While urinary incontinence is not “normal,” it is quite common. In fact, by the age of 60, 30% of all women have some annoying symptoms of urinary leakage. I say “annoying” because anyone can have leakage if the bladder is over full, or if they have a bladder infection, or if they laugh hysterically and I would not classify these instances as incontinence. However, when the urinary leakage becomes more prevalent, increases in quantity or frequency and becomes annoying, it is time to consider treatment.
Stress incontinence is urinary leakage associated with “physical stress” or activity that is exercise, coughing, sneezing, changing position, jumping, running or the like. It is related often to childbirth injury and tends to get worse over time for many reasons. Gravity is the first issue. Since we walk on 2 legs, our pelvic organs are just above our vagina. If there is a disruption in the support structures of the vagina and uterus from childbirth we then have prolapse or “falling” of the bladder, uterus and possibly rectum. This results in urinary loss, difficulty with bowel movements at times and sometimes an uncomfortable bulge at the vaginal opening. Although this bulge can be alarming, it is rarely dangerous. If we were like man’s best friend, the dog, we would not have prolapse because animals that walk on four legs have a vagina that is horizontal and not affected by gravity.
The urinary leakage is also caused by the hormonal changes of menopause. Less estrogen can result in weakening of the support structures and more urinary leakage. And aging is a factor as well.
So when do you consider surgery? If there is minimal or no prolapse, the TVT Sling procedures are outpatient procedures with minimal pain and short recovery times. Most women are back to work in a week and pain medication is required for only a day or two. There are no external stitches, just a few dissolving stitches in the vagina and most activities are manageable in a short time. There is a limitation on strenuous exercise and heavy lifting for 2 months and no swimming or intercourse for 1 month.
When I counsel women I find that most put up with symptoms of urinary leakage far too long. When they get this corrected they invariable ask, “why did I wait this long? I didn’t have to suffer with pads and embarrassment as long as I did”. Many younger patients note that their symptoms get worse with each subsequent delivery.
If you are finished having children, if you are limiting your activities because of your bladder, if you are wearing more than 1 mini-pad per day, if you are not playing sports, hiking, playing tennis or golf because you can’t find a bathroom every 30 minutes, it is time to consider surgery for stress incontinence.
The success rate of these nylon-like slings is 90% and the slings are permanent. They act as a hammock to support the urethra (the tube that empties the bladder) when there is a cough, sneeze, or when exercise tightens the abdominal muscles.
Some women have heard that mesh is dangerous, and in large quantities this may be so, BUT these mesh ribbon slings have been implanted in women in the USA for the past 15 years and in Europe for another 5 years prior to that. There is a very long experience with them. I have been implanting them since they were first introduced in this country and have a 15 year experience with them. They are very safe.
So, if you are bothered by your bladder, consider surgically correcting the incontinence (if it is stress incontinence). You do not have to live with it, there is no benefit to putting off treatment, it is not likely it will be necessary to treat it again. You can reclaim your life now, feel better, and be more active with yourself and your family.
