STRESS URINARY INCONTINENCE

Most common form of urinary incontinence

Stress urinary incontinence is the sudden, unintentional release of urinary during normal everyday activities

You have stress urinary incontinence if you lose urine when you:

  • Cough, sneeze or laugh
  • Walk, exercise or lift something
  • Get up from a seating or lying position
  • You may also go to the bathroom more frequently during the day to avoid accidents

What causes stress urinary incontinence?

  • Damage to pelvic muscle that may occur during pregnancy and childbirth
  • Obesity
  • As a result of pregnancy and childbirth, there is damage to the pelvic floor muscles, results in dropping of the bladder and urethra in the vagina from its normal intra-abdominal position.
  • Under normal circumstances any increase in the intra-abdominal pressure is also simultaneously exerted at the bladder neck and urethra, this prevents any urinary leak. However in patients with damage to the pelvic floor, the increased intra-abdominal pressure is not distributed to the bladder neck and urethra – thus preventing them to close resulting in stress urinary incontinence.

Diagnosis

We spend time with each patient to evaluate the type of urinary incontinence and the underlying causes before developing a treatment plan:

  • Comprehensive medical, gynecological obstetrical history
  • Physical examination including pelvic examination
  • Urinalysis
  • Urine culture
  • Urodynamic evaluation
  • Cystoscopy
  • Pelvic ultrasound

Treatment

Most patients treated at Cleveland Urology Associates are symptom free or their symptoms have improved significantly. Treatment for urinary incontinence varies for each patient based on type, severity and underlying other health issues, therefore we work with patients to determine the best possible treatment available.

Non-invasive treatment

  • Behavioral modifications
  • Pelvic floor exercise
  • Biofeedback
  • Medications
  • Pessary and bladder neck support device

Minimally invasive treatment

  • Bulking agents
  • Collagen

Surgical treatment

Suburethral sling:

Ever since the introduction of this minimally invasive surgery to correct stress urinary incontinence our urologists have performed this procedure on hundreds of patients with excellent results. They also teach other urologists and gynecologists from all over the country to do the operation. This operation is

  • Minimally invasive
  • Outpatient surgery
  • No skin incisions
  • Procedure usually takes 10-20 minutes
  • Less or no pain
  • Small incision is made in the vagina
  • A synthetic, prolene mesh tape is placed underneath the urethra. It acts as a hammock, compressing the urethra to prevent unintentional urine loss
  • Minimal complications
  • Short recovery period
  • Little interference with daily activities
  • 98% of women treated are still dry or report significantly less leakage

PATIENT INSTRUCTIONS

Before the operation

  • We will schedule the operation at the hospital of your choice
  • Hospital will call you to arrange for pre operative testing and evaluation (EKG, chest x-ray, and blood tests)
  • Please do not eat or drink any thing after midnight the night before your surgery
  • You may take your regular medications with a sip of water
  • Please do not take aspirin or any blood thinning medications for 7 days

On the day of your procedure

  • Please arrive at the hospital as suggested
  • You will be seen by anesthesiologist
  • They will start an I.V. line in your arm and you will be given medications to calm your nerves and
  • will be given antibiotics
  • Procedure will be performed under anesthesia
  • There are no skin incisions
  • When you wake-up you will have a catheter in the bladder and tampon like packing in the vagina
  • After your vital signs are stable, you will be taken to your room
  • You rest and relax until next day
  • You may have regular diet
  • Foley catheter and vaginal packing will be removed early AM.
  • After you void – you will be allowed to go home with your family
  • You will be given two prescriptions – one for antibiotic and another one for pain

After the procedure when you are home

  • Take it easy for 2-3 weeks after your operation
  • There are no dietary restrictions following your surgery
  • Please take mild laxative such as Milk of Magnesia, Colace or Metamucil everyday for 2-3 weeks
  • Please drink plenty of water everyday
  • Avoid alcoholic beverages for 2-3 weeks
  • Avoid strenuous exercise for 2-3 weeks
  • You may walk, but do not run
  • Avoid lifting over 15 pounds for 2-3 weeks
  • You should not drive a car for 1-2 weeks
  • Avoid sexual intercourse for 6-8 weeks
  • Avoid tampons or self examination for 6-8 weeks
  • There are sutures on the vaginal wall –they will dissolve on their own. Please do not touch or try to remove them.
  • You may shower or take a bath anytime
  • You should use a small sanitary napkin for 6-8 weeks as there will be some bleeding or discharge during the healing time
  • If there is excessive bleeding, please call our office
  • We have prescribed for you an antibiotic. Please take as instructed.
  • We have prescribed pain medication for you. Please take them as necessary.
  • If you are experiencing severe pain, fever, chills, or swelling, please call our office
  • You may return to work 1-2 weeks after your surgery; however, if your work require heavy lifting or heavy duty work you may want to wait for 3-4 weeks before returning to work.
  • Please call our office to arrange a follow-up visit in 3-4 weeks time
  • Should you have any other questions, please don’t hesitate to call us.

Are there any risks or complications?

All medical procedures present risks

Complications are rare, they include:

  • Bleeding from vaginal incision
  • Infection
  • Scarring in the vagina
  • Exposure of mesh into vagina, bladder or urethra
  • Urinary retention
  • Bladder injury
  • Painful intercourse
  • Managing Incontinence (Pelvic Floor Muscle Exercises - Kegel)

Why do the exercise?

The pelvic floor muscles act as a sling to keep the bladder and bladder neck lifted; they also form the external sphincter. Sometimes these muscles weaken, allowing the pelvic organs to drop down. By doing specific exercises over a period of time, you can tighten up and strengthen the pelvic floor and sphincter muscles.

How to do them?

Sit on the toilet and start to urinate. Try to stop the flow of urine midstream by contracting (tightening) your pelvic floor muscles. These are the same muscles used to stop a bowel movement.
Repeat several times, until you are sure of the action and sensation of consciously contracting these muscles. Do not tighten your abdominal, leg, or buttock muscles.

An alternative way to exercise the pelvic floor muscles is with a small vaginal weight, which you insert briefly in the vagina. Holding the weight in makes you contract the right muscles.

When to do them?

For stress incontinence, repeat the exercise four times, holding each contraction for a count of four. Do this every hour, whether at your desk, or watching TV. They must be performed daily for at least 2-3 months to be effective.

Bladder drill:

For urge incontinence, the same exercise can be used to do a “bladder drill” that retains the bladder. When the external sphincter contracts, it signals the bladder to relax, so the urge eventually subsides. Every time you feel urinary urgency, try to stop the feeling by contracting the pelvic floor muscles. Try to hold your urine a little longer each time, gradually increasing the time between urinating to 2-3 or more hours.

You should start to see improvement in 2-3 weeks


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