Urinary leakage or urinary incontinence is the involuntary loss of urine that becomes a social or hygienic problem. About 25% women may suffer from urinary leakage at some time in their life. Incontinence is often wrongly considered to be a normal part of aging and with increasing life expectancy the burden becomes significant. It's reasonable to expect a good quality of life in later years and therefore the treatment is directed towards improving lifestyle.
- Childbirth, difficult vaginal deliveries or big babies.
- Previous prolapse surgery, whether or not the uterus has been removed.
- Increasing age and low level of oestrogens.
- Some medications or medical conditions.
- Obesity or increase body mass index.
- Chronic cough and history of stroke.
- Heavy work and lifting.
- Other conditions such infections, atrophic vaginitis, excessive fluid intake, etc.
There are different types of urinary incontinence
- Stress incontinence - Involuntary leakage of urine that occurs during an increase in abdominal pressure. It may happen with sneezing, coughing, laughing, jogging, rapid walking, jumping or lifting. It may be the result of a weakness in the urethral sphincter.
- Urge incontinence - Sometimes called an “overactive bladder.” It may be due to the bladder muscle contracting without the woman realising. There is a strong desire to void following by obvious urine loss in the absence of any straining. This type of incontinence is only revealed if the woman has some special studies - called urodynamics.
- Mixed incontinence - A combination of both urge incontinence and stress incontinence.
- Overflow incontinence - Urinary leakage associated with overdistention of the bladder. Bladder overdistention on the other hand may trigger a contraction of the bladder muscle and this causes the leakage.
Surgery is in many cases the best treatment, but not every woman with incontinence needs surgery. Bladder physiotherapy may be needed, pelvic floor exercises, obstructive devices or even medical treatment have been showed to be effective, depending on your type of incontinence.
Office UrodynamicsUrodynamics is a combination of several useful tests done at the office to obtain information about your lower urinary tract (bladder and urethra). Urodynamics “draws a picture” of what happens when your bladder fills up and when it empties by measuring volumes and pressures. It allows your Gynaecologist to obtain important information about pressures inside your bladder and urethra. This is a different type of information to the one obtained during an internal examination where only the anatomical problem is determined. Urodynamics has become an important part of pre-operative investigation for correcting incontinence.
Surgical Procedures used to Correct Incontinence
Open Burch ColposuspensionThis operation involves a big cut of 10-12 cm across the lower abdomen. Similar to a cesarean-section incision. It elevates the bladder neck back to its normal position. It is considered one of the best operations for stress incontinence with a success rate of 90%. It avoids also the use of mesh (foreign material).
Laparoscopic Burch ColposuspensionGynaecologists with special training in advanced laparoscopic surgery may perform the Burch colposuspension through “key-hole” surgery, using only 4 small 5-10 mm incisions in the abdominal wall. It results in less postoperative pain with a quicker return to normal activities. It also reduces the use of narcotics for post-operative pain relief. It provides also with an opportunity to assess the rest of your pelvis (uterus and ovaries) and avoids the use of mesh.
Sub-Urethral SlingsThrough a big incision in the abdominal wall, strong tissue is obtained from it and it is placed under the bladder neck to elevate it. The sling tissue is stitched back to the abdominal wall.
Tension Free Tape ProcedureA synthetic tape or mesh is placed underneath the middle section of the outlet (urethra) under no tension. This is tunneled behind the pubic bone to just under the abdominal wall or the labial skin. These operations appear to have a high success rate comparable to the Burch procedure.
Periurethral InjectionsA bulking agent or implant is injected into the tissues around the urethra to partially close it. It may be used in patients where a sling fails to provide full cure. The success rate is only moderate but it avoids open surgery.
Anterior RepairA bladder prolapse is repaired and the bladder neck is reinforced. The operation is performed vaginally.
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