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Urinary Incontinence Evaluation & Surgery

Overview

It is believed that more than half of all adult women suffer from urinary incontinence. It is considered an under-reported problem because women are embarrassed about or unsure there is a problem. The condition is typically associated with older women, but many researchers believe more than 45% of women between the ages of 20 and 48 also suffer.

There are several different causes of urinary incontinence and determining the cause is an important part of creating an effective treatment plan. The following are the six different types of urinary incontinence:

Stress incontinence occurs in response to activities that increase intra-abdominal pressure, such as laughing, coughing, or exercise. This is due to a loss of bladder neck support, caused by muscle, tissue, or nerve injury that is often a result of vaginal childbirth.

Overactive bladder or urge incontinence is the urge to void the bladder, even when it is not full. It can be caused by urinary tract infections, bladder stones, bladder cancer, or the inability to suppress contractions in the bladder.

Mixed incontinence is a combination of overactive bladder and stress incontinence.

Functional incontinence is caused by a chronic impairment of cognitive or physical function. This might be combined with other types of urinary incontinence.

Overflow incontinence occurs when there is an over distention of the bladder. The over- distention might be caused by underactive bladder muscles, diabetic neuropathy, radical pelvic surgery, a lower spinal cord injury, or multiple sclerosis.

Deformity is usually the result of a fistula, which is caused by complications from a hysterectomy or pelvic surgery.

Urinary Incontinence Evaluation

The evaluation begins with several questions about the history of the patient’s incontinence. Patients might be asked if their urine leaks, and if so, when, if they wear pads to protect from leakage, if it hurts when urinating, how many times they urinate throughout the day and night, and if they ever feel as if they are unable to empty their bladder when urinating. The patient’s medical history is also taken into account, as diabetes, chronic lung disease, stroke, cognitive impairment, hormonal imbalance, usage of prescription drugs, and fecal impaction can all play a role in urinary incontinence.

Next, a physical examination is given to diagnose urinary incontinence. The evaluation begins with the patient voiding her bladder and the voided amount being recorded. Within about 10 minutes of voiding, the amount of urine in the bladder is evaluated, through either an ultrasound or catheterization. This information is used to eliminate some causes of urinary incontinence.

The next part of the urinary incontinence evaluation includes a pelvic examination. Your doctor will look for signs of inflammation, infection, or atrophy. There might also be a hormone evaluation because estrogen imbalance can contribute to incontinence. The presence of vaginal discharge is also eliminated, as this is sometimes confused with incontinence by patients.

Stress incontinence and overactive bladder can often be treated with non-surgical methods that include physical therapy, biofeedback, occlusive devices, and electrical stimulation.

When non-surgical treatments do not work, urinary incontinence surgery is an option. Urinary incontinence surgery is invasive and comes with risk, but it can offer a long-term solution that makes life far more comfortable for patients. Surgery is available for several different kinds of urinary incontinence.

Procedure

Stress incontinence surgery options include sling procedures that use natural tissue or synthetic materials to create a hammock around the bladder neck to carry urine from the bladder. Types of slings include tension-free slings, conventional slings, and adjustable slings.

Bladder neck suspension surgery provides support for the bladder neck and urethra. A surgeon makes an incision in the lower abdomen and places stitches in the bladder to secure it to the ligament near the public bone. This reinforces the urethra and bladder neck so they do not sag.

Bulking agents might also be used to treat urinary incontinence. Bulking agents are materials that are injected into the tissue around the urethra to keep it closed. Bulking agents include carbon-coated zirconium beads, collagen, particles from bones and teeth, and silicone.

Surgery methods for overactive bladder include sacral nerve stimulation, tibial nerve stimulation, bladder augmentation, and botox injections.

Who Is Not A Candidate For Urinary Incontinence Surgery?

Women who plan to have children are often encouraged to postpone surgery until their family is complete. Childbirth can put strain on the bladder and urethra, undoing the benefits of surgery.

Those diagnosed with mixed incontinence might need surgery, as well as other treatment methods. Surgery is also unable to completely repair nerve and muscle damage.

Risks

The risks associated with urinary incontinence surgery include:

  • Pelvic organ prolapse
  • Difficulty urinating or completely emptying bladder
  • Development of overactive bladder
  • Painful intercourse
  • Urinary tract infection

Recovery time from some types of urinary incontinence surgery can be as much as six weeks and patients might need to wear a catheter until healing is complete. If you believe urinary incontinence is a problem, speak with your doctor about treatment options at Women’s Health Care of Georgia.




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