In the United States, urinary
incontinence affects more than 13 million people
and is twice as common in women as in men. Yet only 1 of
4 women with incontinence seeks medical help. Some incorrectly
believe that incontinence is untreatable or is a normal
consequence of aging; others are too embarrassed to talk
about it.
Stress Urinary Incontinence (See Web M.D)
occurs when urine leaks as a response to increase pressure
on the bladder. This occurs when the person coughs, sneezes,
laughs, stands, bends, jumps, or exercises. About ½ of all
women get stress urinary incontinence at some point, and
it becomes more prevalent with age. One in five women over
70 years of age have incontinence daily. Many women do not
feel comfortable talking about this problem with their doctor,
and never get evaluated or treated appropriately.
Incontinence is not a hopeless situation, although incontinence
is usually not an emergency but should be reported to the
doctor especially the Gynecologist, the Urologist, and now
the Urogynecologist.
Normal urination; the ability to hold urine and maintain
continence is depended on normal anatomy and function of
the lower urinary tract and the nervous system. Additionally,
the person must posses the physical & psychological
ability to recognize and appropriately respond to the urge
to urinate.
The process of urination involves two phases:
1.
The filing and storage phase
2. The emptying
phase.
Normally during filing and storage phase, the bladder being
to fill with urine from the kidneys, the bladder stretches
to accommodate the increase amount of urine. The first sensation
of the urge to urinate occurs when approximately 200ml of
urine is stored. The healthy nervous systems will response
to this stretching sensation by alerting you to the urge
to urinate while also allowing the bladder to continue to
fill. The average person can hold approximately 350ml to
550ml of urine. The ability to feel and store urine appropriately
requires functional sphincter (the circular muscle around
the opening of the bladder), and the stable bladder wall
muscle (detrusor). See the biolifedynamis.com/incontience.html.
The emptying phase requires the ability of the detrusor
muscle to appropriately contract to force the urine out
of the bladder. Additionally, the body must also be able
to simultaneously relax the sphincter to allow the urine
to pass out of the body.
Epidemiology
The prevalence of
urinary incontinence in women aged 15 to 64 years is 10%
to 30%. Among older women, prevalence estimates are 10%
to 40% in those who live in the community and 50% or greater
in those who are homebound or reside in a nursing home.
A number of risk factor for urinary incontinence have been
identified
(Table 1).
The 3 most common types of urinary
incontinence are stress urinary incontinence (SUI), urge
urinary incontinence (UUI), and mixed urinary incontinence
(MUI).
Treatment
An incontinence management plan should
be individualized for each patient.
85% - 90% of all stress urinary incontinence
can be successfully treated. That means that it is possible
to regain your independence, and return to an active, healthy
lifestyle.
There are a variety of treatment
options for SUI.
Please refer to (www.bardurological.com)
Behavioral Therapy
helps retrain the bladder and sphincter muscles
Bulking Therapy
is an innovative, non-surgical procedure to implant a bulking
agent-either natural collagen protein or another biocompatible
substance-into the tissues surrounding the urethra/bladder
junction to help reinforce the closure mechanism and prevent
accidental urine leakage.
Surgery helps rebuild
the urinary system’s architecture to restore normal bladder
function. One of the most effective surgical treatments
for SUI is the surgical implantation of a urethral sling.
It involves placing a slender strip of material underneath
the urethra to help support your natural tissues. It’s minimally
invasive, and is one of today’s most successful procedures.
In fact, hundreds of thousands of slings have been implanted
worldwide.
To learn more about
SUI, visit the National Association for Continence at www.nafc.org;
or visit the Simon Foundation for Continence at www.simonfoundation.org;
or download an informational brochure at the link provided
Urinary Incontinence Patient Brochure (PDF)
What we do at Valley Woman’s Institute
for Stress Urinary Incontinence
Effective Management of Incontinence
requires an individualized approach in which the physician
helps the patient formulate reasonable goals and experiences,
suggest appropriate treatment.
Here at Valley Woman’s Institute
Dr Alex Abbassi, an American Board
Certified Gynecologist, with over 30 years of experience
in Gynecology surgery and Urogynecology, uses his utmost
experience to treat women of all ages with SUI symptoms.
If it’s necessary he consults with urologist and other teams
of experts.
A.
Bladder training is an educational, and behavioral
process involving pelvic
floor muscle rehabilitation.
B. Mechanical approach such as
the use of bulking agent (Injection of Bulking
substances on and around the bladder neck on older individuals
who can not tolerate the surgery).
C. Surgeries, which include
the old approach (anterior vaginal repair in combined
with Kelly Plication technique, retro pubic suspension,
and Sling Operation).
The best of all Sling procedures is TOT
(Trans Obturator Tape).
Which is a French technique, easy to use and do not involve
any bladder or
bowel damages at the time of surgery. In addition do not
have the complication
of previously performed TVT procedures. However both
of these two techniques are considered Tension Free
Vaginal Tape.
Dr Alex Abbassi
is highly trained to perform the TOT
procedure. This operation is usually performed as an outpatient
surgery and is less painful with out bleeding complication.
Follow up data approximately five years after surgery indicates
90% improvement. However the TOT
surgery could be performed in combined with anterior vaginal
repair, and plication procedures. The result has been 95%
improvement and minimal complications.
Overall experience have shown that
85% of all patients are capable to urinate
spontaneously the next day after surgery and some are capable
to urinate within four hours after surgery in recovery room.
For more information about the technique
of TOT procedure
and use of Uretex T.O. Please see www.bardurological.com
