Women's Services Encyclopedia

Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine. The amount of leakage can vary from large gushes to occasional drops. The condition is not normal, and is not a normal consequence of aging.

Diagnosis:

Firstly, accurate diagnosis is essential. Specific questions will be asked at interview to enable us to categorize the problem.

Additional tests may be required to obtain the correct diagnosis. These tests include:

• Urine Specimen — A urinary tract infection can be a cause of urge incontinence and is easy to cure.
• Ultrasound — A small probe is inserted into the vagina to give a picture of the bladderneck. This will give information on how your bladder reacts when you strain.
• Cystoscopy — A telescope is introduced into the bladder to enable to detect obstruction and other conditions.
• Cystometry — This test measures pressure in the bladder, urethra and rectum. It gives information to determine if and what form of surgery will be helpful.

Treatment:

Surgery is only helpful in stress incontinence, which is why the correct diagnosis is important. Incontinence operations fall into four broad groups: abdominal incision with support procedures, vaginal procedures to support the urethra and bladder support, urethrovesical sling procedures, and peri-urethral collagen injection procedures. Success rates with each of these are always somewhat subjective. In general, there is about an 85% cure rate of stress urinary incontinence. In general, the abdominal procedures are effective longer than procedures done through the vagina.

Other helpful measures are:

• Weight Reduction — Less weight means less strain on the bladder.
• Pelvic Floor Exercises — Making the muscles of the pelvis stronger will enable the bladder to better withstand pressure during straining (e.g. coughing, laughing, sneezing).
• Hormone Replacement — Estrogens are important in maintaining healthy pelvic tissues. After the menopause, when the ovaries stop producing estrogen the pelvic tissues may become weaker leading to stress incontinence.
• Bladder Training — Control of the bladder can be achieved by voiding on command, rather than when one feels the urge. This can be very effective in controlling urge incontinence.
• Control of other diseases such as diabetes.
• Fluid Intake — Limiting fluid intake before long journeys, going out or at might can help reduce incontinence by keeping the bladder relatively empty. Avoid caffeine in tea, coffee and fizzy drinks as this can make urge incontinence worse and cause an increased production of urine.
• Diet — Avoid acidic foods such as tomatoes, lime and lemon. Artificial sweeteners also seem to adversely affect the bladder and worsen urgency.

Laparoscopic Surgery

Laparoscopic surgery for stress incontinence is called bladderneck suspension. In one procedure, two to four stitches are placed between the vaginal wall and pubic bone. This stabilizes the vaginal wall and bladderneck causing slight compression of the urethra at the bladderneck which prevents leakage of urine when straining (e.g. coughing, laughing and sneezing).

The laparoscopic procedure is less painful than the open procedure. You will see immediate results, in approximately 85% of women incontinence is eliminated, 5 years after surgery 65% of women remain completely dry. These figures are the same as for the open procedure.

What can I expect during the procedure?

The procedure is performed under general anesthetic (asleep). Three small incisions (5mm) are made in the abdomen. The laparoscope (telescope), inserted through an incision in the bellybutton allows the surgeon to precisely view the area and perform the procedure which takes approximately 30-60 minutes.

No stitches are used to close the skin incisions, butterfly paper strips are used. A catheter is left in the bladder overnight and removed the next morning. Most patients are discharged the day after surgery, provided no other simultaneous surgery was performed.

Does it hurt?

There is minimal pain involved with laparoscopic bladderneck suspension as the incisions are very small. Most patients require only tablets for pain relief. Stronger pain relief is always available if required.

How long will it take me to recover?

Recovery is usually very fast (2-3 days). Gradually increase the amount of exercise and stop if it hurts. Patients must refrain from high impact sports and heavy lifting for at least 3 months.

Is there any special preparation before the procedure?

We ask that you go on a liquid diet 48 hours before the procedure and that you have nothing to eat or drink on the day of surgery.

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