TREATMENT FOR stress incontinence

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Noninvasive and surgical solutions for stress incontinence include: lifestyle and behavior modifications, physical therapy, and surgery to reinforce the pelvic floor and/or support prolapsed organs.

Our physicians will explore noninvasive solutions first, however patients should be aware that surgical solutions for stress incontinence today are so much simpler, less invasive and more effective than they were even a decade ago. Typically, these surgeries are done on an outpatient basis, taking only 20 minutes or so, and patients go home that day— without a catheter. Only intravenous, local sedation is necessary, and because the incision is very small, recovery is very quick.

Behavioral

Bladder retraining— The patient schedules trips to the bathroom at increasing intervals, thus retraining the bladder to hold the urine longer.

Pharmacotherapy

Topical estrogen—This can be effective for patients whose symptoms are caused by hormonal changes. It can improve the tone and blood supply of the urethral sphincter muscles, and may improve urinary frequency and urgency.

Physical therapy

Pelvic floor strengthening and/or rehabilitation—Pelvic floor muscle exercises, known as Kegels, can be effective in strengthening the pelvic floor to provide better support for the urethra and bladder, thereby treating incontinence.

Vaginal cone weights— These are used to help women identify and exercise the specific muscles of the pelvic floor. Some women have difficulty isolating the pelvic muscles and unintentionally exercise their buttocks or stomach muscles instead. Cone weights inserted into the vagina can only be held in place by the pelvic floor muscles, so women can be assured they are working the correct muscles.

Biofeedback—Special equipment can help patients isolate the correct pelvic muscles. The equipment, which can be used in a healthcare setting or as a home device, sends a signal when the patient performs the correct contraction. It is generally very effective because the feedback (audio or visual) is an immediate indicator of whether the exercise is being executed correctly or not.

Other noninvasive treatments

Pessaries— These medical devices are inserted into the vagina or rectum and used to support the pelvic organs, such as the bladder, uterus, vagina or rectum. Similar to the outer ring of a diaphragm, a pessary is most commonly used to treat uterine prolapse. It may also be effective treating stress urinary incontinence, a retroverted uterus, cystocele and rectocele.

Perineal skin care—Maintaining skin health is very important for patients with chronic urinary incontinence. Our physicians will discuss ways to prevent dermatitis in the pelvic region, as well as restoring the skin’s integrity.

Surgical

There are an estimated 13.5 million women with urinary incontinence in the United States, yet only 225,000 surgeries are performed each year. In fact, only 45% of patients are aware that surgical solutions to the problems exist, and one woman in 12 with bladder control issues seeks medical help.

At GMIC, we want women to know that stress incontinence is both common and curable. And that surgical solutions are now relatively simple matters with a very high success rate.

Mid-Urethral Slings
First developed in the mid-1990s, mid-urethral slings have become the primary corrective surgery for stress incontinence with a long-term success rate of more than 90%. It is considered minimally invasive surgery, with small incisions and minimal pain. Most women are able to return to work and resume normal activities very soon after the surgery.

A sling or hammock-shaped material is placed below the urethra in order to restore and/or reinforce the tissues, ligaments and muscles of the pelvic support system. More than 1,000,000 women worldwide now lead a more active, confident lifestyle following successful sling surgery.

Glen Meade Incontinence Center uses the following mid-urethral sling procedures:

TVT— For stress urinary incontinence cases in which the urethra cannot maintain a watertight seal due to a weakened pelvic muscle floor or a defect in the urethral fascia, the GYNECARE TVT tension-free support system can restore normal position and function to the urethra. The surgeon places a "sling" of mesh tape beneath the urethra, at the middle, because that section is under the most strain with normal activities.

Learn more about GYNECARE TVT.

TVT-O (or TOT)- A similar procedure to the conventional TVT, the TVT-O (also called TOT) is an alternative in which the tape is passed on either side of the vagina, instead of behind the bone and up to the abdomen.

MiniArc -The MiniArc sling is considered the next wave in stress urinary incontinence surgeries. It is the least invasive because it requires just a single incision to place the sling under the urethra. A small, narrow strip of mesh gives the urethra an extra measure of support and minimizes accidental urine leakage.

Learn more about MiniArc.

Women with any of these factors are good candidates for mid-urethral slings:

  • uretheral hypermobility
  • intrinsic sphincter deficiency (ISD)
  • low pressure urethra
  • concomitant prolapse
  • obesity
  • elderly
  • previous failed incontinence surgery

However, slings are not an option for women who are pregnant or plan to become pregnant, or who have future growth potential.

Long-term (approx. five-year) results:

Primary cases—85% cure; 11% significantly improved

Secondary cases—82% cure; 9% significantly improved

ISD cases—74% cure; 12% significantly improved

Collagen Injections

For women with intrinsic sphincter deficiency (ISD), collagen may be injected in the urethral area to make the urethra thicker, which helps to control urine leakage. This is considered minor, outpatient surgery, and it may need to be repeated after a few months to maintain bladder control. All candidates must have a skin test to rule out allergy to collagen.

 

 

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