How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • Go back-and-forth until satisfied
    Rate the answer you receive.
Ask the-good-doctor Your Own Question
the-good-doctor
the-good-doctor, Board Certified Physician
Category: Medical
Satisfied Customers: 75415
Experience:  Medical Doctor
55099014
Type Your Medical Question Here...
the-good-doctor is online now

I am a 50 year old female who has been suffering from stress

This answer was rated:

I am a 50 year old female who has been suffering from stress incontinence since 2012. I was referred to a gynaecology consultant in 2013 and urodynamic testing showed bladder weakness when coughing. A pyridium pad test was positive. I was offered intrathecal injection or vaginal inserts or surgery which would have involved the use of a TVT tape. I was not ready to choose the surgical option so I opted to try the vaginal insert. The name of the vaginal insert was Contiform vaginal insert for female stress incontinence starter pack (issued Nov 2014). Unfortunately, I had trouble inserting the device so I was referred for physiotherapy. I was given a periform device to use at home as a stand-alone device. When I was in the hospital clinic, it was linked up to a biofeedback machine so that they could measure the progress. After a few weeks, the physiotherapy improved the strength of the pelvic floor muscles, but I continued to leak (I later purchased the Pericalm device for home use to use with the periform device). The leakage is continuous throughout the day as opposed to an acute event. I am aware that some ladies report that the leakage is worse after running or trampolining, but mine is a 24/7 issue. Unfortunately, I missed an appointment in 2015 due to unforeseen circumstances (bereavement) and was coldly discharged from clinic care before seeing the consultant again.Since this time, my symptoms have been ongoing. I asked a GP if I could be re-referred and was sent to a urologist instead of the original gynaecology team. The urologist just looked through my notes and said that I had had all the screening tests done and then asked me if I wanted to have surgery. As I was not in a position to consider surgery (due to the missed consultation in 2015) he said that he would liase with the incontinence nurse who saw me in the gynaecology clinic. When I followed things up, the nurse had not heard anything from the urologist and said that as the tests were out of date I would need to be re-referred again. The GPs have tried to prescribe tablets for stress incontinence rather than referring me back to gynaecology, but they do not work. I have had partial success using the Innovo physiotherapy shorts which I purchased in 2019, but other events such as shoulder surgery recovery and formal physiotherapy schedules on the shoulder and other parts of the body have meant that I have had to temporarily suspend the pelvic floor physiotherapy schedule. As I have a history of fibroids and polyps, I suffer from spotting/bleeding if I use the shorts with an intensity above50 mA. During physiotherapy I also get periods where my pants remain dry for a few hours and the urine is ‘pooled up’ and then a small spot of urine leaks out periodically, but I never achieve total dryness.Tablets prescribed:
Oxybutynin 5mg tablets: June 2012
Solifenacin 5mg tablet: October 2012
Regurin XL 60mg capsules: April 2013
Mirabegron 25mg modified-release tablets: May 2017
Solifenacin 10mg tablets: June 2019None of these tablets have worked. The Solifenacin 10mg tablets gave me blurred vision after just four days of use. It also caused muscle relaxation and made my stress incontinence symptoms worse. I actually asked my GP to remove it from my repeat prescription records. Due to this, I would not consider consulting the General Practitioner regarding the matter of stress incontinence again unless I was considering a surgical procedure. However, I had heard reports of vaginal tape being the cause of pain and distress in many women having a surgical procedure and was wondering if the use of a TVT tape is still commonly used? Whenever I resume physiotherapy it seems as though the muscles on the right hand side of my pelvic floor are weaker than those on the left hand side. Could this be a reason why I still suffer from leaks despite physiotherapy? I have never had any children.

Hello. I'm The Good Dr., licensed and practicing physician. Excellent service is my goal.

I'm very sorry about this.

Can I ask your age?

Customer: replied 7 days ago.
I am 50 years of age.

this sounds more like neurogenic bladder and overflow incontinence

Customer: replied 7 days ago.
How do we treat, diagnose or deal with this problem?

generally it is treated with self caths

a post void residual and urodynamic studies will prove it

Customer: replied 7 days ago.
Is TVT tape still commonly used for those patients diagnosed with stress incontinence?

No. Rarely if ever

the-good-doctor and other Medical Specialists are ready to help you
Customer: replied 7 days ago.
Sounds like I would require repeat investigations and up-to-date consultations, but don't know if I would get re-referred again, just given more tablets. Thanks for your response.