CHOICE membership

The impact of incontinence

According to the Continence Foundation of Australia, over 4.8 million Australians experience bladder or bowel control problems, and it is estimated to cost over $42.9 billion to the economy based on 2011 Deloitte Access Economics report. There are also two class actions underway relating to vaginal mesh implants, effecting thousands of women.

While we know this is a sensitive area, we’d like to hear your stories. This could be about pelvic mesh devices, physio, other solutions, the experiences you’ve had with your GP or any other stories you would like to tell. You can comment below, or send an email to investigations@choice.com.au to provide discreet comment.

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Hi Uta, you may want to talk to pelvic floor physiotherapists. My physio specialises in pregnancy and pelvic floor issues for men and women and also has worked extensively in the public hospital system - so she has lots of stories and I believe there’s a whole network of pelvic floor physios who would also have access to patients with unique stories. In case you want to contact her, her website is https://www.physiotherapydownunder.com.au/

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Hi Uta

Something you may not have thought of: talking to men who have undergone radical prostatectomies. (Try the support group www.prostate.org.au/support/find-a-support-group/.)

Complete urine incontinence can result from the prostate surgery. Phyisios aren’t much use if some/most/all the relevant muscles have been removed with the prostate. A suburethral sling is one solution on offer.

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Good idea, thanks for the contact Kalpana.

Thank you, that is a very good suggestion.

The pelvic floor exercises are of limited value I find. Just never travel far from good loo locations. A very limiting situation.

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There is no doubt that most men who have prostate surgery have temporary incontinence and some have long term incontinence. I was diagnosed two years at 60 - no symptoms - picked up by my GP through a slightly increased PSA test. I had robotic surgery and my surgeon advised my outcome was very good in terms of catching the cancer and nerve sparing which impacts on incontinence. However despite doing the pelvic floor exercises both before and after surgery I had ongoing incontinence. After surgery most men have little control and it gradually improves. However after two years I was still wearing 1-2 pads a day. My surgeon recommend surgery for an Advance bladder sling. I had the surgery two months ago and it has been very successful if very uncomfortable for about six weeks after while the wound in the perineum healed. I no longer need pads. Incontinence is very depressing and makes you anxious especially in social situations. I am pleased to have a solution at last.

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I hope that generalization does not deter anyone from having the surgery because of fear of incontinence as the prime reason.

I know a number of “us” who returned to normal continence within days to a few weeks post surgery, only one with ongoing problems, and none spent the extra for the robot. Some were private and some public patients.

It is the skill of the surgeon, the condition of the patient, and individual anatomy. My surgeon claimed fewer than 2% of his patients had ongoing continence problems; he was trained in the robot but does not use it and claims the only difference between “highly skilled hands” and the robot is about $10-12,000 out of pocket (in 2009) and 2-4 weeks faster recovery time. I suspect other surgeons may have a different view.

Of course everyone’s experience may differ. I am posting to reassure any man who might be “spooked” by the statement made. Talk to your surgeon, check his success and reputation as best you can, be realistic about advantages claimed for the robot if it is being “sold” to you, and accept there are always men who will have better or poorer outcomes.

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I agree with all of this. My post was not intended to scare anyone off having necessary surgery. It’s correct that only a small percentage of men have long term incontinence, but it is correct that most have short term (weeks to months) of incontinence. The above writer was very fortunate to have only days. It’s also correct that there is little clinical evidence as yet that the robotic surgery gives any better long term outcomes than laproscopic surgery. My surgeon has a very good track record, but the urologist who did my sling surgery (not the original surgeon) emphasised that the individual’s anatomy has a lot to do with the long term outcomes for continence. I was hoping my post would provide some comfort to those considering having bladder sling surgery. I am pleased with the result. Interestingly I have had no problem with the other more common side effect of prostate surgery - erectile dysfunction.

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Here is our article on incontinence, the causes and how to treat it.

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We have discussed elsewhere (Prostate Cancer) about the large and growing numbers of men with prostate cancer. Incontinence is a common consequence of prostate removal because the muscles controlling urine flow are partially removed or damaged.

I don’t know the numbers, but if prostate cancer numbers are high, and incontinence is a common consequence, does that make the numbers with this form of incontinence significant?

If it is, it would seem to me that it should be listed separately because it does not fit under any of the five main types of incontinence listed, and it would be a recognition of this problem.

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I read the article regarding vaginal mesh. It is written by a journalist, need I say more, and is straight out of the Josef Goebbels book of propaganda in that it states opinion as if it is fact. The article starts with “allegations” and then starts stating things as fact. Even more concerning is that the “human headline” Derryn Hinch is involved. I suggest we wait for the results of the enquiry. How many women have had successful mesh repairs? Every procedure has risk. Not warning of risks is unacceptable but is the journalist seriously suggesting that women had mesh repairs without consent? From my wife’s and my personal experience, it is no fun having your uterus ( removed) and then your rectum and lower colon bulge into your vagina due to an appalling decision to allow a breach delivery by a “specialist” which destroyed my wife’s pelvic floor and vagina. Her mesh has been successful though with some difficulties which are improving. I know which option my wife would prefer, albeit with risk. Perhaps Mr Hinch and journalists should start enquiring as to why so many women need repair surgery in the first place?

Johnson & Johnson loses pelvic mesh court appeal.

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Another class action in Australia regarding pelvic mesh.

https://www.9news.com.au/national/mesh-class-action-aussie-women-line-up-for-boston-scientific-lawsuit/6fa59eb7-2ca9-44a8-8f83-fa26ea526b96

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