Stress Urinary Incontinence

Stress incontinence is leakage that occurs with sneezing, coughing, or physical exertion. Urine loss occurs due to weakening of the pelvic floor muscles and support structures, or because the muscles of the urethra are not strong enough to prevent urine from leaking.

Even though stress incontinence can be very bothersome and disruptive, it is important to note that it is rarely a sign of any serious medical problem. There are many options for treatment of this common problem which are described in more detail below.

Treatment Options

Non-Surgical Treatment

• Do nothing (live with your condition).
  • If this problem is occurring rarely and is not bothersome for you, it is OK to do nothing.
• Behavioral modification
  • Weight loss
    • Excess weight puts extra pressure on the pelvic floor muscles and bladder. Studies show that losing weight can substantially improve urine loss.
  • Smoking
  • This can lead to a chronic cough that strains the pelvic floor muscles and bladder. Nicotine is a direct bladder irritant and dramatically increases the risk of bladder cancer. If you are a smoker, quitting smoking will help.
• Pelvic floor Rehabilitation
• This can be done on your own or with the help of a specialized pelvic floor physical therapist
  • Kegel exercises (pelvic floor exercises)
    • To help improve symptoms, do your exercises at least 3 times a day for at least 5 minutes each time.
    • Do your kegels when the bladder is empty and not with a full bladder or during voiding.
  • Biofeedback/Electrical stimulation
  • In-office sessions once a week for 6 weeks, usually done with a physical therapist.
  • Biofeedback and Electrical stimulation treat pelvic floor muscles with low-strength electricity and can help women learn proper exercise technique.
  • Home units are also available.
• Vaginal weights (cones)
  • Another way to tone up the pelvic floor.
  • Results are comparable to doing Kegel’s alone.
  • Helpful in patients who have difficulty performing Kegel’s on their own.
• Pessaries
  • These are devices like a ring or diaphragm that go in the vagina to give support to the bladder and urethra. This in turn may help prevent urine loss.
  • They need to be taken out regularly, cleaned and replaced.
  • Most patients can be instructed on proper care.
  • They do not work for everybody and may cause bleeding or infections.
• Medications and other options
  • Rarely used in women with stress incontinence

Surgical Treatment

Although surgeries for stress urinary incontinence are generally simple and can be done as outpatient procedures, there are always potential major risks and complications with any type of surgical intervention.

• Mid-urethral sling
  • This is a minimally invasive procedure developed in Sweden in 1995.
  • The first device was known as the “tension free vaginal tape” or TVT.
  • A thin synthetic (permanent) strap is placed under the urethra as a short outpatient procedure.
  • 85-90% of women experience significant improvement. Follow-up studies suggest about 80% of women who have successful surgery are still happy with their results more than 10 years after surgery.
  • Most complications are minor, and major complications are very rare.
  • Some women go home with a catheter, but most women void normally within a week.
  • The surgery can be done under general or local anesthesia with sedation. Only one small ½ inch incision is made in the vagina.
  • Most women go back to work in two weeks with minimal restrictions.
  • Mesh slings have received some bad press recently. Here's a resource from the American Urogynecologic Society discussing the safety of these products.

• Urethral Injections (Bulking Agents)
• A simple procedure that can be done in the office or operating room.
• A synthetic material is injected into the muscle layer of the urethra. This causes narrowing of the urethra and results in less leakage.
• This is usually a temporary solution, but patients generally experience relief for anywhere from 6-24 months.

• Other Procedures (less commonly performed)
  These procedures are available for patients who are not candidates or are not interested in mesh or synthetic materials:
• Laparoscopic urethropexy (Burch)
• Autologus slings (using a patient's own tissue to create the sling)
• Other options that are experimental or rarely used (Radiofrequency, Muscle derived stem cell injections into the urethra, Artificial urethral slings)