Urinary incontinence in women is broadly divided into two categories – stress incontinence (discussed below) and urinary urgency – the need to rush to the toilet frequently often not making it in time. They have different mechanisms of action and may be present in combination or as a single problem, but it is important to note the difference in the two types, as for a sufferer, incontinence is incontinence regardless of the mechanism causing it.
Loss of urine with coughing, sneezing or running is known as stress incontinence. It is seen in women more commonly than in men because;
- Women have a shorter urethral length (the tube from the bladder to the outside) than men
- Damage to the pelvic supports and muscles with childbirth
- Increased frequency of urinary tract infections in women
- Loss of oestrogen support to pelvic floor muscles after the menopause
Interestingly, many women will admit to leaking with increased intra-abdominal pressure but feel that is ”what happens when you have kids, isn’t it?” and put up with it! When stress incontinence affects your lifestyle, either in terms of embarrassing accidents, limiting activities you would want to do (golf, tennis, aerobics etc.), or causes you to continually empty the bladder to avoid accidents (thus reducing bladder capacity and potentially causing urinary urgency) it is time to seek help.
- Pelvic floor physiotherapy will help stress incontinence in up to 60% of women as long as they continue to do the exercises every day
- Prosthetic devices can be inserted in the vagina to support the bladder neck
- Adding vaginal oestrogen may help in mild cases
- Sub-urethral tape insertion (TVT or TVT-O)
- Laparoscopic Burch Colposuspension
Both the latter two options have a 90-95% success rate in curing urinary stress incontinence and are often combined with other procedures such as Total laparoscopic hysterectomy or other prolapse operations. Both techniques have risks and benefits particular to each method and would be discussed prior to choosing the preferred operation.
The colposuspension operation was traditionally performed via a large abdominal incision with a high rate of morbidity to patients (pain, bleeding, 6 week recovery etc). By performing it as a laparoscopic or keyhole operation, bleeding is kept to almost nothing and recovery time is reduced by 75% without any reduction in the effectiveness of the operation. In our practice, it is often added to a Total laparoscopic hysterectomy for those women with both menstrual problems and stress incontinence.
- 6% of women may develop urgency after any type of bladder neck surgery. This is treated with bladder retraining +/- medication for up to 6 months
- Most women will notice a slight slowing of their urinary stream
- Rarely, infection can cause a small blood clot to form in the space above the bladder requiring antibiotics, usually around Day 10 postop.
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