Urogynaecology
Urinary Incontinence
Urinary incontinence is any accidental or involuntary loss of urine from the bladder. It is a widespread condition affecting 4.2 million Australians and vary in ranges of severity from ‘just a small leak’ to complete loss of bladder control. Incontinence can be treated and in many cases also be cured.
There are several types of urinary incontinence, but the common types include Stress urinary incontinence, urge urinary incontinence or mixed urinary incontinence where there is a combination of both. Other causes of urinary incontinence are less common and include overflow incontinence, functional incontinence, fistula and urethral diverticulum.
Stress incontinence
Stress incontinence is the leaking of urine during activities that increase the pressure inside your tummy. The common activities that cause pressure rise include coughing, sneezing, laughing, walking especially down hill, lifting or playing sports. Common causes include pregnancy, childbirth, menopause and other conditions like chronic constipation, chronic cough, obesity etc that put additional strain on the pelvic floor muscles that support the urethra (waterpipe).
Non surgical options
Pelvic floor exercises
These are otherwise called ‘Kegel’ exercises. This strengthens the pelvic floor and help you from leaking urine, gas/wind, stool as well as improving symptoms from prolapse.
You can do these exercises in any position or any time. Aim to do this 3 times a day on 3-4 days a week. Each time squeeze your pelvic floor muscles by counting to 10 and then slowly relax them back about 10 times.
Setting up a reminder on your phone or downloading a pelvic floor app on your smart phone maybe helpful in continuing the routine. (Easy Kegel, Squeezy NHS pelvic floor app) Though a bit slow to start, you can usually see the results within 3 months of starting the exercises.
Vaginal devices
You can wear a device in your vagina on a daily basis to support your waterpipe and control the leakage. Your physiotherapist or specialist may discuss these with you. Reducing weight, if your body mass index is over 30 and stopping smoking helps in improving symptoms.
Surgical options
It's important to remember that the results of surgery to treat stress urinary incontinence are different for every woman. You are the only one who can decide for sure whether surgery is the best treatment for you. If you aren't sure, you might want to try other treatments while you think about surgery. Talk with your doctor about how much surgery might help you. Overall chances of success of primary surgery are around 80-90% for improvement of leakage. If its recurrence, your success rates are slightly lower around 70%.
Retropubic mid urethral sling (Synthetic/ mesh sling)
This procedure involves inserting a synthetic sling/ mesh / tape under the waterpipe (urethra) like the letter ‘U’. The procedure requires a short general anaesthetic and recovery period is around 2-4 weeks. The tissue ingrowth into the sling/mesh gives urethra, the support it needs to stop the urine from leaking.
Burch colposuspension
The operation supports the urethra through a keyhole or sometimes open surgery, under general anaesthetic. The tissues around the urethra is lifted up using permanent or dissolvable stitches and suspended to the ligament on the back of pubic bone (Cooper’s ligament). The recovery time is similar, but hospital stay is overnight. It is intended to support the bladder neck, which is the area between the bladder and urethra (water pipe). No mesh is used in this surgery.
Urethral bulking
This procedure involves injection of a filler directly into the urethra via a camera under general anaesthetic. The filler minimises leakage by bulking up the inner lining of the urethra. The results are fairly instant and there is hardly any recovery apart from the anaesthetic. This treatment is mostly for women who still have stress incontinence after they have already had surgery.
Pubovaginal sling /Rectus sheath sling/ Autologous fascial sling
This operation is similar to the synthetic sling but uses your own tissue for the sling. A small cut is made in your lower tummy at the bikini line. This helps us harvest around 8-10cm of your own tissue covering the rectus muscle (Rectus sheath). This strip of tissue is then inserted via a small cut in the vagina and passed along the sides of urethra like the letter ‘U’ and tied on top of the rectus muscle. The skin wounds are closed with dissolvable stitches. This operation requires a general anaesthetic and has a slightly longer recovery time up to 6 weeks. This treatment is mostly reserved for women who have recurrent stress incontinence.
We don’t recommend surgery to treat stress urinary incontinence in women who want to get pregnant. That's because pregnancy puts stress on the belly and urinary tract. This can make stress incontinence come back, even after surgery.
Please also find the link from the Australian government which may help you in finalising your treatment choice.
Other websites which may be useful to you
https://www.yourpelvicfloor.org/leaflets/
https://www.ugsa.com.au