Answering Incontinence Community Questions - After a TVT Operation; Mesh Erosion

TVT Operation - Reader's Question: What can I expect after a TVT operation, in terms of pain, suture removal, voiding and sexual activity?

Read the original post on TVT operation.

TVT is short for Transvaginal tape and is a brand name for a type of sling called a midurethral sling.  There are many products like this on the market and the type of sling you have performed is often at the discretion of your surgeon.  We all have our favorite.

As far as the amount of pain you will have post-op will vary because people have different tolerances to pain, but in general I usually advise my patients that they should take two weeks off of work, but should be feeling pretty good after that.  Because of the minimally invasive nature of this procedure, you will need to really limit your activities for six to eight weeks. That means no lifting over ten pounds, limited bending and stretching and nothing in the vagina for 6-8 weeks; no tampons, no douching, no sex.

There should be no reason for suture removal.  The sutures should either all be under the skin, or absorbable and will dissolve over a few weeks.

The majority of women have no issues with voiding after the procedure.  It is not unusual for some women to have difficulty voiding in the short term after the surgery and may need to have a catheter or learn to catheterize themselves for a short time.  In general, most women are back to normal voiding patterns by six weeks post-op.  Very rarely does someone have to go back to the operating room to loosen the sling.

Mesh Erosion - Reader's Question: What causes mesh erosion and why are so many women suffering from this?

Read the original post on mesh erosion.

Mesh erosion after a midurethral sling is caused by numerous factors.  Erosion into the vaginal is by far the most common location of erosion, and the easiest to treat. The most common reason is from infection and the infection works it way out of the vaginal incision and the mesh erodes.  Another cause is that the vaginal incision wasn't closed appropriately and the mesh healing within the vaginal wall. 

Sometimes there is a significant amount of blood that collects within the vaginal wall and causes a disruption of the incision.  For erosion to occur into the vagina, there usually is a reason that the vaginal incision is disrupted.

Erosion into the urethra or into the bladder is a more difficult situation to remedy.  Usually, the tape is placed with too much pressure on the urethra or is misplaced into the bladder in the first place.  Removing and remedying this situation is complex but is not impossible.

The good news is that this doesn't happen very often.  To my knowledge and with my research, erosions are not very common and occur much less than five percent of all women who have had a sling. 

An Important Political Issue: Health Care Costs and Drug Prices

Incontinence - An Important Political Issue: Health Care Costs and Drug Prices IncontinenceNetwork.comIn Incontinence?In IncontinenceEntire SiteIn IncontinenceEntire Site Top Incontinence NewsUnderstanding Urinary IncontinenceCheck a SymptomIncontinence DrugsDoctors/HospitalsClinical TrialsIncontinence Web ResourcesThe First 48 HoursPreventionTreatmentTests and ResultsTypes of IncontinenceInsurance HelpOrganize your Caregiving Community! Meet Our CommunitySee All SharepostsSee All QuestionsSupport GroupsAsk the ExpertFree Newsletter.Sign up now!EmailPassword (Forgot Password?)Remember Me Thursday, August 05, 2010Incontinence Home > SharePosts > Health Professional > Jennifer Sobol, D.O. > An Important Political Issue: Health Care Costs and Drug Prices Font size A A A Email MoreRSS Save to My Home This helped! An Important Political Issue: Health Care Costs and Drug PricesRelated: Incontinence, FDA, Incontinence,  More Tags> Journal Entry ,  Fewer Tags> More Topics > Jennifer Sobol, D.O. Health ProfessionalUrologic Surgeon

Jennifer Sobol, D.O., is a urologic surgeon who practices general...

Send MessageSubscribeJennifer Sobol, D.O.Wednesday, December 12, 2007View All of Jennifer Sobol, D.O.'s Posts

Wow, is 2007 almost gone? I always find this time of year an important time to reflect on the year that is winding down and look forward to the upcoming year. This next year is especially important as we head into an election year. I usually shy away from discussing politics but there are hot topics that affect me and my patients.

 

Probably the most important political issue for me is health care costs. One of the hardest things for me to have to deal with is the cost of treating people. I often find myself being controlled by insurance companies telling what tests I can and can't order and what medicines I can and can't prescribe. I am torn between doing what is right for my patient from a medical standpoint, and what is best from a practical standpoint. I always try to take costs into account, but there is often a conflict of interest and I spend a lot of time writing letters to insurance companies explaining that their "approved" treatment will not work for my patient. I find it insulting that after all my years of training I am at the mercy of a pencil pusher. To be honest, I don't know the answer to the health care crisis in this country, but there needs to be an answer. Unfortunately, many of my favorite candidates have plans to help health care costs that I don't think are realistic or practical.

 

Along the same line is the cost of medications. Here is where I get on my soap box for a little bit. I often hear from patients about how the drug companies are wrong for charging so much for medications. I actually have to stand up for the drug companies and point out the root cause is bureaucracy. Granted, the pharmaceutical companies are out to make a profit, but at the same time they are trying to help people by controlling and curing their diseases. For every one drug that makes it to market there are between ten and twenty medications that don't make it. The amount of hoops that the companies have to jump through for the FDA is what is driving up the costs. I fully recognize that we need the FDA to monitor medications and keep us safe, but at some point we have to say enough is enough and allow the companies to cut some inconsequential corners. One of the most glaring examples is drugs in Europe. There are so many medications that have safely been on the market in Europe and when the companies bring it to the United States, they either have to pay the FDA an obscene amount of money to transfer the studies, or repeat the studies. Either way, it adds costs to the medications. Don't get me wrong, I strongly support the FDA, and know we need it, but there just has to be some other way that doesn't cost so much money.

 

I don't know the answer to these problems. If I did, I would be running for office myself. I do know that it is important to make sure that the candidate I vote for understands these issues in a practical way, and has a clear plan for the future.

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Tips on Purchasing Incontinence Products

With so many different products available nowadays that will manage incontinence it can prove difficult in determining exactly which ones to use. So in order for you to determine which sort of incontinence product you should be using we offer some guidelines below that you may find very helpful.

The things which you must be looking for when it comes to making purchase of such products are as follows:

1. What form of incontinence do you experience? E.g. Stress, urge and faecal incontinence all have different needs (e.g. high absorbency to cope with large amounts of liquid in a single episode for urge incontinence).

2. How easy are they to use? E.g. Can you put them on easily or will you need help? Products such as Belted All in One products are simpler for normal toileting than traditional All in One pads

3. Will they fit in comfortably with the kind of lifestyle that you like to lead? E.g. can they be removed easily? Pull up underwear is far easier for most mobile people.

4. How much comfort do they provide you with? E.g. a smaller incontinence product is more comfortable to be worn, even if it means slightly more frequent changing.

5. How durable are they? E.g. Would washable incontinence products suffice or do you need the extra absorbency of disposable incontinence products.

6. How much liquid can they retain before they need replacing?

Once you know the solutions to these questions then you can select the products that you feel are most likely to fit your needs well. Also of course you need to take into account your gender as the design of the product may differ for men and women.

So now you are going to buy some incontinence products but are still unsure exactly what to purchase? Here we offer a number of tips that you may find very helpful indeed.

Tip 1 – Don’t rush into purchasing the first product you come across it is worth spending some time doing some research into what is available. This doesn’t mean you have to spend hours going from one store to another instead why not look to see what is available by going online. There are various websites such as http://www.allaboutincontinence.co.uk/ that are experts in supplying such items and will provide you clear and concise specifics of how each product works.

Tip 2 – As you do carry out your research don’t limit yourself to one particular brand such as Tena. In this way you can get a better idea about how much the item you are considering purchase will cost. As you will soon discover the prices can vary quite a bit from one brand to another and you could end up saving yourself quite a tidy sum on your purchase by spending those few extra minutes doing some comparison shopping, or feel that the extra spent on a quality brand is worthwhile.

Tip 3 – It is important to know that the designers of incontinence products such as Tena and Lille don’t tend to use the same sizing systems. Plus the way that these products are made means that the way that they fit will differ quite a bit. So make sure that you check the size charts for the various products carefully to ensure that you get the right size that will fit well but also comfortably.

It is also a good idea to try several different products out before you make your final purchase for example by purchasing a incontinence sample pack.

Hopefully the tips we have offered above when it comes to purchasing incontinence products will ensure that you manage this kind of problem more effectively. So of course allowing you to lead the kind of lifestyle you want.

Incontinence Help for Holidays

Lounging on a beach towel under the hot sun whilst watching children construct sand castles and listening to the ocean are some of the simple pleasures of a relaxing holiday. After all, the main objective of taking a holiday is to get in some much needed relaxation. The last thing anyone needs is to be worried about finding the closest toilet while in the middle of the beach, museums, amusement parks, traveling, etc.

For the millions of people who experience urinary incontinence, travelling on planes, trains, or cars is possible with the help of many incontinence products. Urine leakage always seems to happen at the worst possible time, and learning to manage it while travelling will prevent a stressful holiday.

Planning a holiday is time consuming especially when plotting around incontinence. Having incontinence products shipped to your home in advance via a home delivery company, such as Allanda saves time and cost whilst preparing your trip and also means you can be sure of having finding the right products for you. Having incontinence products delivered right to your door each month saves you the hassle of rushing out to the shops when your supply is low at anytime.

You could also organize a delivery of products to your holiday location if you are traveling in the UK.

Other simples tips and advice for how to manage incontinence while traveling are:

Transportation: Always allow for delays and hold up’s whilst traveling so plot where toilets will be available on route, and also take the opportunity to use the toilet ahead of needing it to avoid being caught out.

Diet: Ensure sufficient liquids are drunk to maintain hydration but avoid too many caffeinated drinks or too much alcohol which can stimulate the bladder.

Travel Kit: Carry a travel kit containing spare pads, wipes and cleansing products and also hygiene bags for disposal of products in case bins/disposal methods aren’t available when you need to change pads or products.

Living with incontinence is simple and distress-free if knowing how to manage and control the urinary leakage. With all the variety of incontinence products available, traveling can be more effortless than ever before. Worry about having fun on holiday, and don’t worry about incontinence.

Continence care is going down the pan as costs are cut and prices rise

A recent article by June Rogers MBE of Promocon on Nursing Times.net has summarized many of the issues faced by Continence services as continence nurses are being forced to restrict types and quantities of products, regardless of need.

“We know the NHS will have to save £15-20bn over the next five years.

Health secretary Andrew Lansley has said that this “implied something like 3-3.5%, probably about 3%, efficiency savings each year in the NHS… we may need to do more, because we have increases in demand”.

On the ground, we have all been told we need to make significant savings within our individual departments of approximately 10% of our budgets. This means that those of us working in continence services are under considerable pressure to save, on average, more than £100,000 per year. This is almost impossible when we are already struggling on limited budgets, while the cost of disposable incontinence products and the ageing population who need continence care are both increasing.

The cost of continence products produced in the Eurozone has been dramatically affected by the exchange rate. Between 2007 and 2009, costs rose over 30%.

While the exchange rate has moved slightly this year, industry has still seen a cost increase of around 28% since 2007. Products produced outside the Eurozone are affected by fluctuating local currencies. In addition, raw material prices are increasing and, as those used in continence products are priced internationally in US dollars, there will be a double hit as the euro is weak against the dollar.

The figures do not add up. We want to provide the same level of service, balance the books and save 10% at a time when products are costing nearly 30% more.
Continence services can only realistically seek to cut costs via efficiency savings, rather than on product price. However, many of us are frustrated that our ideas to improve efficiency are often lost within the bureaucracy of the NHS and because continence is not anyone’s “target”, which means it sparks little interest.

Particularly frustrating is the snail’s pace at which services are being transferred from acute to primary care, where they could be better served.

Yet it is disposable product provision that leaves many continence nurses in the line of fire. Calls to the PromoCon helpline, a charity that offers product advice, are increasing. Patients and families are complaining about the limited type and number of products for which they are eligible. The phrase “Don’t shoot the messenger!” often comes to mind as nurses are told by management to restrict the type and number of products they prescribe to save money. This means that many services are not able to provide products to meet patients’ needs.”

Tips to prevent frequent urination leading to incontinence

Making regular trips to the toilet to try to avoid incontinence episodes can be quite extremely tiring, not to mention frustrating.

One of the problems with incontinence and/or frequent urination is that it sometimes has the effect of discouraging people from drinking sufficient fluids, which can then lead on to dehydration.

Of course maintaining proper hydration is important, but so is staying dry, and on occasion, the need for frequent urination can end up resulting in light incontinence, especially in the elderly.

To help prevent frequent urination evolving into incontinence, there are some simple things that can be done to reduce the frequency of urination or the feeling of the need to urinate. Caffeine and alcohol are among the many foods that irritate the bladder, leading to incontinence. Both of these drinks are also diuretics, which encourage the body to lose liquids. Medications for high blood pressure are normally diuretics also, which can exacerbate the frequent urination symptoms, again leading to incontinence.

There are also a number of diseases that can manifest themselves as frequent urination (in turn leading to incontinence), so this is another reason that it is important to discuss any incontinence problem with your health professional. Two common causes are Diabetes and kidney disease, even more common is a urinary tract infection. In men frequent urination is frequently the result of an enlarged prostate gland, which again often leads way to light adult incontinence.
If there is any discomfort connected with frequent trips to the toilet, then you should seek medical advice immediately.

However, for the elderly, especially as mobility becomes an issue, frequent urination can be just the start a pattern of incontinence. If there is no infection or disease, then there are several things that can be done to address the problem of incontinence. Limiting liquid intake, but still ensuring that enough fluids are being consumed to remain healthy in line with guidelines, can be a start. Next, increasing the holding capacity of the bladder by gradually extending the time in between trips to the bathroom. This can be done by stretching the time by about fifteen minutes and increase the duration every week.
If medication that works as a diuretic is being taken then discuss with the doctor the option of taking this earlier in the day. This will help prevent waking throughout the night needing to go to the bathroom, or risk an incontinence episode like bedwetting.

Answering Incontinence Community Questions: How Does Bladder Augmentation Work?

Bladder Augmentation - Reader's Question: If a bladder is augmented, do the bladder muscles stop working completely? Or do they have limited function that won't allow the "new" bladder to empty completely, requiring periodic cathing?

This is an excellent question.  Several weeks ago, I wrote about options for improving bladder capacity and decreasing incontinence.  You raise an important question and one that certainly deserves to be addressed.

To briefly summarize my previous post, there are several different ways to augment a bladder, either to use bowel segments and attach them to the bladder, or to make cuts in the bladder muscle and allow the mucous (inside lining of the bladder) to pucker out.  In general, the purpose of bladder augmentation is to increase the capacity and to allow for more storage of urine, therefore decreasing the frequency a person has to urinate, and hopefully to reduce the number of incontinent episodes.  Another effect of augmenting the bladder is to lower the pressure inside of the bladder to reduce risk of injury to the kidneys due to chronic pressure.

Now, back to the question, will the muscles of the bladder work to empty the bladder normally after a bladder augmentation? 

The answer lies mostly in the status of the bladder's function prior to augmentation.  In general, for those people who qualify for a bladder augmentation, their bladders likely are not working all that well in the first place. 

The new portion of the bladder, which is really a segment of bowel, in usually not effective in contributing to the squeeze of the bladder and the majority of the time a person will have to catheterize themselves after a bladder augmentation.

In general, if you were to have a bladder augmentation, you should expect that you will have to catheterize yourself partially, if not exclusively to empty your bladder.  That being said, bladder reconstruction has been revolutionized in the last decade or so since we have started to create entire bladders out of bowel after removing a bladder for cancer. 

In years past, if a bladder was removed for cancer, a person's urine had to be diverted out through a stoma on the abdomen and then often into a bag, like a colostomy. 

For some time now, we have been using bowel to reconstruct a bladder and place it where the bladder used to be.  Not everyone can urinate on their own, and some people do have to catheterize, however, many people do learn how to use they abdominal muscles better and learn to "push" the urine out.

So, to finally answer your question, can someone urinate normally after their bladder has been augmented?  Possibly, but it is important to understand that self catheterization periodically or exclusively is a realistic outcome.  Most people are just so happy to be continent that they get over the issue of catheterizing themselves.