By Meghana Gowda, MD, FPMRS
The involuntary leakage of urine affects over 50% of women and is not isolated to women who are post-menopausal. A recent survey study queried younger women between the ages of 18-50 years old and up to 50% of participants reported leakage. The three most common sub-types of female incontinence are: stress, urge, and mixed incontinence. Despite direct-to-consumer marketing, misperceptions persist regarding the wide variety and efficacy of treatments available. Incontinence is not a normal part of aging. Many think treatment is elective and therefore insurance will not cover. This is not true as it is a medical condition with most treatments covered by insurance.
Stress Incontinence
Conservative management:
- pelvic floor physical therapy
- weight loss
Surgical management:
- midurethral mesh sling or autologous pubovaginal sling using rectus abdominal or fascia lata grafts taken from the patient (success rates ranging from 70-80%).
- Bulking agents for patients who cannot tolerate anesthesia, include MacroplastiqueTM or collagen.
Overactive Bladder (OAB)
Conservative management:
- pelvic floor physical therapy
- weight loss
- timed voiding
- dietary changes
- medications such as anticholinergics
- Urgent PC®
Surgical management:
- Sacral Neuromodulation (InterstimTM). InterstimTM is also FDA approved for fecal incontinence, with success rates that exceed that of sphincteroplasty.
- Botox bladder injections are a successful option in those who have failed medical therapies. Long term adherence to medications is very poor as 50% of patients will discontinue medication within 3 months and 90% discontinue within 2 years. Long term treatment strategies such as InterstimTM and Botox are minimally invasive, efficacious, and can be performed in the office.
Mixed Urinary Incontinence (Stress Incontinence + OAB)
Conservative management:
- Pelvic floor therapy with or without Biofeedback can be first line therapy. This is done by physical therapists who specialize in pelvic floor dysfunction.
- Medical therapy
Surgical Management:
- Interstim®
- Botox®
Patients being treated at Virginia Urology Women’s Health can be assured they are being offered the most up to date treatment options and that our physicians have developed a widely accepted treatment algorithms to address management of urinary incontinence. We understand the frustration that accompanies this issue and work with you every step of the way until you have met your desired goal.
