One out of 3 women suffer from urinary incontinence, and “stress” incontinence is the most common form of bladder leakage. Dr. Brad Campbell discusses the main risk factors, possible treatments and the high satisfaction rates of women who are treated:
Here is a summary of Dr. Campbell’s comments:
The main risk factors that people have for incontinence are the same as for pelvic organ prolapse. These include:
Those are the main risk factors that you’ll see for stress incontinence. Obesity can contribute to stress incontinence, but it’s not the first thing we think about.
You can tell a lot about stress incontinence and if a woman truly has it through a simple examination. We want to make sure that stress incontinence is really the problem. There are several things we can do without putting a catheter in you. I might have you push down and we can tell a lot by what happens to your bladder when you’re bearing down. You have a kink in your urethra, and if your bladder moves down so there is no longer a kink, urine will spill out.
At this point, your options include physical therapy. Whether you go to a physical therapist for professional training and help or you practice Kegels on your own, it’s fine.
The next mainstay of treatment after that is surgical. That brings up the “mesh” controversy. But a lot of that controversy had to do with mesh used for pelvic organ prolapse, where they were using large amounts of mesh to suspend the vagina. They essentially wrapped the vagina with mesh.
With a midurethral sling procedure for incontinence, the amount of mesh that comes in contact with your vagina is minimal. A “sling’ is basically about the size of a shoestring – about one centimeter wide and the length of a child’s shoestring. I think of “mesh” like a screen in a screen door. If you just cut out a piece of that screen, a mesh sling is just like that, except it’s made out of Gortex, almost like a fishing line.
An area only one 1 centimeter by 2 centimeter comes into contact with the vagina.
It’s pretty rare for the mesh to erode into the vagina. And very few people have any pelvic pain problems with this midurethral sling mesh. In my experience, I’ve rarely had any problems with erosion of a sling into the vagina because the area of contact is so small.
The other question is: How effective is it?
One to three years after the procedure, 85-89% of women reported significant improvement in their stress urinary incontinence after that procedure. Over 95% are happy they did it.
So the studies are there to say that women like it and it works. It’s a lot better than the older procedure that was done with a big incision on the abdomen and you were in the hospital for a week afterward.
Today, a lot of physicians do these as outpatient procedures with the patient going home the same day.
Urge incontinence is a totally different problem. If women have symptoms of both stress and urge incontinence, treating the urge incontinence with a medication may improve your symptoms enough so that you no longer have a problem with stress incontinence.