Midurethral sling surgery for stress incontinence a month ago, now a few questions.

[Beabun]

I had a midurethral sling for stress incontinence a month ago and have had no leakages with sneeze, cough, etc.  But my stream is still a little slow, sometimes slow in starting the stream, but the stream will be more forceful if I flex my pelvic muscles (such as which I learned when I had to take PT for SI).  My urologist told me not to strain much yet, and I don’t.  What bothers me most is when I’m done urinating, dribbling has stopped, when I stand up, it starts again, I sit back down, a few more dribbles, done again.  Then everything’s fine, out of the bathroom, going about my routines, and then when I sit down, I feel a discharge, as if a bubble popped.  Not sure if it is urine or vaginal discharge.  During the sling surgery, there were a couple tears of the vagina due to thinning I guess because of  low estrogen and my age of 53, which were sutured and no further problem.  I passed a few pieces of string, presumably those sutures on toilet paper after patting myself dry.  My specific question to you is could this discharge be either urine or vaginal or both?  It happens mainly when I go to sit down, as if something is pushing on my bladder to cause urine to leak, but not like before.  No pressure in bladder or vagina, no bleeding, and I’m premenopause.

[Kevin Pho, MD]

It is difficult to say without examination.  The discharge can be either vaginal discharge or urine.  

If there continues to be urinary incontinence, urodynamic studies can be considered, as well as a follow-up with your urologist who performed the surgery.

However, if there is evidence of vaginal discharge, a pelvic exam needs to be performed as well as an evaluation by a gynecologist.  

The source of the discharge should be evaluated and the aforementioned options considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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