![]() Check perianal sensation and reflexes to rule out neurological deficits – the same nerve root supplied perianal sensation and the sphincter muscles.Perineum (look for urine leak with coughing).Examination – Abdomen (identify distended bladder).Check bowel function and other medications.Keeping a voiding diary may be useful including the volume of urine passed, frequency and any precipitating factors. A detailed history may indicate a relationship with certain activities or drugs.Botox to the bladder neck may also be considered.You should avoid giving these if there is a history of UC or glaucoma. Examples include oxybutynin and tolterodine. Often anticholinergic drugs may be used as these will reduce the activity of the autonomic nervous system (which will control bladder contraction in the lack of conscious control seen in conditions of brain damage). Drugs – there are several drugs available, although their efficacy is debateable.It might also be necessary to try aids, such as pads. Try a toilet regimen (perhaps every 4 hours) – the aim being to keep the bladder volume below that which triggers the incontinence. Often it involves a disabled patient with a CNS condition. Basically, this is very hard to treat.If there is a long history of vaginitis, and there has been no hysterectomy, consider treatment with cyclical progesterone, as this reduces the risk of uterine cancer. Test for vaginitis (inflammation of the vaginal mucosa).If this is present, then treat with estriol.Examine for spinal cord and CNS signs to determine if is it as a result of brain damage.Try limiting fluid intake and avoiding irritant foods. ![]() There is a 5% risk of incontinence or difficulty passing urine afterwards. ![]() It also means you can’t have children after you have had it done. It is more effective than a sling procedure, but is a much more serious operation. Cholposuspension – this is a large operation in which the bladder is attached to the posterior abdominal wall. ![]() It is does via the vagina under local anaesthetic, and can be done as an outpatient procedure. Tension-free vaginal tape (TVT)– this is a more modern procedure, and basically has fwere side-effects, and higher success rate than a sling procedure.There is a chance that the procedure will have to be redone within 10 years.The procedure involves open surgery, and thus there is a recovery period of 2-4weeks, although patients may return home after 3-4 days.The sling is attached to the abdominal wall, and lifts up the top part of the urethra thus increasing pressure around this region and reducing incontinence. A sling is created, either from native body tissue (such as fibrous connective tissue from the rectum) or man-made materials (such as telfon – although these are not as effective as natural body tissue). Sling procedure – this is about 85% effective and is the procedure of choice for most women.You can surgically alter the position of the bladder or the urethra to relieve symptoms of this condition: Surgery – if pelvic floor exercises are unsuccessful, another option is surgery. It will not cure the condition, but will relieve symptoms in about 50% of cases, but has significant side effects, including nausea, vomiting and abdominal pain This occurs due to dysfunction of the muscles that usually hold the uterus in place.ĭuloxetine – is a SNRI (serotonin-norepinephrine reuptake inhibitor) that is usually used to treat depression. A prolapsed uterus is basically where the uterus slips downwards – it may move so far that is protrudes out of the vaginal orifice. It is usually used to prevent prolapse of the uterus. Ring pessary – this is rubber/metal/plastic ring in which the cervix of the uterus sits. Intravaginal electrical stimulation may help, but many women find this unacceptable. Pelvic floor exercises – improves symptoms in 50% of cases
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