Female Urinary Incontinence: السلس البولي عند النساء
Urinary incontinence affects 60% of women between 40 -70 years, many women suffer in silence thinking that it is a normal aging process, and there is no treatment for urine leakage, it posses a tremendous physical, and psychological limitation to their professional and social life styles, and embarrassment in front to family and friends.
Child birth trauma, aging, constipation, chronic cough, and obesity are factors leading to weakness of pelvic floor muscles, and laxity of ligaments, causing lack of support to pelvic organs and urine leakage, usual symptoms are:
. Involuntary loss of urine with a cough, sneeze, laugh, or straining.
. Poor bladder control
. Frequent urination
. Compelling urge to urinate
. Loss of urine before reaching toilet
. Stress urinary Incontinence: (SUI) Escape of urine during a cough, sneeze or laugh
. Over Active Bladder: (OAB) Frequent Urination or a compelling desire to pass urine
. Nocturnal Enuresis: (NE) Unconscious bed wetting at night
. Overflow Incontinence: Overflow of urine after bladder is filled due to neurological causes
. Urinary Fistula: An abnormal passage between the bladder and vagiina
. Interstitial Cystitis: Recurrent inflammation of the bladder wall
Conservative: Non surgical for Over Active Bladder & Nocturnal Enuresis
– Behavior Therapy & Bladder retraining: (40% success rate)
. Urinating according to a schedule, gradually patient’s bladder control improves.
– Avoiding dietary irritants to bladder such as:
. SPICY FOODS – VINEGAR – CITRUS FRUITS – COFFEE – TEA – CHOCOLATE – ASPARTUM – SODAS
– Pelvic floor exercises: (Kegel Exercises) Higly effective when done properly.
– Physiotherapy: pelvic floor muscles electric stimulation.
– Medical treatment: Highly effective in OAB: Oxybutanin 5mg – Teltoradine 2mg – Sonafanicine 5mg.
– Artificial sphincter: Device inserted in urethra, and opens a valve for urinating.
– Vaginal pessaries & Urethral inserts (FemSoft) are used to temporarily control urine leakage.
Surgical: Treatment for Stress Urinary incontinence
– Burch Colposuspension: Old invasive method, rarely used nowadays (80% success rate)
– Peri-urethral Injection: Injection of collagen material in the peri-urethral space forming a sphincter.
– Laser Vaginal Correction: Incisionless technique, using Er:YAG laser thermal technology to shrink collagen fibers within the vaginal mucosa, around urethra and bladder base to support them and stop urine leakage
– Mid-Urethral Tape Slings (TVT – TOT – Mini Arc): a minimal invasive procedure, by which a tape sling simulating a hammock is inserted via the vagina to form a U shapes sling underneath and around the sides of the urethra, supporting and compressing it in cases of increased intra abdominal pressure like coughing or sneezing, to stop urine leakage.
* There are three generations of these Mid-Urethral Tape Slings (TVT – TOT – Mini Arc Sling), mechanism is the same and it takes 15 minutes to apply, newer generations carry less risks, side effects, and complications, patients can resume normal duties the day after surgery.(success rate 90%)
1st Gen. – Retropubic sling: (TVT sling)
2nd Gen. – Trans-Obturator sling: (TOT sling)
3rd Gen. – Single incision Sling: (Mini Arc Sling or TVT secure)
Urinary Fistula: الناسور البولي
An abnormal communication between the bladder and vagina(VVF), due to trauma to bladder wall, by delivery, pelvic surgery, accidents, or during conflict situations (Wars – Rape). Vesicl0-Vaginal Fistula can happen in prolonged obstructed labor, causing tissue necrosis to bladder wall, while Vesico-Cervico-Vaginal Fistula & Uretero-Vaginal Fistula happen as a complication of hysterectomy.
These types of fistulas are unfortunately still common in Africa.
Surgical treatment to suture and close the defect in bladder wall, vaginally or abdominally according to level, size, and site of fistula. Uretero-Vagianl fistula requires ureteric re-implantation in bladder wall.
Rectal & Fecal Fistula: Complete perineal tear الناسور البرازي
Surgical repair to re-suture anal canal, anal sphincter, vagina, reconstruct the perineum, after adequate bowel preparation
For medical inquiries contact:
Amr Seifeldin, M.D
Email: email@example.com or firstname.lastname@example.org