Treatment of Stress incontinence: Good news! It’s not always surgery!

  • Urinary incontinence in any form is extremely prevalent in this society. A study was done recently, and women 60 years or older self reported an incontinence rate of 20%. That’s a lot of women, and that’s only counting the women willing to admit they had incontinence. As we have talked about before, incontinence comes in many forms, but the most common is stress incontinence and motor urge incontinence. I believe that many women do not seek medical attention for this disease because they are afraid of surgery. Good news! Not all treatments involve surgery, or medication even. Even though most of the treatments I am going to talk about are for the treatment of stress incontinence, the majority of women with mixed incontinence (having both urge and stress) find that their symptoms will be alleviated. Some women with pure urge incontinence also find improvement of their symptoms. What have you got to lose? These techniques and treatments are pretty benign.
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    The easiest place to start is with lifestyle modification. Probably the most important is weight loss if you are overweight. No one likes to hear that, but it is true. The extra weight a woman may be carrying around puts extra pressure on the bladder at baseline and makes it easier for urine to leak out. Even women who need to lose over 50 -100 pounds may find improvement of incontinence after losing only 10-20 pounds. Every little bit counts.

    Other lifestyle modifications include decreasing the amount of fluids you take it, but you should discuss this with your primary doctor before doing so, because this can have adverse effects on other areas of your health. There is also conflicting evidence out there stating that decreasing smoking, caffeine, and alcohol may be helpful. It’s worth a try, and it’s not like those things are healthy for you to begin with.

    Behavioral therapy is another option, including what is called a voiding diary. This is when you keep track of how much you void, how often, when and how much you leak, and how much you are drinking. Sometimes, just laying it out there shows you what situations are the worst for you and you and your urologist can modify your lifestyle together.

    Most women know that Kegel exercises are often recommended, however many women find they don’t really work. What we have found actually is that even though you think you are doing them correctly, there is a good chance that you are not. This is where pelvic rehabilitation comes into play. This is when you work with a physical therapist to help learn to isolate the important muscles and really give them a workout. Results are quite amazing. Working these muscles can also decrease urge incontinence as well. The main issue with this type of treatment is there has to be a great deal of motivation, and you have to keep up with the exercises long term. Along with pelvic floor physical therapy is biofeedback, which is another technique used to help identify the correct muscles groups.

  • A pessary is a support device placed into the vagina, usually by a Gynecologist to help support your pelvic organs and bladder that may have lost it’s support and might be contributing to your incontinence. It is temporary and easily removable by you. You would need a pelvic exam by your Gynecologist or Urologist to make sure this is a suitable option for you.
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    There are some other less common options that I will just briefly mention below. As always, be sure to discuss these with your physician prior to trying them.

    Vaginal Cones and Weights- weighted cones placed into the vagina and you have to use your muscles to hold them in.

    Pelvic Floor Electrical Stimulation- a small electrode is placed into the vagina and delivers a small non-painful energy dose to the pelvic floor muscles to stimulate a contraction.

    Magnetic Therapy- Patient sits on a chair and a magnetic field is generated. No patient effort is required. Long term results are not readily available at this time.

    I hope this summary makes things a little better for you to seek care for your incontinence. Just because you see the doctor, doesn’t mean you will end up with a pill or surgery. Hope this helps!
Published On: September 01, 2006