Stress urinary incontinence (SUI) – uncontrolled leakage of urine during exercise, coughing, sneezing, lifting heavy objects (with an increase in abdominal pressure). In the most severe cases incontinence also occurs at rest.
There are two types of incontinence:
- anatomical – associated with hypermobility of the bladder and the urethra,
- anal sphincter – associated with the weakening of the sphincter muscle.
Causes of incontinence:
- deliveries, especially when delivering a bigger baby
- menopause and postmenopausal period and related hormonal deficiencies,
- congenital malformations,
- urethral surgeries.
To SUI may be also caused by obesity, chronic cough, some neurological diseases, frequent urinary tract infections, constipation, heavy physical work, smoking.
Urge incontinence – incontinence caused by involuntary bladder contractions due to the excessive activity of smooth muscles (detrusor muscle). The patient feels the need to urinate, often disproportionate to the degree of bladder filling (even at low degrees of bladder filling). The detrusor hyperactivity can accompany bladder pathologies (kidney infections) and disorders of the central nervous system. In most cases of urge incontinence, no cause can be found. Acute urinary incontinence may be accompanied by frequent urination during the day and night, and the constant need to urinate regardless of bladder filling. Other causes include systemic diseases, such as diabetes, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, as well as senile dementia or e.g. taking drainage medications.
S. Wroński, P. Radziszewski, D. Lewczak, Pęcherz nadreaktywny i naglące nietrzymanie moczu – choroba jednostki czy choroba społeczeństwa. Etiologia i leczenie, [Overactive bladder and urge incontinence – a disease of unit or society. Etiology and treatment], Przegląd Urologiczny 5, 2010, 63.
Overflow incontinence – occurs when you are unable to completely empty your bladder, which leads to overflow. In this case, the bladder is filled, and its walls extended, with the result that urine leaks involuntarily. Urine left in the bladder is a breeding ground for bacteria. This can lead to repeated urinary tract infections. This type of incontinence is most common in men with prostate problems.
There are two surgical treatment methods of stress urinary incontinence: TVT and TOT. In both cases, an urological tape is implanted through the middle section of the urethra. These techniques differ in the application way of the tape. In the TVT case the procedure is performed with the vaginal access. The TOT method is performed with trans-obturator access.
Surgical methods give a 95% chance of early cure and about 85% cure rate after 5 years.
Complications are rare (10%). These include:
- damage to the bladder or the urethra (usually due to needle puncture while passing the tape),
- erosion of the bladder, vagina or urethra,
- urinary retention,
- urethral pain,
- urinary tract infection,
- disorders of micturition (urination),
- groin pain,
- migration of the tape / broken sutures,
- exudation of blood and/or serum,