Urinary incontinence is the involuntary loss of urine that can be very bothersome and can prevent women from participating in certain activities that they enjoy. There are three types of incontinence: stress incontinence, urge incontinence, and overflow incontinence. Each is treated uniquely and differently from the other. Stress incontinence is the loss of urine during activity such as running, walking, jumping, lifting, or during coughing, sneezing, or laughing. Stress urinary incontinence is very common among women who have had a pregnancy or vaginal delivery, but can be seen in young women and girls who have not been pregnant. Urge incontinence occurs with sudden urge to urinate, or without warning. Urge incontinence very common in women of all ages but does worsen with age. Finally, Overflow incontinence occurs as a continuous loss of urine because a woman does not empty her bladder well.
There are many treatments for incontinence: If you have stress or urge incontinence, you may be offered Pelvic Floor Physical Therapy or Pelvic Floor Rehabilitation Program. Both programs are designed to strengthen the pelvic floor muscles, or Kegel Muscle. The pelvic floor muscles are important in preventing incontinence. Many women either are unaware of how to engage or contract their pelvic floor muscles, and others need strengthening. Studies have shown that women who participate in a pelvic floor strengthening program improve faster and show more improvement than women who do home exercises on their own. The process of PFPT or PFR involves visiting a pelvic floor therapist once a week for 45 minutes, during which time the therapist works you on how to use the pelvic floor muscles. She will use an internal exam and often will place a small probe in the vagina to stimulate the muscles. This does not hurt. You are then given exercises to do at home during the intervening week between visits. Most women see good improvement by the end of an 8-week session. However, some women do not require the full 8 weeks and others need more than 8, depending on your situation. Most patients who are seen in consultation at WUA will be offered this non-invasive, effective, treatment for incontinence.
Pessary: Pessaries are vaginal inserts that are often used to treat stress incontinence. These are vaginal inserts shaped like rings, that apply pressure under the urethra and prevent incontinence. Pessaries are fit in the office by a nurse. You will then be taught to place, remove, and clean the pessary to manage this at home. Many women are very happy with pessaries as treatment. The advantage to a pessary over alternative treatments are that it does not require recurrent visits to the doctor, and is a non-invasive treatment. Approximately half of women who opt for a pessary are happy with this treatment and use their pessary for years.
Periurethral injections: This treatment is an office based procedure that involves injection of a bulking agent, or filler, into the wall of the urethra to plump the urethral wall. This tightens the urethra and prevents stress incontinence. The procedure is a 30-minute procedure done in the doctor’s office either with or without IV or oral sedation. The results are immediate and the material remains effective for 1-2 years before it is resorbed and needs reinjection. The material used at WUA is Coaptite, or hydroxyapatite, and biologic material that is safe and effective. Other materials include Contigen, Durasphere, and Macroplastique.
Sling surgery: A sling is a strap of polypropylene (synthetic) mesh surgically placed beneath the urethra to compress the urethra and prevent incontinence during times of increased abdominal pressure such as sneezing, coughing, laughing, or exercising. Sling surgery is very effective in the treating stress urinary incontinence; 95-97% of patients are either cured or significantly improved. Long term data demonstrate they are durable. Eighty-five percent of women at 10 years after a sling are still continent, and 75% at 17 years are continent. These outcomes and durability make the sling the superior treatment for stress incontinence. Slings are placed under a general anesthetic in either a hospital or WUA’s ambulatory surgery center. Board certified anesthesiologists administer the anesthetic. The procedure is a 45-minute surgery and patients are discharged to home the same day.