Dr. Beier discusses Urinary Incontinence and Treatment:
“Urinary incontinence is one of the most troubling problems for women and comes in multiple forms. The two most common forms are urge incontinence and stress incontinence and both can occur with coughing, sneezing, or physical activity. Treatments of these forms of incontinence are quite different depending on your age. Therefore, it is important to distinguish which type is present. Some women have mixed incontinence, with combinations of both. Less common forms include overflow incontinence, often the result of medical conditions such as multiple sclerosis and diabetes, and functional incontinence caused by problems, such as immobility and dementia.
Urge incontinence is associated with the feeling of urgency, as the name suggests. Women have the sudden urge to void, which is extremely difficult to suppress, along with leaking of urine with a cough or sneeze. Physical examination results are normal and do not show evidence of urethral support loss. Treatment of urge incontinence can be as simple as voiding frequently in order to maintain smaller bladder volumes. Also, learning to reflexively tighten the perineal muscles (Kegel maneuver) helps to minimize leakage. Another conservative treatment includes "bladder drills," where the bladder is retrained to work through the feeling of urgency, and your physician can help you with this problem. Those who do not find success with these conservative measures are treated with medications to help relax the bladder. Surgery, in women with true urge incontinence, often makes the condition worse; therefore, surgery is not advised in these instances.
Stress incontinence is when you leak urine when coughing, sneezing, jumping, dancing, or performing other types of physical activity which increase intra-abdominal pressure. Patients with true stress incontinence do not have the feeling of urgency. With stress incontinence, you do not have to wake up frequently to void at night, which is more often associated with urge incontinence. Physical examination of women with stress incontinence shows a loss of support in the urethra, causing hypermobility of the bladder neck when the patient coughs or sneezes. Conservative treatment of mild cases is often successful and includes frequent voiding during the day to avoid an over distended bladder. Also, teaching reflex contraction of the perineal muscles (Kegel maneuver) is helpful when coughing or sneezing. Personally, I have not found routine performance of occasional exercises to strengthen the perineal muscles to be very useful. Teaching a woman to reflexively squeeze her perineal muscles is more important in helping prevent leakage. In more severe cases of stress urinary incontinence, conservative measures fail, and surgical options are most effective.
Today, the most commonly performed surgical procedure for stress incontinence is the bladder sling. A sling of mesh tape is used to support the urethra and return it to its normal anatomical position. This procedure can be performed in an outpatient surgical center and has a much shorter recovery time, then the older surgical procedures such as colposuspension. The bladder sling also has a much lower failure rate, resulting in enhanced patient satisfaction. Occasionally a periurethral injection is used, in association with the sling procedure, for the most severe forms of stress incontinence. This involves injecting a paste-like substance around the urethra to bulk up the area.
Many patients are hesitant to use mesh, because of advertisements seen on TV, by attorneys seeking clients who have had complications with the use of mesh and vaginal surgeries. It is important to distinguish the mesh used in sling procedures from the mesh referred to by these advertisements. The complication rates, using small amounts of mesh in a sling procedure, are quite low and are also easily managed. The advertised mesh complications pertain to repairs which are more extensive, such as vaginal prolapse problems, not the minimal amounts of mesh used in bladder slings. However, for patients who remain uncomfortable with the use of the mesh sling, there are more natural alternative materials that can be used.”