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To Your Health: Talking about Incontinence and Treatments

by Ali Azadi, MD, MSc, and Sean Francis, MD last modified Apr 11, 2013 01:16 PM

Urinary incontinence is a condition in which you cannot control the flow of urine.

It affects about two in 10 women younger than age 65 and more than half of women age 65 or older. “Prolapse” means to fall or slip out of place. Prolapsed organs bulge or sag. Although this can sometimes happen quickly, prolapse usually takes many years. One in 10 women will undergo surgery for prolapse of the uterus, bladder or vagina.

Women often develop both prolapse and incontinence. Each may be caused by damage to the pelvic floor after delivering a baby. Constant heavy lifting, chronic coughing, severe constipation and obesity also may contribute to prolapse and incontinence.

When prolapse becomes more pronounced or when urine leakage becomes bothersome, it’s time to seek treatment. There are a multitude of practical solutions that can help you enjoy an active lifestyle.

Treatments for incontinence or prolapse might include: sacral nerve modulation (Interstim) and Botox injections to bladder for treatment of overactive bladder; pessary fitting and placement, which is a device worn inside the vagina like a diaphragm to provide internal support for prolapse; minimally invasive surgical repair using natural tissue (laparoscopic or robotic); and mesh, a synthetic material made in different shapes inserted surgically to support the urethra, bladder or uterus by means of a “sling.”

The use of mesh has become a hot topic, with lawsuits and the media warning women of its dangers. It is still a viable option, but it is not the only option.

Here are some things you should know about mesh:

  • Polypropylene is the most common mesh used in surgical procedure. The biggest advantage of mesh is that it lowers the rate of surgical failure by improving the anatomical success. Mesh also lasts longer than the use of natural tissue.
  • Risks include: Mesh absorbs inflammatory cells and causes scar tissue. It will be degraded by the body and potentially can migrate. There is also a possibility of infection. Treatment of the infection can be difficult since it is a foreign body and antibiotics cannot penetrate the mesh.
  • Potential problems include: With mesh, patients may experience pelvic pain, discomfort and pain during intercourse, urinary symptoms such as urgency and frequency. Sometimes the mesh can erode to the adjacent organs such as vagina, bladder and rectum. In some instances, the complications of the mesh require its removal via additional surgery.

UofL Physicians-Female Pelvic Medicine & Reconstructive Surgery providers have obtained specialized training for mesh placement techniques, in addition to training for all other possible treatment options. To find out what options are best for you, please call 502-588-4402.

Editor’s Note: UofL Today reprints To Your Health articles from the “UofL Physicians-Insider” newsletter. Read the entire April Issue (opens as a PDF document).

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