Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intra-abdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence.
The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity.
Treatment is keyed to the type of incontinence. The usual approaches are as follows: Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication.
Tension-free Vaginal Tape (TVT & TVT-O) - a relatively new method with very good success rate of 94% since KKH started using it in 1998. It has become the commonest type of continence surgery.