Every month, Dr. Sobol answers your questions about incontinence. Email Dr. Sobol at firstname.lastname@example.org with your question.
Question: When being released from the hospital, after my hysterectomy, the nurse pulled out the catheter, and the pain was great enough for me to scream. I believe she forgot to release water from the bulb, thereby ripping the muscle. From that day, I have been unable hold in urine. Over the past 10 years, it has only gotten worse. Can this be corrected? How involved would the surgery be? How do I pose this to my GYN? Is this something he could correct, or do I need to see a urologist?
Dr. Sobol: It does sound like the catheter may have been removed without releasing the balloon. This unfortunately is not a totally rare occurrence. Usually, it does not cause long-term damage, and many women may experience some self-limiting incontinence. You describe a ten year history now of incontinence, that may be, at least in part, a consequence from the urethral trauma you described. I am sorry to hear that this has happened to you. The good news there are treatments available to you.
First of all, let me explain a bit of what appears to have happened to you anatomically. All urethra’s have what is call an intrinsic sphincter. This is the most important continence mechanism women have. It is basically a circular band of muscles that squeeze the urethra closed when you are not trying to urinate. Injury to this band of muscles is called “Intrinsic Sphincter Deficiency (ISD)”. Without this sphincter, you have some control over urination by consciously squeezing your pelvic floor muscles (Kegel exercises), but rarely is this enough to keep you dry. Injury can come from trauma like you described, childbirth, or from other pelvic trauma.
As far as treatment goes, surgery or some other procedure is the only way to treat this. There are no medications to fix this. The basic principle for correction is to help compress the urethra to keep it closed. There are urethral bulking agents available that doctors can inject into the lining of the urethra through a small scope that is passed through your urethra. Some doctors will do this in the office, and some elect to do it in the operating room with some sedation for you. This is not always a permanent solution, and you may need injections every 3-6 months. For some women who would rather not undergo surgery, or may not be healthy enough for surgery, this is a good solution,.
The surgery for ISD is actually not too big compared to all other surgeries. Doctors have their personal preference for performing the surgery, but the outcome is the same, to compress the urethra with some kind of material. In general terms, the procedure is referred to as a pubo-vaginal sling. There are different variations to this surgery which I will cover in my blog in the next couple weeks.
It probably would be a good idea for you to see a urologist regarding your problem for a full examination and work-up. Some GYN’s will do this type of surgery, but since your problem starts from the urethra, and not just the bladder, I would see a urologist too. Your GYN should not mind that you want to seek a consult from a urologist regarding this problem.
Question: I need some help. I had prostate surgery last November, and I also had a urethra blockage. My doctor took care of it. But I have problems with incontinence because of a fall and damaged spine. My doctor tested me, and said I have a Neurogenic bladder. I probably had it since last summer. Now when I go, my stream is weak. Sometimes I go 3hours before I go and it burns. I drink plenty of fluids. My signals are getting mixed up. I don't feel my bladder, unless it's really full. I am prone to infections so cathing is out. I think my spinchter is not working right. I just would like to hear what you say. I am calling my MD. I am getting a referral to a urologist. I'm afraid my kidneys are going to be damaged unless something is done.
Dr. Sobol: It sounds like you have a very complicated urologic situation with multiple issues. I will try to answer as best as I can, but I fully advise you to continue to seek urologic care with a urologist who can evaluate you in person, and examine you. It is also always a good a idea to get a second opinion. You may want to look for a urologist who has a background in neurology as well.
Having a spinal injury, as well as a urethral blockage can definitely cause a weakened stream. The cause can be because of a blockage itself (which even if treated can reoccur), or from a weak bladder muscle, which can happen because of your spine, or long-term damage to the muscle from the blockage.
When people have a hard time getting their bladder and brain to coordinate, I tell them not to wait until the bladder tells them to go, but to urinate according to the clock whether you feel the urge or not. Start by going every 2 hours while awake without fail, and see if it that doesn’t help a bit.
It’s also possible that you do not empty your bladder completely either. The recurrent infections may be from that, and catheterizing may actually cut down on infections. You would need a urologist to check what is left in your bladder after you urinate.
In regards to you thinking your sphincter is not working right, I can’t really say since I do not have the ability to examine you, but since you do have some spinal injury, it is possible, and you are correct that if left untreated, you may ultimately have kidney damage. The good news is that this takes quite some time to develop, so you have some time to work with your doctors and figure out what is really going on. I hope this helps. Please email me with any follow-up questions as well.
Published On: July 14, 2006