly, though, they will want to ask you a lot of questions
When they have decided what your problem is, your doctor or nurse will start you on some treatment. Remember, the great majority of people with your condition can be cured or substantially helped.
Just occasionally, if the answers you give do not add up or if your initial treatment seems after some weeks not to be working, you may be asked to have some tests, called urodynamics. This will usually involve an outpatient appointment at a special clinic, usually at the local hospital.
Questions you may be asked
When your problem is assessed, you will probably be asked all or most of these questions. You may like to think about the answers beforehand.
- Do you get wet when you cough or exercise?
- How often do you pass water each day?
- How many times are you woken up at night by the need to pass water?
- Do you have to rush to the toilet?
- Do you always make it to the toilet in time?
- Do you have to wait for the stream to start?
- Does your urine come out reasonably fast?
- Do you feel as if you empty your bladder?
- Do you have to strain or push?
- Do you ever get wet unexpectedly when you think you have finished passing water?
- Does it ever hurt or burn when you pass water?
- Does your urine smell unpleasant?
- Have you started to pass water very frequently?
- Do you ever see blood or "smokiness" in your urine?
- When did you start "leaking"?
- How often are you getting wet?
- How much leaks out - a few drops, enough to wet your clothes, a whole bladder full?
- How do you cope with this leakage?
- How often do you open your bowels? Is the motion hard? Do you ever have to strain?
- Do you ever get leakage from your back passage?
- How many cups of liquid do you drink in a day? What type of drinks?
- What medicines are you taking - including any you bought yourself?
- Where is your toilet? Do you have any difficulties getting to it?
- Do you have any difficulties adjusting your clothes?
Urodynamics
The proper operation of the urinary system depends on a complex system which most of the time works without us being aware. When anything goes wrong, doctors or nurses cannot always decide what the origin of the problems is simply from what we can tell them from our conscious experience.
This is where urodynamics can help. The word refers to a range of procedures that are used to test how your bladder fills and empties itself, so that nurses or doctors can diagnose what exactly is going wrong or can confirm a provisional diagnosis, especially in complex cases where there may be an interaction of different problems. Urodynamics can also help prior to surgery and some other types of treatment.
Tests are normally conducted at a hospital and the machines and techniques differ from place to place. If you have any questions about the particular procedure they use, you should not hesitate to ask the staff at your hospital. There is a small risk of infection from the test which your doctor should discuss with you. Such infections are easy to treat and your doctor will give you advice if you feel concerned.
Basic Urodynamics
Although the techniques of urodynamics differ from hospital to hospital, most procedures follow a similar process. The basic aim is to measure the way the bladder fills and empties - in particular the changes of pressure inside the bladder and in the tummy (abdomen) generally as the bladder fills and empties.
You will probably be asked to arrive at the hospital with a full bladder. On arrival, the staff will take you to a room and ask you to pass urine into a special toilet. This toilet is fitted with equipment to measure your flow of urine.
Following an explanation of the procedure, the staff will prepare the main part of the test. First, two very fine plastic tubes (catheters) are passed into the outlet tube of your bladder (the urethra). Some hospitals use a local anaesthetic gel when inserting these catheters but this is not always necessary.
One of the tubes is attached to a supply of sterile fluid so that it can be used to fill the bladder artificially. The other is attached to a machine which records the pressure in the bladder. Next another fine tube is placed in the back passage (rectum). This tube also is attached to the machine to record the pressure inside your abdomen.
Once the tubes are in place, the doctor or nurse will start filling your bladder. He/she will usually ask you to say when you first feel the desire to pass water and describe how you feel as your bladder fills. You may be asked to do a few simple things, such as cough or perhaps stand up and jump. This is used to test how the bladder behaves when put under stress from increases in pressure.
Depending upon why the test is being performed you may be asked to pass water again into the special toilet.
The doctor may also perform another test on how your outlet tube (urethra) closes by asking you to squeeze the muscles under your pelvis as one of the small catheter tubes is being withdrawn.
Specialist Tests
A number of hospitals have very specialised equipment which allows the doctor to examine your bladder while performing these tests. This uses ultrasound or x-rays to produce video pictures. If an x-ray technique is used, the tests will be performed on a special x-ray table which is capable of being tilted into an upright position. (Do not worry about falling off while the table is moving: it is very safe!)
A relatively new development (ambulatory urodynamics) is miniature equipment which can be worn unobtrusively while you go about your normal activities. This is used to monitor your bladder under less artificial conditions. The equipment records its results and the doctor or nurse can read them back when you return after (typically) a few hours.
What problems can Urodynamics diagnose?
There is a large number of bladder problems which can be diagnosed using urodynamic tests. The most common of these are:-
Overactive Bladder
where the bladder muscles contract irregularly during filling. This creates a strong desire to pass urine (known as urgency) which it is difficult to suppress and may require very frequent visits to the toilet or even leakage (known as urge incontinence).
Neurogenic Bladder
sometimes called an Atonic Bladder. This is a bladder which is not able to produce a good enough contraction to empty properly. It can give rise to a type of leakage known as overflow incontinence.
Obstructions to the flow
These can be caused by a number of problems including a narrowing of the outlet tube from the bladder (a stricture) or (in men) enlargement of the prostate gland. They can give rise to the type of leakage known as overflow incontinence.
Incompetence of the sphincter
If the pelvic floor or sphincter (the ring of muscle which keeps the outlet tube from the bladder shut) is weak, leakage (called stress incontinence) can occur when you do anything - for example, cough, laugh or take exercise - that raises the pressure in your abdomen and hence in the bladder.
What happens after the test?
Your consultant will normally discuss the findings with you either immediately after the test or at a later appointment. Advice and treatment may then be offered depending upon the type of bladder problem diagnosed.