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Urinary Incontinence

What is Urinary Incontinence?
Urinary incontinence is a condition in which a person unintentionally leaks urine when she coughs, laughs or exercises. Or she may find that she cannot wait to reach the bathroom.
What are the common causes of urinary incontinence?
Normal vaginal delivery is probably the most important cause of this condition, as the birth of the baby through the vagina affects the whole pelvic floor in 3 ways:
  1. Direct damage to the pelvic floor muscles
  2. Damage to the nerves which supply the pelvic floor muscles
  3. Damage to the muscles which control the passage of urine and faeces
Other contributory causes are womb prolapse (as the support of the uterus is common to that of the bladder), menopause, obesity, chronic constipation, excessive exercises, chronic medical problems, and less commonly, pelvic tumours.
Can this condition be treated effectively?
Yes! Although a large proportion of women accept this condition as a necessary condition of motherhood, or that there is no remedy.
What are the methods of treatment?
Before rushing off to surgical treatment, always consider a trial of conservative treatment. Contributory factors like obesity, menopause, chronic constipation and medical conditions need to be looked into. Only when these have failed, or if associated pelvic pathologies are present, will surgery be advised.
Surgical Management of Urinary Incontinence
Over the last 100 years since this problem was recognised and documented, there have been many operations devised to treat the condition. The following procedures are the ones carried out most commonly today.
  1. Kelly’s repair was the earliest operation, and bears the name of the gynaecologist. This operation is a vaginal route operation and is an extension of the anterior repair operation (colporrhaphy) for uterovaginal prolapse. It is simple, and is still carried out today by many gynaecologists. However, the main disadvantage of this operation is that, though the patient gets relief from the condition, the recurrence rate is high. The 10 year cure rate is about 30-40 per cent. An overnight stay in hospital is required.
  2. Burch colposuspension. This is an invasive operation and is approached from the abdomen, either by a laparotomy incision or by laparoscopy (key hole surgery). It is very effective, and the 10 year cure rate is about 80-85%. Being invasive, complications like bleeding, infection and urinary retention are more common. It is also a more difficult operation, technically. Hence, it has been superceded by the next operation described, which is now deemed the operation of choice, the gold standard.
  3. Tension Free Vaginal Tape (TVT), (view diagram). This procedure has been extensively studied since the mid-90s, and very well documented in the medical literature. It is done via the vagina, but there are two small puncture wounds near the pubic area where the tapes are pulled through. In experience hands, it is relatively simple to perform, and the patient requires at most a night’s stay. In some instances, the patient can return home the evening of the operation. The 10 year cure rate is as high as 90-95%. There is a variation of this procedure where the puncture wounds exit the thighs. (TVT-O).
Discuss these options with your gynaecologist, and it is important to note the whichever operation is chosen, it must be done well, as any repeat operation will be more difficult and give poorer results.
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Contact Info
6 Napier Road, #07-11
Gleneagles Medical Centre
Singapore 258499
Tel : 6472 2283 (call for appt)
Fax : 6473 5928
Email : seethoclinic@gmail.com