Treating Urinary Incontinence

The promise of a more confident tomorrow

Sudden, unexpected odor and wetness can shatter a woman’s confidence and restrict her freedom. Fortunately, there are many urinary incontinence treatment options available. Speak to a specialist and find out if one is right for you.

Stress Urinary Incontinence

	Non-surgical treatment methods New minimally invasive procedures Other surgical options Risks and precautions

Non-surgical treatment methods

Women who are just beginning to experience symptoms of urinary incontinence may opt for non-surgical methods as their first step. For women dealing with mild symptoms, these simple changes may be effective.

• Behavior therapies — By introducing simple lifestyle changes—like making frequent visits to the restroom, drinking fewer liquids at night, and limiting coffee and alcohol—some women are able to minimize the frequency and severity of their urinary incontinence symptoms. Evidence also suggests that postural changes (i.e. not crossing legs) may help minimize stress urinary incontinence symptoms, while weight loss can reduce symptoms of stress, urge, and mixed incontinence.

• Pads, liners, and absorbent products — Absorbent products like Poise® and Depend® trap leaks away from the body and clothing, while also neutralizing odors. However, these products only help manage symptoms, they do not minimize or eliminate them.

• Pelvic floor exercises — Known to many women as Kegels, they help strengthen the pelvic floor muscles for improved bladder control in women who suffer from stress urinary incontinence. They are easy to learn and perform, simply relax and contract the muscles you would use to halt your flow of urine midstream. However, in order for Kegel exercises to make an impact, they must be done correctly, regularly, and for an adequate duration.

• Vaginal pessary — Similar to the outer ring of a diaphragm, when placed into the vagina, a pessary can provide support to the pelvic floor and help relieve stress urinary incontinence symptoms. Pessaries and other urethral inserts must be fitted by your doctor to ensure optimal results. While these devices are an acceptable treatment for some women, others prefer a treatment option that doesn’t require daily intervention.

• Medications — For women who suffer from urge incontinence, daily prescriptions like DetrolLA® may restore bladder control. However, there are no medications currently available to treat stress urinary incontinence.

• Bulking injections — Not unlike injecting collagen for fuller lips, this procedure involves thickening the urethral lining, which helps the urethra close more tightly. Although bulking agents reduce leakage in women who suffer from stress urinary incontinence, the effectiveness of the injection does decrease over time. After 1-2 years, the procedure will likely need to be repeated. The most common complications are pain during the injection, as well as a potential for transient urinary retention and voiding dysfunction after the procedure.

New minimally invasive procedures

For women who’ve decided to seek treatment for stress urinary incontinence, they’ll be glad to know that the options have changed dramatically since the days of their mothers and grandmothers. Now, more and more women are turning to minimally invasive treatment options. These new procedures are effective and often involve less pain and a shorter recovery time.

• Urinary incontinence slings — Known as urethral support slings by specialists, these soft and flexible surgical mesh systems cradle the urethra like a hammock, providing additional support and helping to restore it to its normal anatomical position.

  Urethral support slings are proving to be an effective surgical procedure for stress urinary incontinence. In fact, clinical research shows that slings are up to 90% effective*.

  *This number may vary, depending on the type of procedure performed and products used, so be sure to ask your doctor for more information.

  
  

  About the procedure
  While each sling procedure varies slightly, placing the mesh generally involves these steps: *

  • A small incision or incisions will be made in the vagina, the abdomen, or where the top of your thigh meets your pelvic area
  • The mesh is threaded through the incision and positioned under the urethra to form a cradle of support
  • The mesh allows your body tissues to grow into it, providing support to your urethra and securing the mesh in place.
    
    

    *Procedure may vary by product.

  Your body with stress urinary incontinence

  Your body after sling repair

  What to expect
  Following your sling procedure, your doctor may also advise the following:

  • While your incisions will be small and should heal quickly, your doctor may prescribe pain medication for you if it’s needed. In addition, your doctor may also prescribe antibiotics.
  • In some cases, a physician may insert a catheter to drain urine from your bladder temporarily. The catheter is usually removed before you leave the hospital or clinic. However, if you are unable to empty your bladder on your own, the catheter may remain in place for a short time until you’re able to do so.
  • While you should avoid sexual intercourse, heavy lifting, and exercise for approximately four to six weeks following your procedure, you can usually return to your non-strenuous daily activities in a short time.

  Your doctor will share more information about how you should care for yourself after your procedure. Be sure to follow your doctor’s instructions.

While some surgical mesh products are more flexible and porous than others, they all serve the same purpose—to restore the urethra to its correct anatomical position. However, some surgical mesh products are more effective than others. Be sure to ask your doctor about the product she/he recommends.

Benefits of slings
If you’re considering a urethral support sling to treat stress urinary incontinence, consider these important benefits shared by women and their doctors:

• They’re effective for most women
• Many women regain complete bladder control within hours of their procedure
• In most cases, women can return to normal, non-strenuous activities shortly after the procedure
• Depending on the specific type of procedure, they may be performed under local, regional, or general anesthesia on an out-patient basis
• Incisions are small, reducing pain and recovery time
• The procedures can be performed in women who have scarring from previous pelvic surgeries

Potential Risks
As with any surgical procedure, inherent risks are present. Some of the most common risks associated with sling procedures include urinary tract infections, symptoms of urgency and difficulty with urination. Sling procedures should not be performed on patients who are pregnant or planning future pregnancies. Be sure to discuss all of the benefits and risks with your doctor to ensure slings are the right treatment option for you.

Other surgical options

For some women, a more invasive procedure may be necessary. If you are one of them, make sure you are fully aware of the risks and side effects before scheduling your urinary incontinence surgery.

• Burch Colposuspension — This surgery elevates the urethra and bladder neck to a higher anatomical position, alleviating stress urinary incontinence symptoms. Before consenting, women should understand that this is a more invasive surgery, often requiring a long recovery period.

• Neuromodulation — Similar to a pacemaker, an electrode implanted in the spine regulates abnormal reflexes between the bladder, urethral sphincter, and pelvic floor muscles using electrical stimulation. This can be an effective treatment option for women who suffer from urge urinary incontinence.

• Biofeedback — Used to treat stress, urge, and mixed urinary incontinence, this therapy uses electrodes to create visual or auditory signals when the pelvic muscles are being contracted. Using these cues, women may learn to control muscle contractions and maintain continence. Depending on the type of incontinence being treated, the results have been mixed.

Know the risks as you consider the benefits

No one option is right for every woman. That’s why it’s so important to discuss the benefits and risks of each possible treatment with a specialist before choosing the one that’s best for you. Click here for some important questions you’ll want to ask your doctor before you commit to a treatment.

Remember — surgical procedures are not recommended for everyone, especially if you:

• Are pregnant or plan to become pregnant in the future
• Have blood coagulation disorders
• Have a compromised immune system
• Have renal insufficiency
• Have an upper urinary tract obstruction