Urinary Incontinence

How is urinary incontinence diagnosed?

The diagnosis is made by a gynecological examination that includes testing for relaxation of the pelvic floor and rectal sphincter, a neurological examination that examines perineal reflexes, and a urodynamic examination that assesses the amount of urine loss and the type of incontinence.  Depending on the patient, the doctor can proceed to check the filling and emptying of the bladder or check the mobility of the urethra.

Urinary incontinence: What is the appropriate treatment?  Is there immediate treatment?

The treatment of urinary incontinence with surgical methods has spread and been recognized worldwide, including simple or combined techniques such as the placement of incontinence tapes ((TVT or TOT) or colporrapies that restore cystorectoceles as well).

In the modern era and in view of the economic crisis, easier and less traumatic techniques are sought.  The invention and application of a revolutionary type of laser called the erbium laser is coming to mark the new day in incontinence treatments.

More specifically, with the use of the intimalaser, i.e. the special application of Fotona’s dynamis pro, endogenous collagen production is activated, below the urethra, which results in the natural strengthening of its supporting mechanism, correcting stress urinary incontinence.

The use of the laser at the Forever Skin Laser Gynecological Clinic is painless and has a low cost, in sessions lasting about 20 minutes.

Depending on the degree and severity of incontinence, 1-3 treatments are required to fully restore the normality of urination.  The duration of the effect of the treatment varies, depending on the anatomy and the quality of the patient’s tissues, from 1.5 to 2 years, where of course you can restore the previous effect with a repeat treatment.

It is a fact that the non-surgical restoration of stress urinary incontinence is the future of the correction of the disease, because it non-traumatically intervenes in its background and restores the damage in a painless way, without the patient undergoing painful and expensive surgeries.

It applies to all age groups and has excellent results, while it can simultaneously restore coexisting cystorectoceles, improving the anatomy and overall functionality of the vagina.

Conservative therapy

Before the woman undergoes the erbium laser, she can try Kegel exercises, which improve the symptoms of incontinence.  It seems that women who tried them generally saw poor results, so they are recommended with caution as a first step for some women with incontinence.

For postmenopausal women, it is possible to administer estrogen as medication, as a first treatment strategy before laser.  Lack of estrogen can cause weakening of the urethra and bladder.

What is urge incontinence?

This form of urinary incontinence usually concerns older women and practically means loss of urine involuntarily to a different degree, but which occurs automatically, sometimes without warning.

This loss of urine often happens at night while sleeping or when waking up in the morning where the woman does not even have time to reach the toilet even if it is next to her.

Urge incontinence is not related to movement, weight or other pathological causes but is caused by a sudden activation of the detrusor muscle of the bladder and it is often impossible to hold back the urge to urinate.

Pathognomonic, a hyperactivity is found in the urinary bladder and its muscular substrate and is due to damage to its nerves, which is aggravated by the lack of hormones in menopause as well as with age.

Thus, urge incontinence concerns women after the age of 55-60 and with possible concurrent neurological problems such as stroke, multiple sclerosis or other degenerative diseases, hypertension, diabetes mellitus, depression, epileptic disorders, etc., while almost always vaginal atrophy coexists.

It is therefore understood that there is no direct and surgical treatment for urge incontinence (detrusor instability) but only pharmaceutical, using anticholinergic drugs.

Recently, some new treatment methods have been introduced in the field of treating this difficult and annoying pathological entity, which, while not the golden rule of treatment, often have very good results and thus improve the quality of life of the patients who suffer.

More specifically, the use of a special type of laser (the erbium laser) with the ability to produce collagen from the deeper layers of the vagina is the primary treatment measure as the increase in elasticity and the local estrogenization of the vagina seems to affect the function of the neural networks of the vagina.  .

After restoring the hormonal structure of the vagina with 2-3 laser sessions and depending on the results and the progress in the patient’s clinical picture, the next step is to use an injectable PRP solution, a solution with the patient’s blood plasma term, enriched and with activated platelets as  pluripotent cells.

The local injectable treatment for the improvement of urge incontinence is carried out in a painless way, after the application of analgesic ointment and injection therapy throughout the mucous membrane of the bladder and also of the vaginal floor.

The action of this special PRP is based on neoangiogenesis and neoneurogenesis of the epithelium of the urinary bladder.

This renewal of the epithelium brings a nervous renewal and redistribution of the blood and nerve structures of the vagina, improving urinary continence.

PRP therapy together with erbium Laser alone or in combination with drugs and topical ointments are the most modern and effective treatment for urge incontinence.

Are there techniques to restore urinary incontinence?

The fall of the angle between the urethra and the bladder (vesicourethral angle), is the main anatomical etiology that causes urinary stress incontinence (GSI:genuine stress incontinence). In this type of incontinence, common activities such as coughing, sneezing, laughing, dancing  ,sex or weight lifting result in urine loss.  This of course makes the social, romantic and professional life of the patients difficult and reduces their self-confidence.

More specifically, the most important traumatic events that cause alteration of the angle of the urethra, resulting in stress urinary incontinence, are primarily pregnancy and natural childbirth in combination with age, genetic predisposition and possible weight gain, which results in the increase  of the pressure in the area.

The non-traumatic treatment with laser erbium (incontilase) is carried out in three sessions of 15-20 minutes each, painless and with a difference of one month from each other.  The patient can have contacts after it reduces their self-confidence. from 1-2 weeks after the end of each treatment.