Incontinence

Female Stress Urinary Incontinence

Three out of ten women develop incontinence (stress urinary incontinence), a symptom that occurs when bladder control is lost. Urinary incontinence in women is not necessarily related to age. In contrast, the majority of patients with incontinence are active middle-aged women. Female incontinence (stress urinary incontinence) occurs in combination with other symptoms of the urinary system

Seek medical help if:

• You experience a slight loss of urine when: laughing, coughing, exercising, after a sudden movement (incontinence from effort)
• You suffer from frequent urination
• You suddenly feel an urgent need to urinate, with possible loss of urine by the time you reach the toilet (urgecy incontinence)
• You experience pain when urinating
• You have difficulty urinating
• You suffer from urinary tract infections
• You observe urine loss after surgery
• You have a feeling of pressure in the vagina or “bloating” in the lower abdomen (vaginal relaxation or uterine prolapse)

What causes incontinence?

Each type of incontinence is treated differently. The correct diagnosis of the cause of incontinence enables the doctor to choose the appropriate treatment.

Incontinence may be due to:

• Predisposition: Congenital tissue and muscle relaxation that support the internal organs and bladder.
• Pregnancy-childbirth: The uterus, growing due to pregnancy, presses on the bladder and the nerves in the area. During childbirth, it is possible for injuries to be caused in muscles and tissues that support the vagina and uterus; thus urinary incontinence, vagina relaxation and uterine prolapse can develop. Cesarean section does not always protect against such problems
• Obesity: Excess weight strains and pressures the bladder.
• Chronic increase of intra-abdominal pressure: lifting heavy weights, chronic cough (smoking, asthma), constipation.
• Menopause: Lack of estrogen leads to the thinning of vaginal and bladder tissues
• Age: Over time, the bladder and urethra do not function as efficiently.
• Neurological issue: Strokes, diabetes, Parkinson’s, multiple sclerosis

What is an urodynamic examination?

This is a simple, painless test lasting only 30 minutes. The urodynamic test assesses the function of the bladder and urethra. This test is also recommended for some women with cystocele or uterine prolapse, even without incontinence symptoms, in case surgery is planned.

Female incontinence – Non-surgical solution

With the advancement of medicine, new specialized incontinence treatments are now available to all women. In fact, for most patients, incontinence treatment is accomplished without surgery, through special exercises or medication.

Pelvic floor exercises (Kegel exercises)
Kegel exercises will help you strengthen internal muscles that support the bladder and urethra. The pelvic floor consists of muscles that contract every time you cough or sneeze so that there is no involuntary urinary incontinence. Also, the pelvic floor supports the abdominal organs when you are standing up and protects them from injury. 
 A prerequisite for the normal function of pelvic floor muscles is their good condition and fitness, just like any other muscle in the body. Kegel exercises contribute significantly to the treatment of urinary incontinence, as they strengthen and, at the same time, relax the pelvic floor muscles to provide adequate support without becoming overactive. Kegel exercises must be done correctly to be effective. In the beginning, guidance from a specialist will be required.

Pelvic floor exercise chair – Extracorporeal Magnetic Stimulation
The pelvic floor can be trained by using a a magnetic field produced by a unique external device leading to a passive contraction of the pelvic floor muscles. These pelvic floor exercises can be performed while you are dressed by sitting comfortably, dressed and comfortably on an armchair without inserting any vaginal device.

Electrical stimulation
Eight out of ten women with urgency incontinence, in which conservative pharmacological therapies have failed, were found to respond very well to electrical stimulation of the posterior tibial nerve. The method is similar to electroacupuncture treatments, painless, and is provided on an outpatient basis. Electrical stimuli are transmitted through a fine needle inserted in the ankle. Usually, 12 treatments (30 minutes each), are needed for the resolution of urgency incontinence.

Special training program for the bladder
Bladder training aims to increase the amount of urine that can be withheld without feeling the urgency of emptying the bladder or leaking urine. During the training you will learn to endure more time between your visits to the toilet.

Drugs
Some forms of incontinence ( overactive bladder) are effectively treated with medication that inhibits abnormal bladder contractions.

Urinary incontinence – Solution in 20΄

When conservative treatment is ineffective, or you are looking for a permanent solution, your doctor will recommend you to undergo a minimally invasive surgical method, such as placement of a Tension-free vaginal tape.

When is the placement of a Tension-free vaginal tape appropriate?

It is applied in cases where there is urinary incontinence from effort (stress incontinence). No incision is needed. A thin tape of synthetic material is placed under the urethra, like a brace, to provide support. The tape is placed with no tension and supports the urethra to its normal position, preventing the involuntary loss of urine.

Advantages of the tension-free vaginal tape method

• Success rate > 90%
• It is performed under local anesthesia. This also helps with the correct placement of the tape
• Lasts 20′ – 30΄
• Postoperative pain is kept to a minimum
• The cases of postoperative voiding difficulties needing bladder catheterization are reduced
• Has minimal complications when performed by specialists
• The patient is discharged from the hospital the same or the next day and can return to work and normal activities within two weeks,
• Provides immediate and long-term effectiveness.

Incontinence treatment – On the first appointment

Take notes before your first appointment and ask your doctor any questions you may have. After consultation, the ideal solution for your problem will be decided.
These are some of the questions that women ask their doctor
• Is there a more serious underlying problem? • Why did this happen to me? Did I do something wrong?
• Is the treatment permanent?
• Do I have to reach menopause before surgery?
• Can I get pregnant after treatment?
• Does a caesarean section prevent incontinence?
• Should I change my life or limit my activities?
• Does the tape bother during sex?