What is incontinence?
There are 3 main types of incontinence.
Stress incontinence which is the sudden unintentional loss of urine during everyday activities like coughing, sneezing, laughing, walking, running or lifting. It can also occur on rising from a sitting or lying position or with sex. It is the commonest and easiest to fix.
Urge incontinence which is sudden unintentional loss of urine with an urgent desire to pass urine usually occurring before arriving at the toilet. This type of leakage often occurs with the sound of a running tap, putting the keys in the door and with the symptoms of frequency, urgency and rising often at night. It may occur in combination with stress leakage.
Involuntary incontinence without any feeling at all. This is more complex and is the least common.
What is the cause of stress incontinence?
The urethra which is the tube from the bladder through which urine exits the body does not stay closed with exertion. This is due to poor support for the urethra which does not allow it to kink like a garden hose when the base of the bladder descends on exertion. Less commonly it is caused by a deficiency of the urethral valve itself.
Stress incontinence is not a natural part of aging and can affect women of all ages. The main cause of Stress Incontinence is childbirth, followed by heavy lifting and straining, the menopause and obesity. Because Stress Incontinence is caused by the same factors as Prolapse, the two conditions are often seen together, but they are different conditions which require individual and different treatment.
How is it diagnosed?
The first step is to realize you have a problem.If you lose urine in situations described above and if you need to wear pads to absorb the urine or if your activities are limited by this leakage you need to be investigated by your doctor. A full examination of the pelvic floor is needed together with urine testing and sometimes an ultrasound of the kidneys or pelvic floor.
The diagnosis of a weak urethra suitable for surgical correction is usually made by a study called a Urodynamic Test which involves hooking you up to a computer and pressure testing the bladder to see when exactly leakage occurs as well as looking at the urethra and bladder with an external ultrasound and looking inside the bladder with a camera to make sure there are no abnormalities inside the bladder itself. The Sydney Women’s Endosurgery Centre (SWEC) has its own unit to perform these studies at the St George Urodynamic centre ( 02 95793110). Appointments can be made through your specialist or GP..
How is it treated?
Most people will have tried pelvic floor exercises like the ones you do after childbirth before they get a surgical opinion. These may help with early stress leakage but with over time they appear to be less effective especially where the leakage is a big problem.
There are 3 types of surgical approaches.
Vaginal surgery. This traditional approach which is still commonly performed has been shown to be ineffective with success rates of often less than 50%. It is this type of surgery that has given incontinence surgery a bad name in the community because the leakage often returns.
Mesh tapes. These can be inserted under the urethra to support it as a minimally invasive operation with good results achieving success in around 90% of cases. The only problem is the long term success rate is not known and the mesh is a foreign body which can occasionally ulcerate into the vagina, the bladder or the urethra itself.
Burch Colposuspension. This operation using the keyhole or Laparoscopic approach achieves excellent success rates.
Back in 1961 this was first described as an abdominal operation with a bikini cut with excellent results achieving success rates of at least 90% without using mesh. Unfortunately, The problem was that the Caesarean type scar was a major operation and it involved pain and a long recovery.
In 1992, the surgeons at SWEC performed this operation for the first time in Australia using the keyhole or Laparoscopic approach and have duplicated the results of the open operation, with the benefits of much less pain and a much faster recovery time.
SWEC have now performed over 1500 of these keyhole operations with excellent success rates which have been published. As a result, We believe the Burch Colposuspension method using the keyhole or Laparoscopic approach is still the gold standard operation because we have nearly 50 years experience with the method and 17 years experience with the keyhole approach which allows most SWEC patients to go home on the 2nd postoperative day and be back to normal around the house and back to work in 1-2 weeks respectively. It is also worth pointing out that many women with heavy or painful periods have a keyhole hysterectomy at the same time with no extra recovery.
What do you do now?
Every woman is individual and her situation requires an individual plan of management. If these issues worry you or you have a positive family history of these conditions, call us at SWEC on 1300 498 448 to arrange a personal consultation and discussion of your case.