Urinary incontinence is the loss of urine against our will. It afflicts millions of women around the world and unfortunately continues to be a taboo subject, with the result that many women do not seek appropriate medical help and suffer needlessly.

Incontinence is not an organic disease, but it dramatically affects everyday life and can lead to serious psychological problems. The woman feels old and stigmatized, giving up many daily activities and withdrawing into herself.

The relationship with her partner and her family life are seriously disrupted, since the woman feels insecure and ashamed. Especially the symptoms of an overactive bladder significantly limit a woman’s activities and sociability, while the presence of symptoms during the night leads to sleep disturbances with serious consequences.

We distinguish two forms of urinary incontinence:

• Stress incontinence: The woman loses urine when coughing, sneezing, laughing or lifting weights. In a more advanced stage, loss of urine is also observed when climbing stairs and walking, while in the final stage the loss of urine is continuous.
• Overactive bladder: Frequent episodes of sudden and strong need to urinate during the day, but also at night with or without loss of urine.

What causes urinary incontinence?

Stress incontinence is due to the relaxation of the sphincter muscle of the bladder, which is “responsible” for its tightness. Factors that lead to this relaxation are chronic physical fatigue, childbirth, menopause, etc. Incontinence occurs very often together with prolapse of the uterus and bladder (i.e. cystocele), since incontinence is also due to the general relaxation of the pelvic floor.

Overactive bladder is a phenomenon, which is due to an increased stimulation of the detrusor muscle, which is the muscle responsible for emptying the bladder.

What tests are required for a safe diagnosis of incontinence?

The diagnosis is made in the context of a simple visit to the gynecologist, through taking the history of the symptoms and performing an ultrasound. Urodynamic testing, a rather unpleasant and expensive examination, is no longer necessary.

What is the treatment for incontinence?

Treatment for stress incontinence is surgical. The operation is performed laparoscopically, that is, through three small incisions of half a centimeter to one centimeter in the lower abdomen and without vaginal trauma. During the operation, the sphincter muscle is strengthened, which leads to the treatment of incontinence. At MITERA, we apply the safest surgical method (Laparoscopic Vaginal Suspension), where the strengthening of the sphincter muscle is done laparoscopically with stitches, without the use of mesh, tape or other synthetic materials. If uterine prolapse and/or cystocele are present, these are again corrected laparoscopically in the same operation, so that the treatment of incontinence is effective. The woman can return home the very next day.

In some cases, an alternative and simple solution is the injection of hyaluronic acid, where as part of a cystoscopy, hyaluronic acid is injected into the area of ​​the relaxed sphincter muscle. So 3-4 “pillows” of solid hyaluronic acid are created, which cause a “narrowing” in this position, thus curing incontinence.

The treatment of overactive bladder is either medicinal or invasive. We have at our disposal several preparations that can lead to a reduction of symptoms. In case this is not enough, the treatment is invasive. As part of the Cystoscopy, which can be done under partial (intoxication) or local anesthesia, Botox is injected into the bladder.

After these operations, we always recommend special physiotherapy exercises in order to achieve a long-term strengthening of the pelvic floor.

The above operations offer a modern and safe treatment for incontinence and have several advantages, compared to previous techniques (eg vaginal tapes) that have been applied until now, the main one being the absence of long-term complications.

Mr. Dr. D. Panagiotopoulos, Scientific Associate of MITERA, is a Gynecological Surgeon specializing in Laparoscopic Surgery and Urogynecology. He holds the highest distinction MIC III of the German Society of Laparoscopic Surgery, while he is an internationally certified Trainer-Surgeon in Laparoscopic Surgery of the Pelvic Floor.