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Stress Urinary Incontinence

STRESS URINARY INCONTINENCE (SUI)

Incontinence is a condition in which there is involuntary leak of urine.

Stress Incontinence is due to weakness of supporting muscles in the pelvis . As a result urine leaks out unintentionally during physical activities like coughing, sneezing, laughing or heavy lifting.

The incidence of SUI is more in females.
Weakness of supporting pelvic muscles commonly occurs in

  • Multiple vaginal deliveries causing over stretching of these muscles
  • Perimenopausal obese woman with previous vaginal delivery

Evaluation

Many a time SUI is accompanied with urge Incontinence ( a sudden need to urination). Both conditions may coexist together and often due to unrelated pathology , therefore your doctor has to subject you to various tests and examinations before determining the treatment that you require.

These are the important steps in the evaluation of SUI patients

  • A detailed history and physical examination
  • Blood and Urine analysis
  • Ultrasound scan
  • Urodynamics study (to assess the storage and voiding function of bladder)

Treatment plan :

In some patients conservative therapy (with exercise and medication) is enough , But others may require surgical correction.

Tension Free Vaginal Tape-Obturator

It is a minor operative procedure performed for the treatment of SUI , under anaesthesia.

Preoperative work up

  • Laboratory investigations
  • Anesthetic fitness
  • Physician fitness ( for older patients)

This is done before admission and before date for surgery is fixed.

At admission

You need to come 1 day prior to the procedure and directly take admission to room / Ward (as your preference)

On the day of procedure

  • You must be in fasting (no food or fluids) since morning on the day of surgery (at least 6 hrs prior)
  • You will be taken to theater 30 minutes before the procedure
  • Under anesthesia a mesh is placed in the anterior vaginal wall (support the urethra ) by one small incision in the vagina and 2 small skin incisions in the groin
  • Procedure usually takes about 30 minutes
  • There will a vaginal pack to prevent bleeding from the site which will be removed after 4 hrs
  • After the procedure you will be under observation in the postoperative ICU for about 4 hrs , then you may shifted to the room and can restart the diet
  • There will be a urinary catheter and you will be advised with antibiotics and analgesics

1st post operative day

  • Urinary catheter will be removed at early morning
  • You will be monitored and by evening you may be discharged with oral medications

Advice on discharge

Factors you should be careful about,

  • Any persistent cough and constipation should be treated properly
  • Avoid heavy lifting, squatting,and stressful activities
  • Avoid sexual intercourse for 4 weeks
  • Normal diet with more fluids and rich in fibers
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