Regaining Control:
Treatment for Urinary Stress Incontinence
April 2002 -- Imagine being too afraid to laugh or too embarrassed to exercise. Womenwho suffer from urinary stress incontinence experience these feelings everyday. But with new medical treatments, including minimally invasive procedures, women can stop stress incontinence and get back to enjoying their lives.
"The 'stress' form of urinary incontinence is characterized by decreased muscle strength and loss of elasticity in the pelvic floor," says Harvey Samowitz, MD, FACS, a urologist on staff at Memorial Hospital West who subspecializes in female urology and urogynecology. "Physical actions – laughing, sneezing, coughing and exercising – cause a mechanical 'stress' and place pressure on the bladder. When there is weakening of the tissue and a loss of support for the urinary sphincter (which is responsible for keeping urine in the bladder), leakage can occur."
Testing for Stress
In the United States, 10 million women suffer from stress incontinence, although some estimates are even higher. The reasons behind the loss of control include:
- Heredity
- Weight gain
- Menopause
- Pregnancy and childbirth
- Damage to pelvic muscles
- Hysterectomy or other pelvic surgery
"Since there are several types of incontinence from various causes, it is important to make an accurate diagnosis," says Dr. Samowitz. "When it comes to identifying stress incontinence, the patient's medical history is probably the most important resource, followed by a good physical examination. After that, we may utilize two specific tests."
A urodynamic test evaluates the function of the bladder and urinary sphincter. The bladder is filled slowly with water through a small tube called a catheter in an attempt to recreate in a laboratory setting how the bladder stores urine. Physicians can then measure how the bladder reacts to the fluid challenge with what are called "provocative stress maneuvers," such as coughing or straining, and check for changes in pressure and leakage. The bladder is also checked for its ability to empty properly.
A cystoscopy is a test that focuses on the condition of tissue and internal organs. A small, flexible fiber-optic tube with a tiny light is inserted into the bladder. This allows the physician to check the bladder muscle, urethra (the tube from the bladder that controls the passage of urine outside the body) and other areas.
After the cause of stress incontinence has been determined, the physician can focus on an appropriate form of treatment for the patient.
New Procedure Provides Support
One new treatment is the pelvic vaginal sling procedure, a minimally invasiveprocedure that provides support for the urethra. The patient is sedated for the procedure, which requires three tiny incisions – two just above the pubic bones and the third in the vagina near the urethra.
Two thin needles are directed through the two openings above the pubic bone, guiding a strip of mesh tape toward the urethra. The tape is sticky and frayed along the sides, which allows the tape to "stick" once it is in the proper place. Since the tape is a woven mesh, it is permanently fixed in place when tissues grow around and through it. The tape forms a sling, supporting both the urethral sphincter and the bladder neck, stopping stress incontinence permanently with a greater than 90 percent success rate.
Immediate Control
After the procedure, patients may stay in the hospital vernight, but it is not required. The next day, the patient is up, moving around, and already enjoying life without the worries of stress incontinence.
"Many people see stress incontinence as embarrassing, so they don't seek treatment," says Dr. Samowitz. "They believe in certain myths and misconceptions – that it is a normal part of getting older, that nothing simple can be done and that adult diapers are an acceptable solution. People need to know that stress incontinence is easily treatable, and the procedure is extremely patient-friendly."
If you are experiencing stress incontinence, treatment is available. To find a physician in your area, contact the Memorial Healthcare System Physician Referral Service at
(800) 944-DOCS.