Stress Urinary Incontinence

Stress urinary incontinence is urine leakage that occurs with exercise, cough, sneezing and or laughing. This type of incontinence is common and occurs more often after pregnancy and vaginal delivery, with repeated straining (such as heavy lifting, constipation, chronic cough) and usually worsens with weight gain. 

Treatments 

Weight Loss

Weight loss has been shown to improve urinary incontinence. In one well done trial, women losing an average of 17lbs, had only half as many incontinence episodes (Phelan 2012).

Pelvic Floor Muscle Training

Pelvic floor muscle training can be done with or without a physical therapist. Studies demonstrate that pelvic floor muscle training cures over half of women with incontinence. Most women find they must continue to do these exercises, or the incontinence will return.

Pessary or Vaginal Insert

A pessary or vaginal insert can be useful for patients who experience incontinence during situations. Vaginal inserts may be tried during exercise or any other situation that usually results in incontinence.  In well-done trials women using pelvic floor muscle training had better results than with a pessary, but some women may prefer to try a pessary. (Richter 2010)

Surgeries

Several surgeries are available for stress urinary incontinence. The first thing to decide is how the patient and provider feel about the use of synthetic mesh. Mesh was developed in order to make repairs stronger and longer lasting. It is used in other areas of surgery such as for hernia repair.

Midurethral Slings

Midurethral slings using mesh are considered by most Female Pelvic Medicine and Reconstructive Surgeons to be the standard of care in the United States. In fact, the American Urogynecologic Society and the Society of Female Urologists created a statement supporting the continued use of mesh midurethral slings.

They are one of the most well studied procedures that we do and there is a large amount of data on their safety and effectiveness. However, there are known risks to using a permanent implant and every patient has the right to decide together with their surgeon, what will best satisfy their goals and values.

Autologous Fascial Sling

For women who do not want a permanent mesh implant, strong tissue called fascia may be taken from the abdomen or thigh to be used for the sling surgery. This recovery generally takes a little longer, which is why many women and physicians prefer to use mesh.

Burch Colpopexy 

Burch colpopexy is performed by elevating the tissue on either side of the urethra to a strong ligament in the pelvis. Traditionally this was performed open. Smaller trials of laparoscopic Burch suggest that it is likely as good as the open procedure.

Urethral Bulking

Urethral bulking is a procedure that can be done in the office or the operating room. It can be helpful for women with incontinence secondary to intrinsic sphincter deficiency (this is when the urethra doesn’t move – is fixed in place and with very low urethral pressures) and women who are too ill or do not want to undergo surgery. It is not as effective as sling or Burch procedures, but usually 2/3 of women will have at least moderate improvement.