DOES YOUR BLADDER CONTROL YOUR LIFE?

Laughing, coughing, sneezing, exercising, a simple trip to the supermarket... to a woman with incontinence, these things signify insecurity, fear, embarrassment and humiliation.

Urinary incontinence is not normal and is always a symptom or sign of an underlying problem which can be treated.

Although millions of women allow incontinence to restrict their lives, the good news is that it can be successfully treated at any age.

There are several different types of urinary incontinence. The most common cause is STRESS INCONTINENCE, which is the leaking of urine when pressure is put on the bladder, such as when you cough, sneeze, exercise, laugh or when you lift heavy objects or even change body positions, such as getting up from a chair. Weakness of the ligaments supporting the urethra is the most common cause of stress incontinence.

The second most common cause of urinary incontinence is URGE INCONTINENCE, which is when the urge to urinate is so strong that it is not possible to reach the toilet in time.

This overwhelming desire to go may occur frequently during the day, as well as several times at night. It may be due to external pressure on the bladder, such as a vaginal prolapse, or it may be due to an inherent overactivity of the bladder muscle. Restricting fluids and constant preventative trips to the toilet only make matters worse.

LEADING EDGE SOLUTIONS

Doctor Salerno specializes in the management of urinary incontinence and prolapse problems in women. Doctor Salerno's reputation for treating women suffering from urinary incontinence has made him a LEADER in our community in offering leading edge solutions to enhance womens lives.

Many women afflicted with this condition do not seek relief. They are either unaware that help is available or too embarassed to ask. The problem in most cases can be cured or significantly improved.


WHAT DOES THE SERVICE INVOLVE?

When you phone to make your first appointment, the initial consultation will include an assessment, which will include a general medical history, a detailed questionnaire regarding your bladder symptoms and a gynaecological examination. As part of your evaluation, a Urodynamic Study including an Ultrasound Scan may also be performed. This does not involve harmful radiation, as used in other methods.

Treatment options include a Pelvic Floor Rehabilitation programme, medication or a minimally invasive surgical technique, such as Trans-obturator urethral tape placement(T-O-T), site specific cystocoele repair with dermal allograft or collagen biomesh or Avaulta bladder suspension.

Your treatment options using these cutting edge approaches to incontinence surgery will be discussed between you and Doctor Salerno to enable you to make an informed decision regarding your care.

Anterior intra-vaginal sling placement for genuine stress incontinence

THE SURGICAL TECHNIQUE
Traditional surgical techniques were based on an inaccurate understanding of the anatomy and physiology of the female pelvis, and often led to complications such as urge incontinence or prolonged retention of urine, requiring long term catheterisation. Long term results were poor.

It is now realised that what keeps a woman dry is mainly a ligament arising from the pubic bone, which is attached to the mid-point of the urethra. When you cough, the pelvic muscles pull the upper part of the urethra backwards and downwards, thus kinking and closing the urethra. If this ligament is weakened, the urethra cannot close properly and leakage occurs.

The operation involves passing a special tape under the midpoint of the urethra to strengthen, support and replace the weakened ligament.. Collagen grows into the tape, creating a new ligament. By restoring the anatomy, post-operative retention of urine and other problems are usually avoided and a catheter is not normally necessary.

The technique has undergone modification since it was introduced in 1998, and currently in excess of 95% are completely and permanently cured.



A LEADER IN THE TREATMENT OF VAGINAL PROLAPSE

Vaginal prolapse is a common condition and can cause symptoms such as a sensation of a vaginal lump, constipation, difficulty emptying the bowel or bladder or problems with sexual intercourse. An operation is only indicated when the prolapse is symptomatic. The majority of women will have improvement of symptoms following an operation.

Some women will be suitable to try a vaginal pessary instead of surgery. This is a device that supports the vagina and requires removal, cleaning and reinsertion every 4-8 weeks at the doctor'soffice.

Previous experience has shown that about 70% women undergoing conventional vaginal prolapse surgery have a successful outcome. In women with very weak muscles and tissues and in those women in whom a previous operation has failed it can be useful to reinforce the weak natural tissues with something stronger. This is with the aim of reducing the risk of the prolapse returning. Various materials can be used each having its own pros and cons. These operations can be performed in combination with various other procedures.



What are these materials?

Mesh is a synthetic nylon material and is permanent (Prolene, Softmesh, Pelvitex).

Mesh has been extensively used in surgery, especially in hernia repairs.

The mesh has many holes within it to allow the body's own tissue to grow into the mesh. The mesh then provides a framework of support.

Any mesh that doesn’t have properties such as this including those with a very dense weave should be avoided as they do not allow the body to grow into them as easily.

What happens during surgery?

Women undergoing a vaginal prolapse surgery can have the operation with a regional (spinal) anaesthetic or a general anaesthetic. There will be incisions inside the vagina and the tissue supporting the vagina will be strengthened with stitches. This may be at the front (cystocele or anterior repair) or the back walls of the vagina (rectocele or posterior repair) or both. The reinforcing material is then placed underneath the vaginal skin and provides reinforcement of the weakened vaginal tissue. The body’s own tissues will then grow into it within 3-4 weeks.

The reinforcing material needs to be fixed onto a solid attachment. This may be bone, the cervix (neck of womb), or ligaments at the side of the pelvis. An additional stitch (sacrospinous / Ileococcygeal stitch) may be required at the top of the vagina or into the cervix to support the vagina. This stitch may occasionally cause some discomfort in the buttock which is usually temporary.

At the end of the operation a catheter will be inserted into the bladder to drain urine and a material pack may be placed in the vagina to prevent bleeding for the first 6-12 hours post-surgery.

Antibiotics are usually adminstered during the surgery, and you will be asked to take antibiotic tablets for a few days after the surgery.

Are there any complications?

Possible complications and discomforts from vaginal surgery for prolapse include pain, infection, perforation of the rectum or bladder (very rare), recurrence of symptoms and/or prolapse, and pain with intercourse.

Whenever mesh is used, there is a small risk (about 5%) of mesh coming through the vagina. This is usually treated with oestrogen if the vaginal skin is thin or a small vaginal operation to cover the mesh.

There are general risks involved with having an operation, including the anaesthetic, bleeding and blood transfusion, infection within the pelvis or wound and clots in the legs that can travel to the lungs.



Recovery time

Most women stay in hospital for 8-24 hours. You will be sent home once you are feeling well and once you are able to pass urine with no problem.It is important to rest after the operation and allow the area to heal. Generally it is recommended:

You restrict activity for two weeks.

After 2 weeks do light activity only.

Avoid heavy lifting for 6-12 weeks, including shopping bags, washing baskets and children.

Abstain from sexual activity for 6 weeks.

Avoid playing sport for 6 weeks.