question-icon

Suggest treatment for urinary incontinence

default
Posted on Tue, 31 Mar 2015
Question: I am a 40 yr old female with Crohns dx, pelvic floor tension, pelvic adhesive dx, I.C. prolapse. I wear a ileostomy because of a 4th degree tear during childbirth which my rectum has never been the same. tests conclude I'm screwed. My question? my damn bladder is out of control. Its not that I am flaring right now for which I have Elmiron if need be but I'm leaking if I do not get to the rest room in time, major leaking. I had sex a week ago and when I climaxed (been 10 yrs) I actually peed on him! Embarrassed. How bad do I need to see a Urologist and how bad do I need a bladder lift. Keep in mind, my pelvic pain is no laughing matter. I take pain meds, mild for it. In addition, Had a hysterectomy (partial) in 2/11.
I would like to take the opportunity to describe, in my own words, the circumstances I find myself today and what has brought me to this point. I hope that you will take the time to read this letter and take it into consideration.

When I delivered my daughter in 2000, completely natural, I was able to handle pain. Unfortunately after the birth of my child I suffered a 4th degree tear. What started out as a little gas passing from the rectum into the vagina became a nightmare.

My OBGYN, Dr. XXXXXXX Clinch, initiated a minor repair on the “rectal-vaginal” fistula six months following the birth, it failed, I found myself with feces passing from the rectum into the vagina.

After yet another six months to heal I contacted a colo-rectal surgeon. Dr. XXXXXXX Kalhorn felt confident repairing the fistula rectally rather than vaginally would increase our chances of success, it did not. I arrived at home and experienced extreme complications which included; extreme diarrhea that literally disintegrated or “ate away” my vagina, my anus, or rectum and the perineal wall. The pain was so intense I would stand in the shower watching tissue run down the drain and faint from the pain.

I now had a deformed rectum and vagina and perineal wall which was described as a “gaping hole” through the perianal wall. I now had more feces passing from the rectum into the vagina. I lived and breathed Depends diapers with diaper rash down my thighs. Psychologically I was in a delicate state of mind. I developed agoraphobia for fear of an accident or panic attack.

Up to this point I was hospitalized numerous times for the extreme pain. In addition to controlling pain I had flares, G.I. bleeds, bowel obstructions, C-Diff, gallstones, kidney stones, septicemia, TPN, pancreatitis, etc. I have experienced everything from picc lines, central lines to NG tubes. To top it off I FINALLY developed MRSA staph on every part of my living body. The pain was incomprehensible. I would often collapse soaked in a puddle of sweat.

I was finally referred to a “pelvic-pain” specialist, Dr. Hibner. Dr. Hibner coordinated a massive surgery with Dr. Edmund Leff, a experienced colo-rectal surgeon, First and foremost, Dr. Leff diagnosed the Crohns Disease. Additionally, he had two experts from NYC come in to assist with this challenging surgery. The six hour surgery included: the reconstruction of my vagina and rectum, the removal of my appendix and gallbladder, a portion of my intestines, and finally I was given a much appreciated ileostomy or colostomy bag.
To Note: After this enormous surgery I experienced a “psychotic episode” for five days. My defense to my critics: monumental pain.

I will leave the above series of events and its impact it had on my emotional state for another time. Needless to say I undergo monthly sessions’ so I might better handle pain which includes relaxation techniques and medication for depression and anxiety which in turn has helped my pain..a little. I was able to decrease my dose after starting medication.

In 2/2011 I underwent a hysterectomy with a desperate desire to help with my chronic pelvic pain…it helped 0%. It has only irritated my interstitial cystitis and caused urinary incontinence.

In addition to the above I also have a severely deformed back which is scoliosis. I will include my MRI report for your reference. Please take into consideration the 30 DEGREE curvature and its impact on my spine. I live with the pain from this daily although I have found an excellent Chiropractor and sometimes find some relief from an adjustment yet it is always temporary.

My current weight (83 pounds to 130 pounds) has been a blessing, my doctors I finally prepared to start surgeries again and I am hopeful this will help with my pain.

The current medications I am taking I have been taking for 12 years now, needless to say they are more or less ineffective. I am hoping with a combination of shots, etc, and a medication change we can get a better handle on my pain. I have researched several pain doctors in the valley and feel confident at Valley Pain Consultants we will find a new course and I will have a much more productive life.


Thank you for taking the time to read this letter,
XXXXXXX J. Bloxham


For your reference I have included some diagnosis’s I have received. Please refer to enclosed records to confirm.
Crohns Disease
Severe Scoliosis: 30 degree curve, DDD, arthritis, left disc osteophyte complex, Sacrolotis, anklosing spondylitis, Cervicalgia, Lumbago,
Rectal-Vaginal fistula
Fecal incontinence: Ileostomy bag
Interstitial cystitis: Blood in urine, difficulty passing urine, dysfunctional, painful urination.
Pelvic floor adhesions
Pelvic Floor Tension Myalgia
Chronic Pelvic Pain
Proctalgia
Possible Immune compromise
MRSA staph (in remission)
Fibromyalgia
Chronic Abdominal Pain; Hysterectomy
Migraines
Degenerative Joint Disease
Muscle spasm
Radiculopathy
Mood disorder
Sexual Dysfunction; vaginal and pelvic prolapse
Painful sex
Dyspareunia

doctor
Answered by Dr. Ramadevi Wani (6 hours later)
Brief Answer:
First get urine culture sensitivity test done

Detailed Answer:
Hi,

Thanks for writing to Healthcare Magic.
I am Dr Ramadevi Wani. I will be answering your concerns today.

I empathize with you.
I understand your concerns.

Your symptoms are suggestive of urge incontinence. Your bladder has become overactive.
There are several reasons why one develops urge incontinence.
1. Ideopathic i.e. there is no apparent cause
2. Urinary tract infection
3. As a complication of nerve or brain related injury

I advise you to first get a urine culture and sensitivity test done. If infection is found, it needs to be treated.
Coffee tea cola can increase the symptoms. So cut down on these drinks.

If there is no urinary infection found, then you need to see urologist.
He would first do bladder function tests ( Urodynamics) to confirm the diagnosis.
If confirmed it can be treated by medicines and bladder training physiotherapy.
Bladder lift surgery is not required.
I hope I have answered your concerns.
If you have any further concerns do write to me. I will be happy to answer.

Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
default
Follow up: Dr. Ramadevi Wani (10 hours later)
Dr. Wani:
I am concerned you did not take the time to read my medical history because you would then know I have already had the testing done to confirm there is not an infection, it is I. C. (Interstitial cystitis) for which I have Elmiron accessible to take, I do not take it daily because of its severe side effects, I take it only when the spasms are unbearable and the painful burning is unbearable. In addition, as you can see I have suffered SEVERE trama to all pelvic organs from incompetent doctors and my medical history complicated things. Please take a moment to read the history. Thank you.
My urinary problems did not give me any problems until the partial hysterectomy on 2/11. Since then it is progressively getting worse. I even wake up to a wet bed several times a night. It seems I had more control when I was taking all the pain meds. I have aggressively tapered off 175 ml of fentanyl, somas and oxycodone, I am only taking a small dose of the oxycodone. The spasms in my bladder and rectum are unbearable. Note*
8 inch laceration, 160 stitches head injury with loss of conscience although with all that has happened I highly doubt the symptoms are from a head injury. So which way should I go from here???
doctor
Answered by Dr. Ramadevi Wani (17 minutes later)
Brief Answer:
Start the management with baseline urine culture sensitivity test.

Detailed Answer:
Hi,
I did read your notes, before I wrote to you. I did make note of IC. From your notes i understood it as you having IC since quite some time and incontinence as a new symptom of recent onset.

For the urinary symptoms you are having you need to have urodynamic studies done. Urine culture sensitivity test to make sure that there is no infection is a
pre requisite before the Urodynamic studies. Sometimes urinary tract infection can also cause such symptoms. So I feel you should do this basic test first and then consult Urologist.
From what you have described it appears that you have overactive bladder. If confirmed as I wrote earlier treatment will be with medicines and bladder training physiotherapy.
I hope I have answered your concerns.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Ramadevi Wani

OBGYN

Practicing since :1985

Answered : 1362 Questions

premium_optimized

The User accepted the expert's answer

Share on
Suggest treatment for urinary incontinence

Brief Answer: First get urine culture sensitivity test done Detailed Answer: Hi, Thanks for writing to Healthcare Magic. I am Dr Ramadevi Wani. I will be answering your concerns today. I empathize with you. I understand your concerns. Your symptoms are suggestive of urge incontinence. Your bladder has become overactive. There are several reasons why one develops urge incontinence. 1. Ideopathic i.e. there is no apparent cause 2. Urinary tract infection 3. As a complication of nerve or brain related injury I advise you to first get a urine culture and sensitivity test done. If infection is found, it needs to be treated. Coffee tea cola can increase the symptoms. So cut down on these drinks. If there is no urinary infection found, then you need to see urologist. He would first do bladder function tests ( Urodynamics) to confirm the diagnosis. If confirmed it can be treated by medicines and bladder training physiotherapy. Bladder lift surgery is not required. I hope I have answered your concerns. If you have any further concerns do write to me. I will be happy to answer.