Urinary Incontinence & Bladder Problems

Firstly, the most important thing to note is that everyone with a bladder problem can be helped and many can be cured.

Urinary incontinence is the  release of urine unwillingly. It can affect both men and women and there are a number of reasons for this and there are also a number of ways it can be treated or managed.

The Continence and Urodynamics Unit at the Bristol Urological Institute (BUI), is a centre of excellence with a national and international reputation in the assessment and treatment of  urinary incontinence. The unit offers secondary and tertiary regional, national and international services for urinary incontinence. Urinary incontinence comes under the umbrella of female urology, neurourology and urodynamics, often termed functional urology.

Clinicians, specialists nurses, continence advisors and physiotherapists come together to run a dedicated incontinence clinic at the BUI.

The service is led by a team of three clinical experts, Prof Paul Abrams, Prof Marcus Drake and Mr Hashim Hashim, who have gained an international reputation for their dedication into developing new diagnostic tools, treatments and devices to help those suffering from what was seen as, until recently, a taboo and unmanageable disease.

Types of Urinary Incontinence

Stress incontinence
This type of incontinence actually does not have anything to do with emotional stress but is related to pressure to the bladder such as being overweight, pregnancy, sneezing, lifting heavy objects, exercise and some medical conditions. Leakage is due to a weakness of the pelvic floor that supports the bladder and the urethra. It is often termed ‘ effort’ incontinence.

Treatments for stress incontinence in women
Non-surgical treatments include:

  • Restricting fluid intake
  • Stopping smoking
  • Reducing weight
  • Pelvic floor exercises
  • Medications such as Duloxetine

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment.aspx

For 1 in every 3 women with symptoms of stress incontinence these non-operative treatments can make symptoms much better or cure them completely.

Surgical Treatments for Stress Incontinence at BUI
Surgical treatments include:

  • Injection/Bulking agent treatment
  • Sling procedures (Natural and Synthetic)
  • Colposuspension
  • Artificial Urinary Sphincter

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx

Operations for stress incontinence depend on supporting the urethra. There are several  operations to cure this type of leakage, and the BUI is one of the few centres in the United Kingdom that can offer all these treatments. According to the National Institute of Clinical and Health Excellence (NICE), women with stress incontinence should be offered all forms of treatment and not restricted to one type. NICE also recommend that women are discussed in a multidisciplinary team meeting. The surgeons at the BUI are also experts in dealing with tape complications and are the regional centre for such treatments.

Stress Incontinence in Men
The most common reason for men having stress incontinence is due to treatment for prostate cancer. Surgery and radiotherapy can weaken pelvic floor muscles and the urethral sphincter (a ring of muscle that keeps the urethra closed)

Non-surgical treatments include:

  • Pelvic floor muscle training (PGMT)
  • Bladder retraining
  • Medicines

Surgical treatments include:

  • Artificial sphincter
  • Male Sling
  • Urethral bulking
  • Penile clamp

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx

Urgency incontinence and overactive bladder (OAB) syndrome
This type of incontinence is characterized by a strong urge to urinate with no ability to stop it and often leads to leaking before reaching the toilet in time. It can affect about 12% pf the population with no known cause or it can be caused by as a result of an injury to nerves or muscles which help control urinary flow but it can also be caused by some medical conditions.

The doctor/nurse will ask you questions about the problem and your general health. He/she may do a physical external examination, perform an internal examination and a urine test will be done to check for infection. You will be asked to complete a 3-day frequency/volume chart to record the time of voiding and volumes of urine passed. A flow test may also be performed. This is a test which involves passing urine into a special machine to measure the strength of flow and to check whether the bladder has emptied completely.

If the symptoms fail to respond to conservative and medical treatment a more invasive investigative test may be performed called urodynamics. This is a special test to measure pressures inside the bladder.


  • Change of drinking habits
  • Bladder training
  • Medication
  • Surgery

Surgery for Overactive Bladder
The surgeons at the BUI are the only centre in the South West of England that can offer all forms of treatment for refractory overactive bladder syndrome including Botox injection in the bladder, Sacral nerve stimulation, and major surgery.

Pelvic Organ Prolapse
Mr Hashim is one of a few urologists in the United Kingdom who is fellowship trained in pelvic organ prolapse repair in women and also works closely with urogynaecologists and colorectal surgeons at Southmead Hospital to offer a first-class service for women with prolapse.

Pelvic organ prolapse is the bulging of one or more of the pelvic organs (uterus, vagina and bowel) into the vagina. Pelvic organ prolapse can affect the front, top or back of the vagina.

Symptoms are:

  • the sensation (feeling) of something coming down or protruding of the vagina
  • discomfort during sex
  • problems passing urine 

Some women with a pelvic organ prolapse don't have any symptoms and it’s only discovered during an internal examination such as a cervical screen.

Pelvic organ prolapse isn't life-threatening, but it can affect your quality of life.

The main types of prolapse are:

  • anterior prolapse (cystocele) – where the bladder bulges into the front wall of the vagina
  • prolapse of the uterus and cervix or top of the vagina – which can be the result of previous treatment to remove the womb
  • posterior wall prolapse (rectocoele or enterocoele) – when the bowel bulges forward into the back wall of the vagina

It's possible to have more than one of these types of prolapse at the same time.

Genito-urinary Fistula
A fistula is an abnormal communication between the bladder and the vagina or the urethra and the vagina. This causes women to leak continuously. The BUI surgeons are trained in vaginal and abdominal vesico-vaginal and urethro-vaginal fistula repairs and offer a regional and tertiary service for such repairs.