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Stress incontinence

It is such a common condition that many women assume it is just one of those things and so don’t ever seek treatment. However, studies have shown that incontinence is a major cause of stress and unhappiness.

When performed by a specialist with appropriate training, surgery for stress incontinence can be highly effective, with success rates of over 80%.
Stress incontinence

Causes

What causes stress incontinence?
Stress incontinence can affect anybody but it is more common in women who have had children. The risk of developing stress incontinence is higher if you have had more children, larger babies, or have had difficult deliveries. Pregnancy can cause stretching and weakening of the muscles and ligaments in the pelvis that help to support the bladder. If this happens, then the bladder is unable to hold urine at times of increased pressure such as coughing.

How can I tell if I have stress incontinence?
Do you leak any amount of urine when you cough, laugh or exercise? If you do, you are not alone: 10% of women have this type of bladder problem. It can be embarrassing and have a huge effect on quality of life but a specialist in urinary incontinence will be able explain the available treatments that can help.

How does the specialist know if I have stress incontinence?
The doctor will talk to you about your urinary problems as well as carefully examining you. He will look at your bladder diary with you and do some urine tests. This is usually all that is required to diagnose the problem and initiate a treatment plan. Sometimes further tests are necessary, such as urodynamics.

Pelvic floor muscles

Treatments

Pelvic floor exercises
Pelvic floor exercises help strengthen your muscles to improve your bladder control. The results are not instantaneous but most people notice a significant improvement in their symptoms. Pelvic floor exercises help to strengthen the muscles that lie at the bottom of the pelvis. These muscles support the internal organs including the womb, bladder and back passage. If these muscles become weak, or damaged during childbirth, then this important support is lost. This can lead to urinary problems, including incontinence. It can also cause vaginal prolapse, bowel trouble and sexual problems.
Pelvic floor exercises are usually easy to learn, but studies have shown that they are most effective when they are taught by a trained continence advisor or specialist.

Do not expect instant results! It will take several weeks of regular exercise to regain the strength in your pelvic floor muscles. You need to do these exercises for the rest of your life. If you stop exercising, your problems will return.

Medications for SUI
Duloxetine is a medicine which has been designed to treat stress incontinence.
Stress incontinence

Studies of Duloxetine have shown that it can reduce the number of incontinence episodes. It is sometimes used on its own but may be used with other treatments such as pelvic floor exercises. Side-effects include nausea, dizziness, drowsiness or insomnia (difficulty sleeping).

Midurethral sling (vaginal tape operation)
In this operation, a ribbon-like tape is inserted via a small cut in the vagina to form a sling under the middle part of the urethra – this is the tube that drains urine from the bladder to the outside. This tape helps to provide support to the urethra to help it remain closed when you cough laugh or exercise. Many patients are able to go home on the same day as their operation. For others, a single night in hospital is preferable.

Stress incontinence

Periurethral injections
SUI can be reduced by giving injections around the urethra (water-pipe). These work by compressing the urethra so that urine is less likely to leak during coughing or exercise. The effect of these injections may wear off over time but further injections can be given if necessary. This type of procedure may not be as effective as other procedures such as colposuspension or mid-urethral tapes (TVT, TOT). A variety of injections can be used, including Collagen and Macroplastique.
Stress incontinence

Burch Colposuspension
This operation involves inserting stitches inside the pelvis to help support the bladder during exertion. This is a bigger operation than vaginal tapes and has a longer recovery time. The effectiveness of colposuspension is about the same as mid-urethral slings (eg TOT).

Burch colposuspension diagram


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