still have problems with incontinence

  Had a total hysterectomy and bladder repair done in 1996. The problem of wetting when coughing or sneezing are gone, which is great, but, whenever I have to lift something or get shortness of breath ,I have no control over my bladder.  It just pours out whether I have the urge to go or not.  This is so embarrassing, especially when it happens at work. I thought for sure when I had the surgery this was fixed.  What do I have to do.  Any suggestions?  

[hfhs M.D.-AK]

Dear Faye,
I think you need to go back to your Urologist, or Uro-Gynacologist, who did your surgery and explain your difficulties.  He or she can determine by history if your bladder is contracting when it is not supposed to, or when you lift something, your abdominal pressure increases so much, you lose urine.  Stress urinary incontinence, which it sounds like you had and still have a mild form of, is divided into three categories (primarily divided by the fluoroscopic or radiologic evaluation). The definition of stress urinary incontinence(SUI) denotes involuntary loss of urine when the total intravesical pressure exceeds the maximum urethral pressure in the absence of bladder activity. Type 1, is incontinence without primary sphincter incompetents and on fluorourodynamics(FUDS) a bladder above the pubic bone.  Type two SUI is a competent sphincter with a bladder below the pubic bone on FUDS.  Type three SUI  is an incompetent urinary sphincter(weak muscle).

I think a sling operation may correct your symptoms, but the proper testing and physical anatomy must be present before this operation could be undertaken..  This could take care of your problem and you could expect a good result.  Sometimes patients can experience the opposite type of problem, going into retention(not empty) until their bladders have a chance to compensate.  Overall, you need to talk to your doctor.  There are other options, such as medications, and these may not benefit you.  Surgery is always a big decision so talk to your doctor and come up with a plan that is best for you.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Incontinence