Urinary incontinence is unintentional and uncontrollable release of urine. This happens usually when a person coughs, laughs or sneezes. One can experience urgent need for urination without having opportunity to reach the bathroom on time. The condition mainly affects elderly people, women in particular. The state is not as severe as it is embarrassing. Urinary incontinence caused by bladder infection is temporary. Unlike short-term urinary incontinence chronic condition is much more serious. Chronic urinary incontinence includes stress incontinence and urge incontinence. The first one happens together with different activities which increase pressure within the bladder (cough, laugh etc.). The urge incontinence happens when a person suddenly feels unstoppable need to urinate but he/ she cannot make it to the toilet on time. In older women these two types of urine incontinence may combine.
Basically the cause of this condition is weakness of pelvic floor muscles or damage of the nerves that control urination in the urinary tract. Stress incontinence may be a result of child birth, obesity and certain conditions which may lead to separation of pelvic floor muscles. Within the separation the bladder prolapses and the muscles which are in charge of closing the urethra tend not to function properly.
The condition is easy to be diagnosed. A simple conversation may help the doctor. Additionally he/ she may ask how often and how much a person urinates and what the intake of water and other fluids is. Certain tests are also conducted.
Generally the treatment begins with the exercise (Kegel's exercise) which will strengthen the pelvic muscles. If this does not help a woman may try with the pessary, a Removable gadget which when placed into vagina puts pressure onto the urethra. This way it may be of great help in the case of stress incontinence. Even some medications are administered. If none of the previously mentioned helps the patient undergoes the surgical procedure. Several surgical procedures are suitable and may help with the incontinence caused by the weakness or separation of the pelvic floor muscles. The goal of the operation is to lift both bladder and urethra and bring them back to their natural position. The surgery is not conducted with the patients who are suffering from urge incontinence.
During the first surgical option or so called tension- free vaginal tape surgery is a mesh like tape is placed under the urethra to hold the urethra and bring it to the normal position. This procedure is done under local anesthesia within 30 minutes. Retropubic types of surgeries (Marshall- Marchetti-Krantz and Burch colposuspension) are done to pull the bladder up. This is done by attaching the tissue around these organs to the pubic bone and surrounding ligaments. During these procedures patients are hospitalized. The third option is urethral sling. The surgeon forms a sling out of muscles, ligaments or tendons and then by using the sling he/ she pulls up the urethra. This surgery is done via abdomen so the patient needs to be hospitalized.
The healing process passes quite well and the operation may not succeed in cases of extreme obesity, prior radiation therapy, poor diet or tiring physical activities.