Urinary Incontinence Centre

Urinary incontinence is involuntary, uncontrolled leakage of urine that causes health, hygiene and social problems. The phenomenon is influenced by several causes. The function of the pelvic floor muscles is altered, and the pelvic floor muscles and bladder sphincter muscles are too weak or overactive. 

As we age, the body begins to lose collagen fibres and other supporting proteins that maintain elasticity and flexibility of the skin and other body tissues (vaginal and external genital area). Ageing and multiple births therefore result in a loss of collagen and elastin in the mucous membranes and a decrease in vaginal hydration (wetness). This results in discomfort in the vaginal area, reduced comfort during sexual intimacy, reduced libido and inability to hold urine, or varying degrees of incontinence. 

Younger people can experience these problems, although it is more common in women in menopause, women with multiple births, women who are less physically active and overnourished, those who have had pelvic surgery, or those who work in physically demanding jobs. 

The most common forms of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI) or overactive bladder (OAB) and mixed urinary incontinence (MUI). 

SUI is defined as involuntary leakage of urine during physical exertion, sneezing, laughing, etc. This condition is caused by the loss of pelvic floor support tissue (collagen, elastin, muscle) and urethral sphincter tone. UUI is the inability to hold urine after a previous strong, urgent need to urinate. 

Overactive bladder is manifested by a strong, urgent need to urinate, frequent urination although the amount of urine in the bladder is low, frequent night-time urination without an underlying health condition (infections, neurological causes). 

Mixed urinary incontinence is a combination of both. 

To confirm the diagnosis, a gynaecologist is needed to carry out a series of tests and diagnostic procedures to determine the type and degree of urinary incontinence. This can then be used to indicate appropriate and effective treatment. The first step is to take a detailed medical history, and questionnaires can also help.

We use the ICIQ-IU questionnaire, which, depending on the definition of the problem, makes it easier to identify SUI. The clinical gynaecological examination is used to determine the condition of the pelvic floor structures. The incontinence test (PAD test) is used to determine the type and degree of incontinence.

If a bladder infection is suspected, a laboratory examination of the urine is also performed. Vaginal gynaecological ultrasound can identify anatomical changes in the bladder. 

Patients with or suspected neurological disorders and some cases of urge urinary incontinence should also be seen by a neurologist. 

A PAD test is part of the diagnostic workup of a patient with urinary incontinence (UI) and is based on measuring the difference in weight of the protective pad before and after wearing it in the underwear for a certain period of time. An increase in the weight of the pad due to urine leakage above a certain value means a positive test. The criteria in the weight increase that give a positive test result vary according to the length of the test. In outpatient diagnostics, shorter (one-hour) tests or tests with a prescribed set of activities are most commonly used, while for home testing, a 24-hour interval wearing of a pad is recommended. A variation of the procedure to suspect stress urinary incontinence (SUI) is the so-called pad stress test, where the patient's bladder is first filled with a certain amount of fluid and a dye, and then – after physical activity – the pad is checked whether it is dry or wet. The test is positive when the pad is wet and this result is in favour of SUI. We use established test protocol (standardisation of test volume and time) to assess UI more accurately and thus choose the optimal treatment for each individual. If we add a provocation test of hand washing with cold water to this method, we can obtain information about the presence of urge urinary incontinence (UUI). Patients can still urinate blue urine after the test. 

The first step in treating urinary incontinence is a conservative approach. These are non-operative procedures. For more severe incontinence, or in cases where conservative treatment options have been exhausted but problems persist, a surgical approach is the treatment of choice. 

Conservative treatment is the first choice of treatment. The first step is to identify the cause of the problem, set goals and establish a treatment plan.

The pelvic floor is made up of both muscles and connective tissue. The connective tissue can be effectively influenced by laser therapy. 

Physiotherapy treatments include pelvic floor muscle training, bladder training, biofeedback, electrical stimulation, manual therapy, transpelvic magnetic stimulation and other procedures. Advice on lifestyle changes, behavioural therapy, complementary therapies, self-care and the use of devices to improve quality of life are important.

It is a minimally invasive method, where laser light influences the collagen fibers in the vaginal tissue and the endopelvic fascia with a thermal effect. The result is transformation, restructuring and regrowth of collagen. Using laser technology is the most up-to-date and very successful method for treatment of stress urinary incontinence and vaginal relaxation syndrome. The method is effective, simple and safe

Over the last 10 years or so, laser treatment of SUI has been increasingly used. A laser is a light source that produces a strong, narrow and monochromatic beam of coherent light. Laser machines use laser beams of different wavelengths. The laser effect can be thermal or ablative. The mode of action of lasers used in urogynaecology is based on hyperthermia (overheating) and coagulation. This leads to tissue tightening and regeneration of epidermal and subepidermal structures, and increases fluid retention and blood supply to connective tissue.

This is why we use the laser to treat mild to moderate stress urinary incontinence, partial mixed urinary incontinence, vaginal relaxation syndrome, vaginal atrophy and vaginal dryness, as well as minor cystoceles and rectoceles. It is an effective, safe and painless method. No sick leave is required after the procedure. 

The photothermal effect of the laser beam causes the collagen to remodel, redistribute and regrow. This increases the support of the urethra and its sphincter, resulting in improved urinary retention. 

When the sensation in the vaginal area changes, sex is no longer experienced with the same intensity and the vagina is too wide, it is vaginal relaxation syndrome. The most common causes are ageing, hormonal changes and stretching of the vagina during childbirth.

Currently, the only effective method is laser treatment. The laser beam, with its photothermal effect, transforms collagen, its redistribution and regrowth. This reshapes the tissue around the vagina and narrows the vaginal tube. If there is a history of vaginal relaxation syndrome together with stress urinary incontinence, both procedures can be done at the same time.

Vaginal atrophy means less blood supply, less moisture, and loss of wrinkling of the vaginal mucosa. It is usually associated with a lack of hormones in the postmenopausal period. It leads to a dry vagina, which can be disturbing in everyday life, especially during sex. 

Women can help themselves with lubricants, topical hormone therapy. Laser therapy, on the other hand, provides a long-lasting solution to problems without the use of hormones. The capillaries in the vaginal wall are re-developed, improving blood circulation. Vaginal wrinkling and wetness increase. 

The procedure takes place in a gynaecological chair, in the same position as a gynaecological examination. It takes about 20 minutes and is painless. We usually recommend three treatments, three weeks apart. 

The pelvic floor muscles (PFM) are located at the bottom of the lesser pelvic cavity. They form a supportive layer for the abdominal and pelvic organs, provide support to the rectum during defecation, strengthen the urethral closure mechanism during an increase in abdominal pressure, have an inhibitory effect on bladder activity, help to relieve and stabilise the spine and pelvic girdle.

At the first visit, the physiotherapist takes a detailed history and performs a physiotherapy examination (vaginal examination). The information obtained helps to identify the cause of the problem, set goals and develop a treatment plan.

Treatment includes pelvic floor muscle training, bladder training, manual therapy, biofeedback, diagnostic ultrasound, vaginal/anal electrical stimulation, tibial nerve stimulation, transpelvic magnetic stimulation and other supportive procedures.

The physiotherapist provides relevant information on lifestyle changes, behavioural therapy, complementary therapies, self-care and the use of devices to improve quality of life.

Vaginal electrical stimulation is a type of therapy used to influence the activity of the bladder and pelvic floor muscles. Pelvic floor muscles play an important role in bladder control. Electrical stimulation can be used to treat symptoms of overactive bladder as well as different types of incontinence caused by weak pelvic floor muscles. Electrical stimulation can improve awareness of PFM contractions in people who are unable to perform a correct PFM contraction. It helps to re-establish the neuromuscular connection. 

Using biofeedback helps patients to better understand and control the function of their pelvic floor muscles. It provides visual and/or auditory feedback on the strength of contraction or relaxation of the pelvic floor muscles, as the biofeedback can be used to monitor the progress of therapies.

FMS (transpelvic magnetic stimulation/functional magnetic stimulation/magnetic chair) is used to stimulate and rehabilitate the pelvic floor muscles. It is a non-invasive therapeutic technique used for problems related to faecal and urinary incontinence. In addition to urinary incontinence, the FMS can be used for treatment after various pelvic floor surgery, sexual problems and erectile dysfunction. It can also be used for various musculoskeletal problems in the pelvic area (pain, injuries, etc.).