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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20386
Experience:  Specializing in general urology and reconstructive urology.
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I have been suffering from stress incontinence last

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I have been suffering from stress incontinence for the last three years. In the early stages I used to notice a dribble on the toilet seat after wiping myself and standing up. I gradually started to suffer from mild dampness in the seat of my pants over a 24 hour period. At this stage I went to see my General Practitioner and after having a negative infection screen on my urine sample and continuing leakage, she referred me to a primary care incontinence nurse. She inserted a device and did a biofeedback test and said that my pelvic floor muscles were weak. She taught me how to do pelvic floor exercises. I was not given a device to use at home so I used to do the exercises without a device inserted. After a few months of having no improvement in symptoms, I was referred to a hospital specialist.
On referral I described my symptoms and I was told that my symptoms were not typical for someone with stress incontinence. I emphasised that I do not run to the toilet and I leak for 24 hours a day. I do not play sport. Symptoms are worse after s..... .........e. I had an internal examination and there was no evidence of a prolapsed uterus. They did a pyridium pad test to see if the leakage was urine in nature. There was a trace of colouration on the pad so I was referred for urodynamics testing. Urodynamics testing showed that there was pelvic floor weakness upon coughing, but otherwise the traces were normal.
I had an ultrasound scan on my uterus which was normal apart from the discovery of a fibroid. I was having pelvic floor training with a hospital physiotherapist. She gave me a device to use at home. When she did a biofeedback test she said that my muscles were quite good apart from when I cough. She suggested doing some bracing techniques. She said that the dampness in my pants could be discharge or general body flow. I said that I leak all the time, not just when I cough. I wanted to continue using conservative methods of leakage control. I was prescribed Contiform, but I had trouble inserting the Contiform pessary for bladder support. I was eventually discharged from the hospital outpatient clinic.
I have never been pregnant and have had about four previous episodes of a persistent cough over the past five years. The last bout of coughing was in April 2015 and lasted for five weeks. It usually lasts for three weeks without treatment, but the last time I had to be prescribed antibiotics to clear the chest infection. In the last few months, the leakage has gone slightly worse and I now have to wear a pant liner every day when I go out. When I do not wear a pant liner I can see and feel the dampness on the seat of my pants an hour after putting on a clean pair of pants. On a good day after pelvic floor exercising, a circular patch of wetness about the size of a 10 pence coin can be seen (on the RHS), but there is still background dampness in my pants. Two months ago, I had a flare-up in symptoms where I had to upgrade my level of protection from a pant liner to a sanitary pad as my pant liner was getting saturated with urine and soiling the crotch of my leggings. I went to a walk-in outpatient centre where the nurse downgraded me without examination when I said it was to do with incontinence and she sent me to my GP.
My GP examined me and said that I had no sign of prolapse and did a sample of urine. She said that she had previously prescribed me Oxybutinin and Regurin XL in 2013 and would prescribe it again if I had any more problems. My urine sample infection screen came back negative. I am now at the end of my tether as it seems that despite doing pelvic floor exercises and taking tablets and having all the specialist tests I am still having problems with leakage. I feel as though I want to go back to my GP and show her the empty tablet box so that I can be re-referred to have a repeat pyridium pad test at the hospital. I feel as though the leakage can only be urine in nature and is too wet to be classed as discharge.
Please can I be advised if there is another possible cause of this leakage apart from pelvic floor. Is there any possibility that there is something wrong with the sphincter muscle. Is the sphincter muscle near to the pelvic floor?
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Y. replied 1 year ago.
This is either due to stress incontinence that is not being detected on your urodynamics test or a combination of stress and urge incontinence. It is very likely that you have a weak sphincter muscle. The center muscle is part of the pelvic floor muscle complex. Even if you have never had children before, it is very possible to have stress urinary incontinence. If nothing else you have done has helped keep you dry, then you will need to consider a surgery to place a urethral sling in order to get you dry again. The only other option is to continue your pelvic floor physical therapy to see if this continues to improve or not. Hope this helps and let me know if you have questions.
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