Stress incontinence

Explanation and classification

Stress incontinence is an involuntary loss of urine from the urethra during exertion or physical activity.

Depending on how bad it is, 3 different degrees of severity are distinguished:

• Grade I: Urine loss during heavy physical exertion such as coughing, lifting or sneezing
• Grade II: Urine loss during light physical exertion (standing up, walking)
• Grade III: Urine loss while lying down

Causes

In women, a general weakness of the pelvic floor is the most common cause of incontinence. Risk factors are multiple vaginal deliveries and overweight.
In men, stress incontinence usually occurs as a result of operations in the pelvic floor area (postoperative stress incontinence), but injuries can also be a cause.

How is stress incontinence treated?

Conservative treatment:

Minor forms can be successfully treated with pelvic floor training or special physiotherapy. During and after the menopause, local or systemic hormone substitution with oestrogens may be useful.

Surgical treatment:

If physiotherapeutic treatment has not brought the desired success, surgery can improve or even cure stress incontinence. There are many different surgical options available for this. Which operation is the right one for you can only be decided after a comprehensive examination.

• • Urethral injections

  In these operations, a kind of erectile tissue is injected through the urethra under the urethral mucosa. This makes the urethra seal better. This operation can be performed under local or short-acting anaesthesia. The success rates are 60% improvement and healing. A second injection after 4 weeks can improve the success rate. Residual urine checks are also necessary here.

• Tape surgery

  (insertion of a synthetic tape under the middle urethra)

  This procedure is the most frequently used operation for stress incontinence. Through a small incision in the vagina under the urethra, a synthetic tape is led either towards the inner thigh (transobturator tape) or behind the pubic arch (retropubic tape). The tape should lie tension-free under the urethra. All currently available types of mesh are inserted in our clinic.

  The procedure can be performed under spinal anaesthesia or under a short general anaesthesia. The duration of the operation is usually 15 - 20 minutes. After the operation, residual urine checks must be carried out to ensure that the bladder empties well. It is very occasionally necessary to loosen the tape a little after 1 - 2 days.

  The probability of success for these operations is an 80 - 90% chance of improvement or healing.

• • Lifting of the vagina through an abdominal incision (colposuspension)

  In certain situations a colposuspension is the appropriate operation. In this procedure, the vagina is lifted via an abdominal incision and fixed with sutures behind the pubic arch. This stabilizes the bladder neck. This operation is usually performed under general anaesthesia and takes about 45 minutes. After the operation, residual urine checks are necessary. The prospects of success are a 70 to 80% chance of improvement and healing, depending on the previous history.

You will be informed in detail about the risks and possible complications in a pre-op consultation.