URINARY INCONTINENCE

Urinary incontinence is loss of normal control of the bladder and involuntary loss of urine. For many people with urinary incontinence it is an embarrassment.

Urinary incontinence in some individuals may be a normal part of growth and disappears naturally over  time. However, if it does not disappear, it requires treatment and the condition improves when the underlying cause is treated.

Urinary incontinence is more common in women than men. Older women experience urinary incontinence more often than younger women. The probable cause for higher incidence in women can be attributed to pregnancy and childbirth, menopause and the structure of the female urinary tract.

Individuals with urinary incontinence may experience strong, sudden, urgent and uncontrollable need to urinate, frequent urination and also involuntary loss of urine.

Causes of Urinary incontinence

Urinary incontinence may be caused by any of these factors:

  • Weak muscles in the lower urinary tract

  • Problems either in the urinary tract or in the nerves that control urination

  • Physiological status such as pregnancy, childbirth, weight gain or other conditions that stretch the pelvic floor muscles

  • Overactive bladder muscle

  • Urinary tract infection

  • Constipation

  • Bladder cancer or bladder stones

  • Blockage within the urinary tract

  • Removal of the uterus (Hysterectomy)

  • Neurological disorders

Types of Urinary incontinence

Urinary incontinence can be categorized into five basic types depending on the symptoms:

  • Stress Incontinence

  • Urge Incontinence

  • Overflow Incontinence

  • Functional Incontinence

  • Mixed Incontinence

Stress Incontinence:  Leakage of small amounts of urine during physical movement such as coughing, sneezing, lifting heavy objects, and straining, that suddenly increases the pressure within the abdomen.

Urge Incontinence:  Leakage of large amounts of urine at unexpected times, including during sleep.

Overflow Incontinence:  Uncontrollable leakage of small amounts of urine because of an incompletely emptied bladder.

Functional Incontinence:  This refers to urine loss resulting from inability to get to a toilet.

Mixed Incontinence: Mixed incontinence is the presence of two or more types of incontinence in an individual. Most commonly, urge and stress incontinence occur together.

Symptoms of Urinary incontinence

Symptoms remain the mainstay of diagnosis and you may be ordered additional tests to identify and confirm the cause for incontinence.

These tests include

  • bladder stress test,

  • urinalysis and urine culture,

  • ultrasound diagnosis,

  • cystoscopy and

  • urodynamics.

Treatments of Urinary incontinence

Treatment depends on the cause, sex and severity of incontinence. Treatment options include medications, injections, vaginal devices and behavioural therapy that include pelvic muscle exercises, bladder retraining, electrical stimulation and catheterization.

If these conservative treatment measures fail to treat your condition, Dr Alexander may recommend surgical procedures such as

  • urethral sling and

  • colposuspension.

INCONTINENCE PROCEDURES

WHAT IS A MINIMALLY INVASIVE SLING PROCEDURE?

Stress urinary incontinence is the inability to control the flow of urine, which leads to the leakage of urine when you sneeze, cough or laugh. Vaginal sling is a minimally invasive surgery performed to treat stress urinary incontinence.

  • Conventional sling: Sling made of body tissue or synthetic material, which is secured with stitches.

  • Tension-Free sling: A mesh sling, which is held in place with the surrounding tissue.

  • The MiniArc Precise Single-Incision Sling system is a mid-urethral sling that is used to treat female urinary incontinence. It offers more accurate delivery and control. It is quite safe and is a minimally invasive procedure that has minimal risk of tissue injury and bleeding.

The procedure is performed under general or spinal anaesthesia. Dr Alexander makes a small incision inside your vagina and under the urethra. A catheter is inserted into your bladder to drain urine.

The sling is passed through the incision and secured under the urethra. This helps in lifting and supporting urethra and bladder neck ( where urethra meets the bladder ). You may be discharged from the hospital on the same day or you may have to stay for 1 or 2 days after the surgery.

POSSIBLE COMPLICATIONS WITH SLING PROCEDURES

As in all surgical procedures, sling procedure may also be associated with certain complications, which include:

  • Break down of the artificial material of the sling ( long term )

  • The synthetic material of the sling can be rejected by the vagina tissue ( long term )

  • Damage to the bladder, urethra or vagina, bleeding ( during procedure )

  • Irritation in the bladder ( long term )

  • Voiding dysfunction

TENSION FREE VAGINAL TAPE

Tension-Free Vaginal Tape (TVT) placement is a procedure employed to control stress urinary incontinence caused by sagging of the urethra.  

What is Stress Incontinence?

Stress incontinence refers to the leakage of small amounts of urine during physical movement such as coughing or laughing that suddenly increases the pressure over your urinary bladder.

About the Procedure

TVT placement is a relatively simple procedure requiring a short hospital stay with a quick recovery compared to retropubic suspension surgery.

The TVT provides support to the sagging urethra so that it remains closed during coughing or sudden movement, preventing the accidental leak of urine.

Inserting a TVT usually takes about 30 minutes and is performed under general or local anaesthesia. Dr Alexander will make small incisions over your abdomen and vaginal wall.

A mesh tape is then passed under the urethra, like a hammock, to maintain its normal position. No stitches are required to keep the TVT in place.

Recover after Tension-Free Vaginal Tape Procedure

Patients undergoing TVT placement may experience slight pain and discomfort. Following the procedure, you will be asked to empty your bladder to see the reaction of the bladder and urethra to the surgery.

Patients may go home on the same day or the next day. A catheter (thin flexible tube) may be inserted in your bladder to drain the urine during the recovery period. Patients may resume normal activities within 1 to 2 weeks. However, you may need to avoid driving for 2 weeks, and sexual activity or strenuous activities for up to 6 weeks.

The most common risks associated with TVT placement include injury to the bladder or urethra, difficulty emptying the bladder and risk of infection. The mesh tape used in the surgery may cause erosion of the pelvic tissue.