Stress incontinence is by far, the most common type of incontinence which accounts for about 75% of cases seen by physicians and can occur in any stage throughout a women’s life. It is a loss of urine that happens during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. Most of the time, this condition results from weakening of the pelvic supportive structures for the bladder, bladder neck, and urethra that can occur due to pregnancy, childbirth, obesity, lack of hormonal support, and prior pelvic surgery. In the past it was felt that most stress incontinence resulted from two distinct scenarios:

• Urethral Hypermobility, due to lack of support to the bladder neck, resulting loss of pressure in the urethra as it rotates down and outside the vagina during increases in abdominal pressure such as cough or sneeze.
• Intrinsic Sphincter Deficiency (ISD): poor tone of the urethral sphincter mechanism

Many patients have a combination of poor urethral support and tone.

The three major categories of treatment are behavioral, pharmacological and surgical:

BEHAVIORAL

Behavioral Therapy is to help train women to behaviorally control mild to moderate incontinence. For example, certain foods and beverages contribute to urgency or increased frequency (i.e., urge incontinence). Therefore, many women find that reducing or eliminating their caffeine intake lessens these symptoms. Also, timed voiding and bladder retraining, which involve urinating on a set schedule during the day regardless of the need or urge to void, is often helpful.

Pelvic Muscle Exercises (sometimes called “Kegel exercises”) can be helpful for mild stress or urge incontinence. When properly and consistently performed these exercises can strengthen the sphincter muscles and lessen the degree of incontinence. There are a variety of devices available, such as vaginal cones which can help you do the exercises correctly at home. Pilates, or any exercise that work on strengthening the “core” muscles of the back and pelvic floor can also help improve stress incontinence. Piedmont Hospital Fitness Center offers a “Total Control” fitness program that focuses on strengthening your pelvic floor muscles.

Biofeedback Exercise and behavioral training can both be enhanced by biofeedback. During biofeedback training, a probe inserted into the patient’s vagina sends images to a television monitor, which allows patients to watch the muscles’ response as they are squeezed. The monitor helps women know when they are contracting the proper muscles, and it guides the training sessions toward better muscle endurance. We can help you find a qualified pelvic floor physical therapist in your area.  

PHARMACOLOGICAL - MEDICATIONS

Medications have limited usefulness in treating stress incontinence, but there are some which may increase urethral closure pressure and provide some improvement in symptoms in patients with mild stress incontinence. The first class of drugs is the alpha-agonists, which is found in pseudoephedrine (a cold medicine/nasal decongestant).   This class of drugs acts to increase the tone of the urethra and bladder neck. Women with mild to moderate stress incontinence will generally get more relief than those women with severe incontinence. The main side effect of the alpha-agonists is hypertension which limits their usefulness in the older patient. Some antidepressants which inhibit serotonin and norepinephrine reuptake, such as Effexor and Cymbalta, are also thought to increase urethral sphincter tone.

Estrogens have been shown to be helpful in urinary incontinence. Thinning of the vaginal tissues after menopause can impair the urethra's ability to close and result in irritative symptoms such as frequency and, urgency. Estrogen helps restore the vaginal tissues by thickening the tissues, improving the blood supply, and restoring the elasticity of the tissues. Though all forms of estrogen can alleviate these symptoms, local administration through the use of vaginal estrogen cream or tablets provides the most rapid response.

Medical Devices

There are also options for women who do not experience relief with non-surgical treatments but do not yet wish to undergo surgery. Options available are urethral plugs and patches, vaginal tampons, pessaries (diaphragm-like devices that support the vagina), catheters, pelvic organ support devices, external collection systems, and absorbent products.

SURGICAL

There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of the incontinence. The two most common procedures for treating stress urinary incontinence are pubovaginal sling procedures, and periurethral bulking injections (collagen injections around the urethra), The mainstay of treatment for significant stress urinary incontinence is surgery.

A tension free pubovaginal sling is now the “gold standard” surgical treatment for stress urinary incontinence. It  works by placing a narrow strip of mesh under the bladder neck to support the urethra. Narrow sling carriers are passed from small incisions above the pubic bone into the vagina on either side of the urethra. The sling mesh then is attached to the carriers and pulled into place. The sling cradles your urethra and gives it support during normal daily activities.

Most patients are “dry” immediately following the procedure and can resume normal, non-strenuous activities within a few days.

It is an outpatient treatment suitable for a wide variety of patients and can be performed using a minimally invasive approach. The success rate 90% and most people are still “dry” 10 years later.

Less invasive surgeries for stress incontinence include peri-urethral bulking agents. This treatment can be done in the office under local anesthesia with no down time, but usually requires multiple injections for maximum benefit. The results may last from 1-5 years. It is particularly useful in patients who have good urethral support but poor urethral sphincter tone (ISD). 

CALL TODAY!

Approximately 80% of women affected by urinary incontinence can be cured or improved. Yet despite the high success rates in treating incontinence, only one out of every twelve people affected seeks help. There are many types of treatments available in the management of urinary incontinence, and through a detailed evaluation, we can recommend the treatment that is appropriate for you.