Incontinence Treatment - FAQ & Links

Urogynecology is a subspecialty within Obstetrics and Gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and constipation. After completing a residency in Obstetrics and Gynecology, Urogynecologists complete additional training where they spend several years focusing only on these disorders.

Many women incorrectly assume that urine leakage is normal. While the problem of urine leakage is very common, it should never be considered normal. The most commonly quoted study estimates that 11 million American women currently suffer from leakage of urine. However, this estimate may be low. A study of 2800 postmenopausal women (average age 67) funded by the National Institute on Aging found that fifty-six percent of women experienced urinary incontinence at least weekly.

Urinary incontinence is a symptom, not a disease. This means that there are many possible causes of urinary incontinence. The key to treatment is identifying the specific type(s) of incontinence that a woman has through a careful medical interview and focused physical exam. It may also be necessary to perform a special test called urodynamics to diagnose the problem. Urodynamics are necessary if a woman is considering surgery to correct incontinence. The two most common types of urinary incontinence are stress incontinence and urge incontinence. Stress incontinence is urine leakage that happens during activity that causes pressure (or "stress") on the bladder such as laughing, lifting, coughing or sneezing. Urge incontinence is urine leakage that occurs before a woman has a chance to get to the bathroom in response to an urge to urinate. Women with this type of leakage may also experience frequent urges to urinate and frequent nighttime waking to urinate.

Stress incontinence can be effectively treated with pelvic floor exercises, devices that "block" the loss of urine, or surgery. Urge incontinence is commonly treated with medications, biofeedback, or electrical stimulation to the nerves that control the bladder. There is even a new treatment for urge incontinence that involves placement of an electrical stimulator under the skin (similar to a pacemaker). BOTOX® injected into the bladder is a new option for many patients. The most important thing to remember is that there is a wide variety of non-surgical and surgical treatment options available for all kinds of urinary incontinence.

When it comes to treating stress incontinence, not all surgical procedures are created equal. Over the years, literally hundreds of variations of anti-incontinence surgery have been described in medical journals, and some of them don't work very well. Fortunately, research studies have identified two basic kinds of surgical procedures that seem to be the "best": the retropubic urethropexy and the suburethral sling. There is no surgery for incontinence that has a 100% cure rate, but either the retropubic urethropexy or suburethral sling should permanently cure 75-95% of women with stress incontinence. A relatively new type of suburethral sling called "Tension Free Vaginal Tape" (aka TVT) that became available in 1998 has rapidly replaced most other surgeries for stress incontinence. Nearly 1 million TVT slings have been placed worldwide, and many surgeons now consider the TVT-type sling to be the 'gold-standard' treatment for the problem. The TVT procedure can be performed on an outpatient basis under local anesthesia. No surgery, however, should be taken lightly. Some potential complications of surgery for incontinence include difficulty emptying the bladder and development of urge incontinence.