Bladder control problems have a significant effect on the quality of life of sufferers on a physical, emotional and social level. Continence is a necessity for comfortable social adjustment and conversely, urinary incontinence frequently causes profound psychological and social consequences and restricts social activities (Wyman et al., 1990). The condition of urinary incontinence is defined by the International Continence Society (I.C.S.) as the complaint of any involuntary leakage of urine.

Many women suffering from stress urinary incontinence (S.U.I.) after pregnancy and delivery refrain from seeking medical advice for various reasons, one of which is the fact that they believe that their situation is an inevitable part of normal ageing and consequently they believe nothing can be done about it. Incontinence has been associated with impaired quality of life, social isolation and depressive symptoms.

Less than half of the affected women with bothersome S.U.I. symptoms, that is, leakage on walking, coughing or sneezing, seek professional help consulting a physician regarding these symptoms. Incontinence is a challenging problem, psychologically, physically and socially which can have a considerable impact on a women's quality of life. It should not be accepted as a natural and inevitable part of ageing.

Unfortunately, the impact of urinary incontinence on a women's quality of life has not always been acknowledged. S.U.I. often has a profoundly negative impact on the well being of women's self-perception, self-confidence and their social and sexual relationships.

Once identified and properly investigated, most patients with incontinence can be successfully treated. Assessment of urinary incontinence includes full gynaecological, medical, surgical and drug history. It is acknowledged by the I.C.S. that urodynamic studies are the most reliable and objective way of diagnosing the type of incontinence and the underlying condition.

Non-specialist investigations include urine testing, completion of a bladder symptom score, pad testing, measurement of residual urine volume. Specialist investigations include urodynamic studies (conventional and ambulatory), ultrasonography and video-urodynamics Conventional U.D.S. include the procedures of uroflowmetry, urethral pressure profilometry and cystometry.

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Urodynamic Studies

Urodynamic studies (U.D.S.), involving catheterisation of the lower urinary tract, are required in investigations of patients with urinary incontinence or lower urinary tract symptoms. Urodynamics are focused on the lower urinary tract to investigate bladder filling and voiding function, to define bladder storage disorders accurately and to assess objectively the severity of voiding dysfunction. Urodynamics are described as a set of tests that measure bladder, urethral and pelvic floor muscle function.

Suggested guidelines for patients who should be referred for urodynamic studies:

  • Patients with significant mixed urge and stress incontinence.
  • Patients with recurrent incontinence, i.e. incontinence following previous failed surgery.
  • Patients with incontinence and evidence of neurological disease.
  • Any patient on whom a surgical procedure for incontinence is contemplated.

Prior to referral, patients with frequency, nocturia, urgency or urge incontinence should be treated with an anticholinergic first and only referred for urodynamics if this does not succeed. Currently, there is a wide range of anticholinergic drug therapy available for symptoms of urge urinary incontinence.

Patients who have a urinary tract infections are not suitable for urodynamic studies. The performance of urodynamics may exacerbate their symptoms. Therefore the infection should be treated with antibiotics and an MSU sent to confirm the pateint is infection free prior to urodynamics.

Urodynamic studies are performed by an healthcare professional who performs an assessment to tailor the investigation to the needs of the patient, to plan and initiate care and treatment modalities within agreed interdisciplinary protocols to achieve patient centred outcomes. Clinical assessment includes neurological testing, abdominal palpation and rectal and vaginal examination.

With these findings established, the most appropriate urodynamic investigation can be selected.In addition, flow study clinics are held to diagnose patients with voiding problems, including post-operative patients and patients with neurological symptoms. Intermittent self-catheterisation procedure is taught to patients who have voiding difficulties.