What is Stress Incontinence?
Stress incontinence refers to the involuntary loss of urine that is generally associated with activities such as coughing, sneezing, or laughing. It is also described when patients are active, including sports activities. Stress urinary incontinence is extremely common, affecting an estimated 12 million people in the United States alone. Stress incontinence is thought to result from a weakness of the urinary sphincter, which is the muscle band around the base of the bladder that prevents urine loss. Weakness of this muscle is unfortunately something that happens to varying degrees with aging. Other factors contributing to the weakening of the sphincter muscle includes child birth, vaginal surgeries and body weight. As a result, we see patients of all ages presenting with this problem.
The right choice for treatment is a joint decision between the patient and her physicians. After discussing your personal situation and treatment goals, we try to target the symptoms that are bothering you the most. The treatments for Stress Incontinence (Leakage with activity or movement) will be different than the treatment for Overactive Bladder (Urgency or “Can’t make it to the bathroom on time”). Many women have both types of symptoms and may require a combination therapy.
There are a variety of treatments available for stress incontinence. These treatments offer a comprehensive and minimally invasive approach to treating your incontinence. Conservative treatments refer to those not requiring surgery, such as medications. Surgical treatments offered are minimally invasive and do not require an overnight hospital stay.
What are some non-surgical treatments?
Pelvic Floor Exercises or Physical Therapy
Pelvic Floor Exercises are commonly known as Kegel exercises. These should be performed on a regular basis in order to strengthen the muscles that help control the flow of urine. Several studies show that patients have better results when this is done with a physical therapist. Working one-on-one with a therapist will target the correct muscles. About half of patients will improve with physical therapy and will not require immediate surgery. At Virginia Urology, we have two physical therapists, Kathy Oxford, DPT and Laura Broman, PT that specialize in female urinary issues.
Several studies show that weight loss can have a major impact on urinary symptoms who are overweight or obese. Even losing 15-20 pounds can cut your leakage symptoms in half.
At this time, there are no FDA approved medication for stress incontinence. The medications advertised in the media are for a different type of leakage called overactive bladder (OAB) or urge incontinence.
What are some procedures that may help?
Your doctor may be able to inject the urethra (the tube that carries urine out of the bladder) with a bulking agent that will narrow the tube to prevent leakage. Different materials may be used as the ‘bulking agent”. Some patients nay require more than one injection to get a good effect. The procedure takes about 5 minutes with virtually no down time. There are not incisions . This is a good option for patients who are not a candidate for surgery.
This is a minimally invasive surgery that is considered the ‘gold standard’ treatment for stress incontinence. Mid-urethral slings have been used in the United States since 1996 and multiple studies show that they are safe and effective. A small ribbon of mesh (about 1cm wide) is placed under the urethra. These slings are tension-free. They do not pull up on the urethra. After they are placed, your body will create scar tissue around the sling and it is the scar tissue that provides strength and stability to prevent leakage. The success rates with this procedure are around 80%.
This is another type of sling for stress urinary incontinence. With this procedure, a sling is created from the patient’s own tissue. Usually a piece of tissue (fascia) can be taken from inside the patient’s abdomen or thigh. This is a great choice for patients who can’t have the mesh sling or simply don’t want mesh to be used. This is also an option for patients who may have failed other treatments, such as the mesh sling. The physicians at Virginia Urology Women’s Health are among the few surgeons in this area that provide the expertise for this surgery.