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Dr. Jacquelyn Paykel
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Home >> Gynecology >> Urinary
Incontinence
Gynecology & General Health
Urinary incontinence is the inability to control the release of urine from your bladder. Some people
experience occasional, minor leaks — or dribbles — of urine. Others wet their clothes frequently.   

Urinary incontinence — the loss of bladder control — is a common and often embarrassing
problem. The severity of urinary incontinence ranges from occasionally leaking urine when you
cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in
time.

If urinary incontinence affects your day-to-day activities, don't hesitate to see your doctor. In most
cases, simple lifestyle changes or medical treatment can ease your discomfort or stop urinary
incontinence.

Types of urinary incontinence include:  
Stress incontinence. This is loss of urine when you exert pressure — stress — on your bladder by
coughing, sneezing, laughing, exercising or lifting something heavy. Stress incontinence occurs
when the sphincter muscle of the bladder is weakened. In women, physical changes resulting from
pregnancy, childbirth and menopause can cause stress incontinence.

  • Urge incontinence. This is a sudden, intense urge to urinate, followed by an involuntary loss
    of urine. Your bladder muscle contracts and may give you a warning of only a few seconds
    to a minute to reach a toilet. With urge incontinence, you may need to urinate often, including
    throughout the night. Urge incontinence may be caused by urinary tract infections, bladder
    irritants, bowel problems, Parkinson's disease, Alzheimer's disease, stroke, injury or
    nervous system damage associated with multiple sclerosis. If there's no known cause,
    urge incontinence is also called overactive bladder.  

  • Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow
    incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you
    never completely empty your bladder. When you try to urinate, you may produce only a weak
    stream of urine. This type of incontinence may occur in people with a damaged bladder,
    blocked urethra or nerve damage from diabetes, multiple sclerosis or spinal cord injury.  

  • Mixed incontinence. If you experience symptoms of more than one type of urinary
    incontinence, such as stress incontinence and urge incontinence, you have mixed
    incontinence.  

  • Functional incontinence. Many older adults, especially people in nursing homes, experience
    incontinence simply because a physical or mental impairment keeps them from making it
    to the toilet in time. For example, a person with severe arthritis may not be able to unbutton
    her pants quickly enough. This is called functional incontinence.  

  • Total incontinence. This term is sometimes used to describe continuous leaking of urine,
    day and night, or the periodic uncontrollable leaking of large volumes of urine.   

When to see a doctor  You may feel uncomfortable discussing incontinence with your doctor. But if
incontinence is frequent or is affecting your quality of life, seeking medical advice is important for
several reasons:  Urinary incontinence may indicate a more serious underlying condition,
especially if it's associated with blood in your urine.  Urinary incontinence may be causing you to
restrict your activities and limit your social interactions to avoid embarrassment.  Urinary
incontinence may increase the risk of falls in older adults as they rush to make it to the toilet.

Adapted from:
Mayo Clinic - Urinary Incontinence
On July 13, 2011, the FDA released a safety communication on the use of synthetic vaginal mesh
(also known as transvaginal mesh or pelvic mesh) to repair pelvic organ prolapse. Pelvic organ
prolapse (POP) is a weakening of the pelvic organ tissues, resulting in "sagging" or dropping of the
bladder, uterus, or rectum into the vaginal opening. These bulging tissues can often be felt through
the opening of the vagina. POP can be caused by stretching that occurs during childbirth. It is more
common after a hysterectomy, after menopause, and with increased age. Surgical mesh is a
permanent medical material that is implanted in the vagina or the abdomen to strengthen the
vaginal wall and support the pelvic organs. The FDA, American Urological Association (AUA) and
Urology Care Foundation would like patients to know that treating POP with surgical placement of
mesh may cause complications for some patients.

Please understand that not all patients treated with synthetic vaginal mesh will have complications.
There is no reason to remove mesh if there is a good outcome and no complications. Also, many
of these complications may occur even if mesh is not used for POP repair. However, if you
underwent POP treatment with synthetic mesh, there are warning signs of which you need to be
aware:
    •Erosion: The most common complication experienced by patients, erosion occurs when    
    mesh materials protrude into the vagina. This may cause vaginal bleeding or discharge.
    Also, male sexual partners may experience irritation to the penis during sexual intercourse
    due to the presence of eroded mesh materials.
    •Sexual dysfunction: Pain during sexual intercourse.
    •Urinary tract infections: Frequent bladder infections could be due to the presence of mesh
    within the urinary tract.
    •Pain: Pelvic or groin pain.

If you are experiencing any of these problems, please talk to your surgeon. While one possible
solution is to remove the mesh materials surgically, non-surgical interventions may also correct the
problem.

If you are not experiencing any of these symptoms, you may continue with your routine scheduled
care. However, it is very important to be aware of the possible complications and carefully follow
postoperative instructions, see your physician for scheduled check-ups, and contact your physician
if you should begin to experience any problems.

If you have been diagnosed with pelvic organ prolapse and are considering surgery, it is important
to discuss with your physician the type of surgical technique and materials to be used. Some
suggested questions to ask your doctor include:

    •What type of mesh will be implanted?
    •How will the mesh be implanted (transvaginally or abdominally)?
    •Are there other alternative surgical techniques available?
    •How many of these procedures has the surgeon performed?
    •What complications have his/her patients experienced and how often?


To see the American Urological Association’s clinical position statements
click here.
Vaginal Mesh for Pelvic Prolapse Repair