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Contact & Location Details

Telephone: 9344 5099
Facsimile: 9344 5299
Call Service: 9387 1000
Email: office@drmarcuscarey.com

Main rooms and addresses for all correspondence and appointments:

Suite B, Level 2, Frances Perry House Consulting Suites (located in the Women's Hospital)

20 Flemington Road, Parkville, Victoria 3052

Dr Marcus Carey

Dr Marcus Carey is a Urogynaecologist working in both public and private practice in Melbourne. He is a Consultant Urogynaecologist at the Women's Hospital in Parkville, Melbourne. Dr Carey's private practice is located at Frances Perry Private Hospital located in the Women's Hospital, Parkville. He also operates at the Epworth Freemason's Hospital in East Melbourne.
Direct:
(03) 93445099
office@drmarcuscarey.com

Karen

Karen is Dr Carey's medical secretary.
Direct:
(03) 93445099
office@drmarcuscarey.com

Hayley

Hayley is Dr Carey's medical secretary. Hayley is also a registered nurse.
Direct: (03) 93445099
office@drmarcuscarey.com

Understanding Bladder Problems

Treatments

 / 

Bladder Problems

Information On Bladder Problems
Overview

Urinary incontinence is the involuntary or accidental leakage of urine. It affects 30 to 50 per cent of women. Although the rates increase with age, incontinence among young women is also quite common. Pregnancy, childbirth and ageing are considered to be among the most common causes of urinary incontinence; however, many other factors can cause urinary incontinence, such as some types of medication or a chronic cough.

Many women with bladder problems are reluctant to discuss it and may be too embarrassed to acknowledge that they have a problem. Sometimes women are made to feel that these conditions are ‘normal’, especially as they get older, and that, since bladder problems like this are rarely life-threatening, they are not really a problem, but the truth is that incontinence can have a very significant impact on your quality of life. The good news is that the majority of women who seek help for their bladder problems will experience significant improvement with appropriate assessment and treatment.

Female urinary incontinence can be grouped in several distinct categories. The most common type of incontinence is ‘stress incontinence’. Women with this problem experience urine leakage with increases in abdominal pressure (physical ‘stress’) from activities such as coughing, sneezing and exercising. The next most common type of incontinence is ‘urge incontinence’. This is often referred to as an ‘overactive bladder’. Urge incontinence occurs when you cannot hold urine long enough to reach the toilet in time. Urge incontinence is usually associated with a strong desire to pass urine. If you suffer from a combination of stress and urge incontinence then you have ‘mixed incontinence’. Often a woman may first experience one kind of leaking and find that the other begins to occur later. Other causes of urinary incontinence are less common and include overflow incontinence, fistula, functional incontinence and urethral diverticulum.

Non-surgical treatments for female urinary incontinence

Pelvic floor muscle training is used to strengthen the group of muscles and ligaments that support the urethra, bladder, uterus and lower bowel. The pelvic floor muscles also help to control bladder function such as allowing you to ‘hold on’ until an appropriate time and place. It is recommended that all women exercise their pelvic floor muscles regularly throughout life, to prevent or correct weakness. Exercising weak muscles regularly over a period of time can strengthen them and make them work effectively again. Around 75 per cent of women experience an improvement in stress incontinence with pelvic floor muscle training under the supervision of a physiotherapist or nurse with expertise in managing female incontinence. Pelvic floor muscle training can be used in conjunction with bladder retraining in the management of women with overactive bladder symptoms such as urinary urgency, frequency and urge incontinence.

Women with overactive bladder (urge incontinence) often benefit from a range of medications that can relax the bladder muscle. These medications are generally effective in 80% of women and can be prescribed by your general practitioner.  Lifestyle changes such as reducing caffeine and alcohol intake, quitting smoking, weight reduction and avoiding constipation can improve bladder function.  For women with urge incontinence who fail to respond to medication, surgical treatments can be offered, such as botulinum toxin injections into the bladder and sacral nerve neuromodulation.

Mid-urethral sling operation

There are various surgical options for women with stress urinary incontinence. Mid-urethral sling is a piece of surgical tape that supports the urethra. It is offered to women with stress incontinence who need support to the middle section of the urethra in order to stay dry. This is usually because the muscles and the nerves in this area are no longer working properly. This operation is sometimes performed in combination with other procedures such as vaginal repair surgery for prolapse.

  • The advantages of mid-urethral sling surgery are:
  • a quick recovery time
  • minimally invasive surgery
  • often performed as a day procedure and you may be able to go home on the same day
  • usually there is very little pain afterwards compared to other operations
  • may be combined with surgery for prolapse

What happens during surgery?

  • Women can comfortably have the operation with a local anaesthetic and some mild sedation, or with regional or general anaesthetic.
  • You will have one small incision in your vagina and two on your lower abdomen, or your groin.
  • A special tape is looped under your urethra to provide lift and support.
  • At the end of the operation the surgeon may look inside your bladder with a medical telescope (cystoscopy) to check for bladder injury.
  • The operation takes about 15 minutes to perform.
  • There are two types of slings that Dr Carey most commonly uses, they are:
  • the TVT retropubic (tension free vaginal tape) sling that requires two small incisions at the lower abdomen and a small vaginal incision.
  • the TVT trans-obturator that requires two small incisions in the groin
  • Dr Carey will talk with you about the most appropriate sling for you.
Mid-stream Urine Testing

Mid-stream urine testing checks for bladder infection (cystitis). Urine is collected mid-stream into a sterile container and is then checked for possible infection. If infection is present the correct antibiotic to treat the infection is determined (this may take a few days).

Antibiotics are often started before the results of the MSU are available, especially if you have symptoms highly suggestive of a bladder infection or if a “dip-stix” test of your urine is positive for likely infection. Sometimes, the antibiotic needs to be changed after the results of the MUS are available.

Urodynamics

What is urodynamic testing?

Urodynamics are a way of testing the functions and behaviors of the bladder and the urethra (the tube that leads from your bladder to the outside). The test usually involves the placement of a very small catheter, or tube, in the bladder, and another small tube in the vagina or the rectum. Sterile fluid is then used to fill the bladder, so that your doctor can tell how the bladder behaves as it is getting full.

Why is urodynamic testing necessary?

This kind of testing can be very helpful to figure out what parts of your bladder and urethra are functioning correctly, and which parts are not. The reasons that a woman might be experiencing incontinence, urgency, or difficulty emptying her bladder can be very complex, and these tests help to figure out what might be going on, and the best way to help get better. The results of these tests will often help your doctor determine the best treatment for you.

Are Urodynamic tests uncomfortable?

The testing should not be painful. An anesthetic gel solution may be used, and the catheters are generally very small. As your bladder is filled with sterile fluid, you may feel as though you have the urge to urinate. These sensations are an important part of the test itself, so be sure to tell the staff what you are feeling. You may be asked to cough, bear down, or other maneuvers which might make you leak urine; do not worry about this. It is important to remember that these tests can often help you find the right treatment to fix these problems.

Some people have mild burning or irritation when they urinate after the test; this should go away within a day. You should be able to resume your normal activities after testing.

What preparation is required before testing?

Your doctor may request that you arrive at the office with a full bladder, if you can. Your doctor may also check for a urinary tract infection in the days before the test, which will require leaving a sample.

About Cystoscopy

What is cystoscopy?

Cystoscopy is a way to look at the inside of your bladder. Numbing gel maybe placed in the urethra, which is the tube between your bladder and the outside world. After this, a tiny telescope is passed into the bladder. Sterile fluid is then used to fill the bladder, so that your doctor can see inside. This allows your doctor to make sure that there are no abnormalities or other problems which might be causing your bladder symptoms. The test generally takes between 10 and 30 minutes.

Why is cystoscopy necessary?

Sometimes, it is important to know if the inside of the bladder or urethra has any problems, such as stones, tumors, inflammation, or other problems which might be contributing to the bladder not working properly.

Is cystoscopy uncomfortable?

The testing should not be painful. The numbing gel helps to reduce any irritation; there is slight discomfort, but generally not pain. As your bladder is filling with water, you may feel the need to urinate. Some people have mild burning or irritation with urination after the test; this should go away within a day. You should be able to resume your normal activities after cystoscopy.

What preparation is required before testing?

Generally, no preparation is required. Your doctor may also check for a urinary tract infection in the days before the test, which will require leaving a sample.

Burch Colposuspension

There are various surgical options for women with stress urinary incontinence who have not responded to physiotherapy or medications. A Burch colposuspension is an operation which has been used for many years with good success rates. It avoids the use of synthetic mesh and is an option for women who do not wish to have synthetic mesh (mesh free incontinence surgery).

This operation can be performed in combination with other procedures.

The advantages to this operation are:

  • it has a good success rate of 80-85% of women becoming cured or significantly improved with their incontinence
  • research has shown that the success rate continues for many years
  • it may be performed as "keyhole" (laparoscopic) surgery. This depends on a number of factors and your doctor will discuss this with you
  • it may be used to add support to the front wall of the vagina.

What happens during surgery?

  • The operation requires you to have a full (general) anaesthetic.
  • The incision may be a lower transverse incision below the pubic hairline or 3 small incisions, if keyhole surgery is used.
  • Permanent stitches are then placed near the neck of the bladder and fixed to the back of the pubic bone (the bone at the lower part of the abdomen).
  • The wounds are then closed.
  • At the end of the operation the surgeon looks inside your bladder with a medical telescope to check for bladder injury.
  • The operation takes 45-60 minutes to perform.

Download your Bladder Diary:

Stress Incontinence: Urine leakage occurs with increases in abdominal pressure (physical “stress”) from activities such as coughing, sneezing and excercising.

Urge Incontinence: Often referred to as “overactive bladder.” Urge incontinence is the inability to hold urine long enough to reach the toilet in time. Urge incontinence is usually associated with a strong desire to pass urine (urinary urgency).

Mixed Incontinence: Refers to the presence of both stress and urge incontinence. For example, someone has the combination of stress incontinence (leaking with coughing, sneezing, exercise, etc.) and urge incontinence (leaking along with a need to get to the bathroom), this is known as mixed urinary incontinence. Often, a woman may first experience one kind of leaking, and finds that the other begins to occur later.