Incontinence Treatment: More Information On Surgical Outcomes

  • I was happy to see some comments regarding my last SharePost, which discusses bad outcomes from incontinence surgery. I hope you all found the information helpful. Some questions were raised by one reader, and I am sure many others out there had similar questions but were afraid to ask, so here goes.


    Many people want to know if they will need to wear pads after surgery. It totally depends on how much leaking and how wet you were prior to the surgery. I find that most people can expect to improve about 70 to 85 percent from where they started. If you were soaking 10 pads a day, I would you would be able to get by with two to three pads a day that are damp. If you were only wetting three pads a day, I would hope you were pretty close to dry.

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    The vast majority of people will continue to wear some sort of pad for a while, or even lifelong, using it like a security blanket. Of course, everyone wants to be totally dry, especially if you have gone through surgery, but as we discussed in previous SharePosts, expectations are everything.


    Then there is the question about bladder infections. I didn't delve into this in the last SharePost, but it is a great question. Bladder infection is definitely a risk after surgery for a couple of reasons. First of all, any instrumentation of the urethra or bladder, like with a catheter, is at risk for infection. A study was done a few years ago that showed that 50 percent of people in the hospital for any reason ended up with a bladder infection.


    The other reason for infections after surgery is usually from incomplete emptying of the bladder, otherwise known as urinary retention. I always give patients the following analogy; have you ever left a bucket outside, and it rains? You will find there is clean rainwater in the bucket. If you leave the water outside in the bucket over the next couple days you will find the water gets pretty scummy.


    Now imagine that you have had urinary incontinence and have not had to have a full bladder for a long time. Your bladder muscle may have gotten a little weak and now that there is more resistance in the urethra it may become a little more difficult for you to urinate and you may not be able to empty your bladder all the way for a little while. Having urine staying in your bladder will definitely set you up for infections. Obviously, this doesn't happen to every one, but after surgery, you should make sure that your doctor checks out how well you are emptying your bladder. This can be done with an ultrasound or a catheter in your doctor's office.


    If you are not emptying your bladder, there are some things that can be done to help, from certain medications to learning to catheterize yourself for a little while. One thing to remember is that just because you had infections beforehand, you won't necessarily get them again, or get them worse.


    Sometimes, anti-incontinence surgery improves your rate of infection by making it more difficult for bacteria to creep up into the bladder. This is always a bonus for people who have had problems with recurrent bladder infections.


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    Sometimes I find that some women get persistent bladder infections for reasons that don't seem apparent. I run a battery of tests and can't find a good reason for the infections. There are many ways to treat this, but it usually involves some variation of treatment with antibiotics. That discussion is out of the scope of this SharePost at this time, but if you are experiencing some of these issues, you need to see a urologist for further evaluation.

Published On: November 30, 2007