Options for treating stress incontinence

All Woman

JANINE is a yoga instructor who recently caught the flu. She is fed up. On top of having to run to the bathroom after every yoga session to “clean up” because of urine leaking down her underwear, she is sneezing non-stop. With each sneeze a gush of urine escapes. She needs help.

Janine is one of thousands of women globally suffering from stress incontinence. Janine, and others, need to know their options for treatment.

The urethra is the tube which connects the bladder to the top of the opening of the vagina.

The bladder is held in place mainly by the levator ani muscle and a group of other pelvic floor muscles.

Under a combination of voluntary and nervous interactions, when we feel the need to urinate the bladder muscles contract and push urine through the urethra.

With advancing age, decreasing oestrogen levels and pelvic floor damage following childbirth, the bladder neck begins to dysfunction and not work how it is supposed to. Please note, this does not happen to everyone. Factors such as genetics, body mass, number of pregnancies and size of babies born contribute to this.

When the pressure in the abdomen is increased, such as while exercising, sneezing, coughing or laughing, this pressure is exerted on the bladder. In normal circumstances, the bladder neck is functioning and holds the urine in place. When there is dysfunction, it is unable to do this and urine escapes through the urethra — leading to leakage of urine and unnecessary embarrassment.

In mild cases, pelvic floor exercises — Kegel exercises — can be beneficial for those women suffering from this condition.

However, in moderate to severe conditions, alternatives are needed.

These alternatives are high-intensity focused ultrasound (HIFU) or laser vaginal rejuvenation.

The HIFU is a non-surgical 20-minute procedure and involves placing a probe into the vagina. It emits ultrasound energy deep within the vagina and bladder neck which causes collagen to re-form, making the muscles stronger. I have had near perfect success rates with this in the ideal patient. The patient is usually symptom free for at least eight months and will require top ups.

Laser vaginal rejuvenation is a day surgical procedure and involves bringing the muscles closer around the bladder neck and holding it in place. In this, too, I have had near perfect results. There is also the additional advantage of increased sexual gratification with this procedure.

Less commonly mentioned are the use of transurethral tapes and slings, which have been losing popularity because of severe side effects associated with them. These tapes act the same way by holding up the bladder neck and are effective. However, they are generally not recommended because of associated infections and scar tissue formation.

Know your options. Don't suffer like Janine!

Dr Daryl Daley is a cosmetic gynaecologist and obstetrician operating from Gynae Associates, 23 Tangerine Place, Kingston 10. Follow him on Instagram @drdaryldaleyobgyn or phone 876-929-6038/9.

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