Women who submit to surgery for urinary stress incontinence should be aware that they may be taking part in what may be nothing more than a large scale clinical trial. Countless women's lives have been devastated by needless and ineffective surgery for urinary stress incontinence. During both a TVT surgery (tension-free vaginal tape), and the newer TOT (transobturator tape), a tape is drawn under the urethra. The theory is that the tape will support the urethra so that under the 'stress' of sneezing, coughing, etc., it will eliminate the leaking of urine that women who suffer from stress incontinence are familiar with. These procedures are most definitely not risk-free and leave some women suffering more after the surgery than before. "In most continence surgery the benefit of restoring continence is often at the expense of developing new symptoms, or exacerbating existing lower urinary tract symptoms". This is from a study undertaken by the Department of Urology, Mid-Western Regional Hospital, Limerick, Ireland, and the Department of Obstetrics and Gynaecology in the Regional Maternity Hospital, Limerick, Ireland, and documented in the National Institute of Health Sciences Bulletin, June 2004. The first TVT was performed in Sweden in 1995. The TOT was introduced from France in 2001. The long term results of these surgeries may be catastrophic for women. Follow up studies are generally carried out within three years of the operation. Three years is not long enough to qualify as a long term study considering the life-span of women today. Health services around the world are investing billions in solutions for urinary stress incontinence that may make the problem worse or create new problems. One recent hospital report states that 57% of women presenting for urodynamic evaluation over the course of the year had already had some form of pelvic surgery. Urinary stress incontinence occurs due to a weakness in the pelvic floor muscles. "There is a better way than surgery to correct most cases of pubococcygeal weakness" Dr Arnold Kegel, TIME magazine, 3 Dec 1956. The better way Dr Kegel, an American gynaecologist, and Associate Professor of gynaecology at the University of Southern California was referring to over 50 years ago is that of properly exercising the pelvic floor muscle against resistance. He was alarmed at the amount of pelvic surgery being carried out back in the 1940's. Resistance exercise was a method he developed which reduced the amount of unnecessary pelvic surgery, and often greatly improved the sex lives of the women who practised it – a welcome side-effect for once! Resistance exercise was found to be so much more effective than surgery in eliminating urinary stress incontinence in women that by 1950, routine surgery for urinary stress incontinence was no longer carried out in Dr Kegel's hospital. The success rate of 93% that Dr Kegel achieved with resistance exercise in alleviating urinary stress incontinence far surpasses the success rate acheived with today's 'minimally invasive' surgeries. "On the strength of these favorable results urinary stress incontinence in women is no longer routinely treated by surgical intervention at...LA County General Hospital." Dr Kegel (A progress in Gynecology 1950, p768). Resistance exercise must not be confused with the nonsensical instruction to squeeze your pelvic floor muscles against nothing. This cannot prevent or alleviate urinary stress incontinence in the same way that working the pelvic floor muscles against resistance can. Just look at any fitness gym – any muscle toning is ALWAYS done against some form of resistance. Pelvic floor exercises were never meant to be done the way they are taught today. They were ALWAYS meant to be performed against resistance. It could be argued that anyone who instructs women to squeeze against nothing may contribute to the problem, as women conclude that pelvic floor exercises don't work for them and opt for surgery as a result. A ‘repair job' can never be better than a woman strengthening her body to the degree that a ‘repair' is unnecessary. A ‘repair job' to alleviate urinary stress incontinence may cause more problems in the long term than it resolves. Both the TVT and TOT involve the formation of scar tissue to fix the mesh in place. It is often only a matter of time before the repair becomes ineffective as the weakness in the pelvic structure increases, and then the incontinence will eventually reappear. There may come a point after successive surgeries where no further surgery may be carried out. The woman may then be left permanently incontinent. Dr Kegel observed that scar tissue from previous surgery contributed to the failure rate of the few women who did not succeed with resistance exercise. More doctors today are becoming aware that resistance exercise, not surgery, is the answer to the problem of urinary stress incontinence. As resistance exercise becomes more widely practised we can expect to see a significant reduction in the numbers of women suffering from urinary stress incontinence and from the after-effects of a surgery they may have been easily able to avoid. A basic understanding of the value of resistance exercise would allow a woman to make a more informed choice about consenting to a surgery that may not be in her best long term interest. © Abigail O'Donovan 2007
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