Diagnosis and treatment of urinary incontinence

Incontinence is a big problem not only from the health and hygienic point of view but also from social reasons. Uncontrollable leakage leaves you with a damp feeling all day which might negatively influence your everyday life and self-confidence. When talking about older people, 40% female and 20% male patients deal with incontinence. Besides these, the number of young female patients rises every year.

Incontinece of women statistics:

  • Women 15 – 64 years old - 5-20% cases
  • During pregnancy - 60% women
  • After giving birth - 32% women

At GynCentrum, we have prepared a special examination room for consultations and gynecological examinations. We respect all individual needs of all our patients.

Causes of incontinence

The emergence of incontinence of women involves many factors, which affect the anatomical and functional stability of the lower urinary tract. These are for instance:

  • birth trauma
  • ligament insufficiency
  • hormonal status of the patient
  • age
  • long-term strenuous physical work
  • obesity
  • asthma, chronic cough

Incontinence may also arise as a consequence of a radical gynecological surgery, after spine injury or can be genetically inherited.

Diagnosis

During the first visit you will have an interview with the doctor, undertake a gynecological examination and fill out a Gaudenz questionnaire to determine the type of incontinence (stress and urge).

Furthermore you will undergo an urodynamic examination, during which the doctor monitors the pressure and volume parameters of the bladder and urethra while filling and emptying the bladder.

Another important examination is an ultrasound diagnostics which focuses on the urinary tract. It evaluates the mobility of the urethra, its shape and course and how it functions when under pressure. It is also important to determine the strength of the bladder wall.

Only three visits are usually needed for the whole diagnostics. Based on the results, the doctor will propose the most appropriate treatment for you.

The head doctor of the incontinence treatment at GynCentrum is MD. Daniel Struppl, Ph.D., who has many years of experience.

Incontinence types

The types of incontinence are divided by the cause and nature of the symptoms. For each type a different treatment is proposed.

Stress incontinence

The most common type of unintended leakage of urine is called stress incontinence, which occurs in about 35-45% of cases. By stress we mean physical stress. It may happen during coughing, sneezing, jumping, lifting the weight, sometimes while walking or changing position. It is usually associated with excessive mobility of the urethra and the lack of support or a weakened cap - when urethral sphincter deficiency (ISD). Treatment of Stress Incontinence is in most cases surgical.

Urge incontinence

Urge incontinence occurs in 25-35% of cases. It is characterized by unwanted leakage of urine, or excessive urination. It is caused either by overactive bladder, or damping reflections disorder leading to bladder outflow. The patient has a repeated need to urinate, frequent nighttime urination and pollakisuria (strong desire to urinate even though there is just a little urine in the bladder). This type of incontinence can be solved by using drugs that stabilize the function of the bladder and restore the appropriate frequency and volume of urine. In 20-40% of cases, the stress and urge incontinence occur together as a mixed incontinence.

Reflex incontinence

This form occurs in 5-10% of cases. It is a disorder of an urination reflex. It occurs in the spinal cord neurons after injuries or by other nerve diseases of inflammatory or degenerative origin.

Paradox Incontinence

It occurs in 5-10% of cases. Paradox incontinence occurs when the bladder overfills and the voiding reflex does not stop the unwanted leakage.  It may occurs for example after radical gynecological operations, sometimes even in states where a tumor or a descent womb hold repress the urethra.

Treatment of incontinence

Surgical treatment of urinary incontinence by TOT and TVT technique

The most common surgical procedure is TOT - Trans-Obturator Tape. During the surgery, a mesh (prolene) tape is placed underneath the urethra so that it acts as a support. It keeps the urethra closed off when laughing, coughing, sneezing or exercising.

The biggest advantage is that with the TOT method, the risk of harming the bladder is at minimum when compared with previously used TVT (Tension Free Vaginal tape) method.

Nowadays, TOT approach is a new Gold Standard in treating of female stress urinary incontinence.

There are two small incisions made to insert the TOT tape. The tape lies freely and functions only when there is any excessive intra-abdominal pressure during which the urethra has a tendency to decrease downwards. The urethra closes by applying the pressure on the tape and that’s to that there is no accidental leakage.

The procedure is carried out under a short 15 minute general anesthesia. The hospitalization is usually only for one night followed by a fast recovery. The recommended downtime after surgery is 1-2 weeks depending on a personal feeling. The success rate of this treatment is between 80-90 %.

Conservative treatment

Within the conservative treatment, the patients are examined by our doctor and a physiotherapist. A special exercise is recommended and shown to support the pelvic area. The exercise also helps the overall body alignment which may consequently improve the pressure in the pelvic area. At GynCentrum, we have devices that can monitor the treatment and show the level of development. By that we can see if the treatment is successful. More information about our physiotherapy can be found here.

For patients insured in the Czech Republic, the whole treatment is covered by the health insurace. The only extra payment may be needed for medication. For foreign patients without local insurance, please contact the receptions for more information or use our contact form.

Our clinic has a contract with the following health insurance companies:
111 Všeobecná zdravotní pojišťovna ČR
201 Vojenská zdravotní pojišťovna ČR
205 Česká průmyslová zdravotní pojišťovna ČR
207 Oborová zdravotní pojišťovna zaměstnanců bank, pojišťoven a stavebnictví
211 Zdravotní pojišťovna ministerstva vnitra ČR
213 Revírní bratrská pokladna, zdravotní pojišťovna
 

 

 

 

 

 

 

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