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Stress Incontinence

Stress incontinence is an involuntary leakage of urine and is commonly associated with a loss of urine during a cough, sneeze or laugh. Some women experience leakage when doing physical activity such as sport or when bending over to pick up a child or a bag of shopping.

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What Causes Stress Incontinence?

Stress incontinence can be caused by a weakness of the pelvic floor muscles, which support the bladder and the urethra (the tube leading from the bladder.) When there is an increase in the pressure in the abdomen, for example when we cough, the muscles are unable to keep the urethra closed and urine can leak out.

What Causes This Weakness?

The weakness in the muscles can be caused by damage to these structures following childbirth or pregnancy. Following the menopause there is an associated change in the elasticity of the muscles of the pelvic floor. This is thought to be due to the reduction in the level of the hormone oestrogen.

Constant straining on the muscles of the pelvic floor, which may occur if you suffer with chronic constipation, can also lead to weakness. Other factors which may affect the function of the pelvic floor muscles are obesity, smoking or chronic chest problems with associated cough.

What are the Symptoms of Stress Incontinence?

Women rarely visit the clinic until the symptoms they are experiencing are affecting their day to day life. In the past there has been a stigma amongst women who suffer these symptoms and many have delayed seeking help. Symptoms include urinary leakage when there is a sudden increase in abdominal pressure, for example, during laughing. Some women experience leakage when they undertake physical exercise, such as keep fit classes. Many women complain of leakage during sexual intercourse. In some cases the leakage of urine lead necessitates the use of pads.

What is Mid-Urethral Tape?

Mid-urethral tape (MUT) is one way of treating stress incontinence using surgery. The tape, which is made of a mesh, is put around the urethra, creating a supportive sling. The tape supports the urethra and this allows it to remain closed, and stops urine leaking out if there is a sudden increase in pressure. The tape only provides support when it is needed, without unnecessary tension on the urethra.

The tape is inserted during a short operation using a local or general anaesthetic. The surgeon inserts the tape through two small incisions in the wall of the vagina. The tape is passed either side of the urethra and is passed onto the skin surface through two cuts near the pubic area. The tape is cut just under the skin surface, and at the end of the operation the surgeon closes the cuts in the vagina and on the skin surface. The tape remains in place and gradually body fibres grow through the mesh and hold it in place.

Is MUT Suitable for Everyone?

As with every operation, the doctor will want to ensure your general health is satisfactory to undertake surgery. MUT is used to treat stress incontinence when there are no associated gynaecological problems, such as fibroids or a vaginal prolapse. In these cases a different surgical procedure may be more suitable. This operation is not recommended if you plan to become pregnant. If this is a possibility, please discuss this with your gynaecologist.

Are There Any Special Investigations That Will be Performed to Confirm Stress Incontinence?

In order for the doctor to ensure you are receiving the correct treatment some tests will need to be performed. These will include urodynamic studies, and may include an ultrasound scan, or an M.R.I. scan.

What Happens When You Come into Hospital?

The procedure to insert the MUT is carried out under local or general anaesthetic, and you will be in hospital for 1 to 2 nights.

When you are admitted to the ward a nurse will show you around and take down details of your previous medical history and personal details. You will be seen by your consultant and the anaesthetist. If any further investigations are required, such as blood a blood test or an x-ray, these can be performed while you are on the ward.

What Will Happen After the Operation?

Following the operation you will probably feel very sleepy. The nurse will monitor your blood pressure regularly. She will be able to give you painkiller if you need them. After 3 or 4 hours most people are able to have a cup of tea and get out of bed. The nurses will encourage you to drink plenty of fluids so you can go to the lavatory.

You will probably be allowed to go home the day after the procedure, providing you are able to pass urine without difficulty and have made a satisfactory recovery following the general anaesthetic.

What Will Happen When You Go Home?

When you are discharged from the ward you may still be experiencing some discomfort when you pass urine and discomfort at the site of the stitches in the vagina and the pubic area.

Please ensure you continue to drink plenty of fluids. We recommend that you should drink one to one and a half litres of fluid a day.

You may resume normal activities when you feel able to do so. However, we advise you do not return to work for two weeks. Please avoid any heavy lifting for six weeks.

You will experience a vaginal discharge for 3 to 4 weeks as the stitches in the vagina heal. The stitches will dissolve and do not need to be removed by a nurse. Please wear a sanitary pad and do not use tampons. You should refrain from sexual intercourse for 6 weeks.

To prevent any extra pressure on the tape while it is new try to avoid constipation: a balanced diet and adequate fluid intake will help.

Your consultant will see you 6-10 weeks following the insertion of the MUT.

Are There Any Complications With the Insertion of a MUT?

Following any surgical procedure there is a risk of an infection. This may be a urine infection or an infection that develops at the site of the stitches in the vagina or on the abdominal surface.

Some women are unable to pass urine following the insertion of the MUT. This is usually because there is local swelling in the tissues which prevents the bladder from emptying. It may be necessary to pass a catheter (small plastic tube) into the bladder while the swelling subsides. It is sometimes necessary to release the tape if too tight, however this is very rare.

During the operation it is possible that the instrument used to insert the tape passes into the bladder. If this occurs it will be necessary to leave a urinary catheter in the bladder for three days to allow the bladder to heal.

Following surgery on the bladder or urethra a condition may occur in which the bladder contracts, causing leakage. This condition is successfully treated using medication, but is rare.

It is recognised that any surgical procedure carries a small risk of heavy bleeding, either at the time of the operation, or at any time up to 6 weeks following the operation. The incidence of bleeding following the insertion of MUT is small.

Further Information

In February 2003 the National Institute for Clinical Excellence (N.I.C.E.) published guidance on the use of mid-urethral tape. The Institute recognises MUT as one option for the surgical treatment for stress incontinence. In its favour, NICE commented that the hospital stay was shorter than with alternative surgery. The procedure is less invasive than some surgical procedures used to treat stress incontinence, with an associated reduction in complications.

The institute reported that information concerning long term effectiveness and problems were not available as it is a relatively new procedure. It recommends that all patients who undertake this treatment discuss all associated issues with their surgeon.

Information about his report can be found at www.nice.org.uk.

Useful Addresses

The Continence Foundation

307 Harron Square, 16 Baldwins Gardens, London EC1N 7RJ
Tel: 020 7831 9831
Website: www.continence-foundation.org.uk

Incontact (National Action on Incontinence)

Freepost Lon 12119, London SE1 1BT
Tel: 020 7717 1225
Website: www.incontact.org