Botox treatment for overactive bladder
An overactive bladder (OAB) is where a person frequently gets a sudden and compelling need or desire to pass urine. This sensation is difficult to put off and can happen at any time during the day or night, and often without any warning.
How do I know if I have an overactive bladder
If your bladder squeezes (contracts) without any warning, it can give you an urgent need to pass urine. This is described as ‘when you have to go, you have to go’. This gives you very little or no time to get to the toilet and is called urinary urgency. If the need to pass urine is so intense that you cannot hold on, it can lead to leakage of urine which is called urinary urge incontinence.
Another symptom of an overactive bladder is a need to pass urine more frequently than usual and only in small volumes. This is called increased urinary frequency.
Both urgency and frequency are typical symptoms of an overactive bladder.
How will I be assessed
Mr Alak Pal will take a detailed history of your problems and your general health. Urine will be tested for infection. You may be asked to complete a 3-day bladder diary to record the timings and volumes of urine passed. You may also have a urodynamic test to assess your bladder fully.
How will I be treated
The initial treatment is by changing fluid habits, bladder training, pelvic floor exercises and medications. If these treatments are not successful, surgery may be considered and Mr Alak Pal will discuss this in detail with you.
Any surgical procedure should be done after a definite diagnosis of an overactive bladder which may require a urodynamics test.
Surgical treatment involves injecting botulinum toxin A (Botox) into the inside of your bladder muscles via a small telescope (cystoscope). This treatment has an effect of dampening the muscle irritability of the bladder. However, it may also dampen the normal contractions so that the bladder is not able to empty fully, a condition called urinary retention. This may affect about 10 – 20% of people after the procedure and may need insertion of a catheter (a small tube) into the bladder in order to empty it.
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Abdominal hysterectomy is a surgical procedure where the uterus is removed through an incision in the abdomen. One or both ovaries and fallopian tubes may also be removed during the procedure.
There are two issues to consider before the planned hysterectomy, if the cervix should be removed and/or if the ovaries should be removed. If the ovaries are removed, the individual may need to decide if she should take estrogen ( hormone) replacement therapy.
A standard total abdominal hysterectomy includes removal of the entire uterus and cervix. However, there are situations where the cervix is not removed which is called a subtotal hysterectomy. Subtotal hysterectomy may be considered if the woman wishes to retain the cervix or if difficulties are encountered where removal of the cervix could cause damage to the bladder or bowels. Women who have a subtotal hysterectomy should continue with routine cervical smears.
Should I remove or keep the ovaries
The ovaries may be removed during hysterectomy, a procedure known as an oophorectomy. Oophorectomy is not always required; the decision depends upon several considerations.
Keeping the ovaries: Premenopausal women may decide to keep the ovaries to provide a continuing natural source of hormones, including estrogen, progesterone, and testosterone. These hormones are important in maintaining general health, cardiovascular health and cognition, sexual interest, preventing hot flushes and loss of bone density.
Removing the ovaries: On the other hand, women who have menstrual cycle related migraines or severe premenstrual syndrome (PMS) or endometriosis may have an improvement in symptoms when hormone levels are reduced by removing the ovaries. Postmenopausal women sometimes choose to remove their ovaries because of a small risk of developing ovarian cancer later during their lifetime.
Mr Alak Pal will discuss the benefits of removing or keeping ovaries, as individual circumstances differ, and the decision is made that fits the individual’s requirements.
Should I remove the fallopian tubes
Fallopian tubes serve as a place for the egg and sperm to meet for fertilisation. They are not known to have any role in hormone production. The finger like ends of fallopian tubes are thought to be the precursor for ovarian cancer, and the current practice is to offer removal of the fallopian tubes (salpingectomy) during hysterectomy.
Should I remove the cervix
A standard abdominal hysterectomy includes removal of the entire uterus and cervix. However, there are situations in which the entire uterus is not removed. A subtotal or partial hysterectomy refers to a procedure in which the cervix is left in place, while the top of the uterus is removed. A subtotal ( or partial) hysterectomy may be done if you want to keep your cervix or if difficulties arise during surgery that make removal of the cervix complicated.
Prior to a planned hysterectomy, Mr Alak Pal will discuss with you about the risks and benefits of leaving the cervix in place.
Individuals who undergo subtotal hysterectomy must continue to have routine cervical smears.
In the past, there was concern that removing the cervix would interfere with sexual satisfaction. However, studies have demonstrated that sexual satisfaction does not appear to differ after hysterectomy between women with and without a cervix.
Life after abdominal hysterectomy
Most women are satisfied with their results and reported improvement in symptoms, such as pain and vaginal bleeding. Sexual function and enjoyment, interest in sex, and pain with sex improved after hysterectomy for most women. However, everyone’s situation is different, and your outcomes may depend upon several factors including your age, the reason for and findings at hysterectomy.
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Patient seen for : Dilation and Curettage
Dr Alak Pal was great. He made me feel comfortable and explained everything clearly, including next steps. Would recommend.
Patient seen for : Hysteroscopy
Very professional and helpful in explaining everything. Helped me make an informed decision with this vast knowledge.
Patient seen for : Total Abdominal Hysterectomy
From the initial appointment, surgery, aftercare and to my final appointment, Mr Pal was extremely professional and understanding to my particular medical circumstances. The entire abdominal hysterectomy procedure was extremely satisfactory. He spent time listening to any concerns that I had and explained clearly and simply the process surrounding the surgery. I would highly recommend him for anyone contemplating such a procedure. Additionally, post-surgical care and appointments were excellent too.
Fantastic doctor, very pleased with consultation. Thanks