Stress Urinary Incontinence

Overview

Urinary Incontinence is Common. We can help.

According to a recent report from the CDC, more than 50% of women who are at least 65 years old have urinary incontinence. 

19% of women younger than 45 years are thought to have urinary incontinence.

The current national estimates are that more than 20 million women have urinary incontinence or have experienced it at some point in their lives.

Stress urinary incontinence is when a woman experiences urine leakage with exertion, coughing, sneezing, or laughing.

Some women have had this their entire lives. Other women develop this condition over time. While women who have never had children can have stress incontinence, it commonly occurs after pregnancy and delivery.

 

Causes

Stress urinary incontinence is multifactorial. There are many factors that can impact continence, including:

  • How much your urethra moves and your levator muscle strength (or kegel muscle)
  • Physical trauma, delivery history, and past surgical history
  • Current medications
  • Hormonal status
  • Weight; an ideal body weight will minimize urinary incontinence

If you think you may suffer from stress incontinence, please contact our physicans for a full medical evaluation.

Treatments

There are many different ways to improve or cure stress incontinence.

After completing a medical history and physical, your doctor may recommend one or more of the following in your treatment plan:

Nonsurgical Options

Pelvic Floor Strengthening

Improving you pelvic floor strength will improve stress incontinence. A recent study randomized women with stress incontinence to surgery of physical therapy and found that about 58% of women were cured in the physical therapy group. We can help you learn how to do these exercises correctly.

Some women prefer to do the exercise on their own. Sometimes an exercise plan focusing on the levator muscles is all that is needed. Sometimes physical therapy helps a patient to stay on track. 

Pelvic floor muscle strengthening only works while you are doing the exercises. This is not  a long term solution for some women. Some women have damaged pelvic floor muscles or ligament damage from childbirth and cannot find benefit with kegel contractions alone.

Pessary Ring

A pessary is a non-surgical solution that can help with stress incontinence. A pessary is a device that fits into the vagina that can easily be placed and removed. It resupports the urethra and eliminates urinary incontinence.

Surgical Options

Sling Surgery

The most common type of surgery at this time is a sling. In a sling surgery, a material is placed through a vaginal incision. This material is used to resupport the urethra.

Slings are a very effective way of treating stress incontinence. They are a success in about 80% of women and many more women have improved symptoms.

Some slings are mesh slings. These slings are very effective. They are minimally invasive outpatient surgeries that are very easy to heal from. However, mesh is associated with an erosion rate where the material can be felt in the vagina.  This happens 3-6% of the time and can be easily fixed. There is a lot of data available on mesh and mesh for bladder slings is considered to be safe. No bladder slings have been recalled. For more information, see Voices for Pelvic Floor Disorder and Gynecare TVT.

A sling procedure can also be performed using your own tissue. When this is done, a small piece of fascia is taken from a bikini cut abdominal incision. This surgery is more uncomfortable and requires more healing time. It does not have an erosion rate and has similar success rates as the mesh sling.

Retropubic Suspension Surgeries

There are other surgeries that use suture to resupport the vagina beneath the urethra. These surgeries are called retropubic suspension surgeries. They are generally done in combination with other surgeries because they require access through the abdominal space.

Other Procedures

There are also procedures that bulk or plump-up the urethra. These procedures do not work well for all types of stress-incontinence, but they can be done in the office. Click to learn more about Macroplastique or Coaptite, two urethral bulking products.

FAQ

Overactive bladder is when a woman experiences urinary urgency and frequency.  This may be associated with leakage as well.

Leakage becomes problematic when it affects your lifestyle and causes bother.

An overactive bladder can lead to decreased self esteem and avoidance of healthy activities like exercise and social gatherings. It also can be expensive due to incontinence pad use and laundry needs. We can improve most leakage. If you have specific questions about stress incontinence, contact us. Our urogynecology specialists and friendly staff can assist you.

Resources

The following two articles do an excellent job of describing incontinence and the appropriate treatments and are written by organizations that have a goal of educating health consumers, and not selling continence products: