By Nancy Howden, MD
Western Carolina Women’s Specialty Center
Urinary incontinence is defined as the involuntary leakage of urine, and can be caused by a multitude of factors that may result in a wide variety of symptoms that can affect an individual’s physical and psychological well-being, with devastating impacts on overall sense of self.
Studies tell us that approximately 25 percent of young women, 44–57 percent of middle-aged women and 75 percent of older women experience some degree of urinary incontinence. This translates into an estimated annual cost of $19.5 billion in the US.
Stress urinary incontinence (SUI) is defined as involuntary loss of urine with effort or physical exertion, e.g., exercise, coughing, sneezing. Evaluation of any complaint of urinary incontinence should include a thorough history and physical exam, urinalysis and assessment of voiding ability (or assessment of post-void residual urine).
Before choosing an intervention, your provider may recommend you undergo a urodynamic study. This evaluation can assess voiding function, bladder sensation, bladder storage potential, intrinsic urethral strength, as well as leakage when challenged with directed cough or strain.
A diagnosis of stress incontinence is just that, a diagnosis. It’s not a statement that you will continue to leak urine forever, or that you are bound for a future in diapers. Instead, the stress incontinence diagnosis is a starting point from which you and your provider can begin further treatment or intervention. The goal is to improve or correct this symptom so you can return to the activities you love, stress free.
Treatment for most forms of urinary incontinence can be conservative, and SUI is no different. Behavioral and lifestyle modifications are the first place to start – these include bladder training with scheduled voiding routines, weight loss and fluid management.
Another conservative treatment includes use of an incontinence pessary, a device worn within the vagina, thought to support the urethra and provide increased urethral resistance to leakage. Other patients who may not be healthy enough for, or decline, surgical intervention can undergo an office-based procedure known as peri-urethral bulking.
Synthetic suburethral slings are the most common surgical intervention for the treatment of SUI, with substantial safety and efficacy data to support their use. Alternatives to a synthetic sling include autologous fascial slings and Burch retropubic urethropexy procedures.
Taking all of this information into account, if symptoms of SUI are bothersome to you and interfere with you enjoying or performing activities of your daily life, talk with your doctor. You have Q and return you to the things you enjoy.
Dr. Nancy Howden is fellowship-trained and board-certified in Female Pelvic Medicine and Reconstructive Pelvic Surgery. To make an appointment with Dr. Howden at Western Carolina Women’s Specialty Center, please call 670-5665.