 | | If you’ve been experiencing symptoms of urinary incontinence, you don't need to panic. In most cases, urinary incontinence can be eliminated and even in those rare situations wherein the condition can't be completely done away with, there are a variety of therapeutic, pharmacological and surgical solutions capable of managing urinary incontinence and easing your discomfort and mitigating the inconveniences mentioned above. |
Stress Incontinence
Have you been having trouble controlling “things” when you’re urinating? Have you been leaking urine when you sneeze or cough? Do you find yourself needing to go to the bathroom unexpectedly and so badly that you aren’t sure that you'll be able to make it in time? Has the fear that you may wet yourself in public kept you from enjoying a normal social life? You aren’t alone. Loss of bladder control — a condition that’s better known as urinary incontinence — is a relatively common, but still embarrassing and frustrating problem for millions of Americans.
Treating women suffering from urinary incontinence secondary to a gynecologic or urinary deformity or lack of continuity typically involves surgery by a urologist or a urogynecologist.
Minimally Invasive Treatments
The rehabilitation of pelvic floor muscles is typically the goal of treatments that rely on pelvic muscle exercises (sometimes called Kegel’s exercises), the intermittent electrical stimulation of a patient’s pelvic floor nerve and muscle tissues with a tampon-like exerciser or weighted vaginal cones. Such treatments are aimed at increasing the resting tension, recruitment speed and contractile force of the pelvic diaphragm’s voluntary sphincter component. Up to thirty-eight percent of the patients who elect to follow such an exercise regimen (guided by a patient education handout) for three months or longer will experience some relief of pure stress urinary incontinence.
It’s also worth remembering that vigilant supervision of the exercise regime has been shown to result in striking differences in the level of success that patient’s can achieve.
Sets of specially designed vaginal weights can also be employed as mechanical biofeedback mechanisms to augment pelvic muscle exercises. Such weights are held inside a patient’s vagina by contractions of the pelvic muscles (for fifteen minutes at a time) and as the patient’s pelvic muscles strengthen in response to the exercise regime, heavier and heavier weights will be used.
Intermittent pelvic floor electrical stimulation using a tampon-shaped vaginal or slightly smaller anal probe can produce contractions of a patient’s levator ani muscles—which will help strengthen the area. So-called occlusive devices, such as pessaries will help prevent urine loss during strenuous coughing. Most patients will be able to insert and remove the pessary device comfortably and further, the device shouldn’t cause any voiding dysfunction.
There are also a number of viable surgical procedures, aimed at correcting genuine stress incontinence. For instance, both Suburethral Slings and Retro-pubic Urethropexy (also known as Burch and Marshall-Marchetti-Krantz MMK procedures) have been shown to offer long-term success rates of between 80 and 96% that are obviously superior to other procedures.
Treating Female Urinary Incontinence with a Bladder Sling
Bladder slings can be effectively used to treat stress-related female urinary incontinence but typically aren’t effective when it comes to treating urge-related female incontinence. So, if you’ve been diagnosed with stress urinary incontinence and weakening of your urethral muscles, you may be an excellent candidate for a bladder sling procedure. The operation can produce enough urethral compression to allow you regain control of your bladder. They can be placed during a, minimally invasive, outpatient procedure.
There are a number of sling types available, from mid-urethral retro-pubic slings to pubo-vaginal slings, to trans-obturator slings. Bladder slings are simply constructs that can be placed beneath your urethra to support and compress urethral activity. Many women who’ve been diagnosed with stress urinary incontinence experience a movement of their urethra away from their pubic bone during incidents of increased abdominal pressure – while coughing, for instance. A bladder sling thwarts this by remaining stationary, and essentially compressing the urethra during its downward movement. Their function can be likened to stepping on a running water hose to shut off its stream.
In the past, bladder slings were fashioned from tissue taken from patients. These days, sling materials vary and include options ranging from cadaveric fascia slings – bladder slings fashioned from tissues harvested from cadavers to synthetic material slings – bladder slings fashioned from polypropylene mesh.
Bladder slings offer women who’ve been diagnosed with stress-related urinary incontinence a number of advantages. First off, as noted above, they can be placed using a minimally invasive procedure on an outpatient basis. Second, bladder slings fashioned from synthetic materials are exceptionally strong, durable and inert. Most importantly, bladder slings are typically associated with fewer postoperative urinary symptoms such as urinary retention – an inability to void, and urinary urgency – the constant need to void.
Tension-Free Vaginal Tape (TVT)
New types of minimally invasive suburethral slings, the non-absorbable polypropylene mesh TVT or Tension-Free Vaginal Tape (produced by GYNECARE®) have been shown to result in less postoperative morbidity than traditional surgical approaches while offering long-term (5-year) success rates of better than 86%. The TVT sling is placed during a surgical procedure, under local anesthesia, in an outpatient setting. The procedure can be performed using either an abdominal or vaginal approach.
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One TVT obturator system "inside-out" technique passes the mesh device via a small incision into the patient’s vagina then out via small incisions in their thigh folds. That passage away from the bladder and urethra deftly avoids the retropubic space and therefore lessens the odds that patients will experience the urethral or bladder injuries associated with obturator devices that rely on the "outside-in" technique. More importantly, minimal dissection facilitates precise and accurate mid-urethral placement. Like the TVT, the obturator System makes use of the same unique proven and effective polypropylene mesh that has been employed in more than 500,000 SUI (stress urinary incontinence) procedures worldwide.
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Periurethral Injection
SUI can also be treated with a minimally invasive procedure known as periurethral injection. The periurethral procedure involves injecting material at the neck of the bladder, just under the urothelium. It is typically performed in an outpatient setting under local anesthesia. Presently, there are two injectable debulking agents that have been approved by the FDA for use in the treatment of stress urinary incontinence via periurethral injection …The Contigen Bard Collagen Implant Glutaraldehyde cross-linked bovine collagen, and Durasphere Advanced Uroscience carbon-coated beads. Both of which normally require multiple treatment sessions to achieve a cure.
Both procedures should be considered as only temporary solutions for a long-term problem, as patients need to be re-injected every six months, to realize the Quality of Life they want.
Overactive Blader
Behavioral therapy, that takes the form of bladder re-training and or biofeedback, attempts to reestablish a patient’s cortical bladder control by insisting that they ignore urgent signals and void (urinate) only in response to cortical signals received during waking hours. In one controlled trial of the technique, 75% of patients reported at least a 50% reduction in the number and frequency of incontinent episodes; and wholly 20% reported complete dryness.
There are also a variety of pharmaceutical agents that may be prescribed to women experiencing overactive bladder symptoms. Two relatively new medications in particular, Ditropan XL (extended-release oxybutynin chloride) and Detrol LA (tolterodine), have replaced generic oxybutynin as the preferred treatment option for overactive bladder because of their negligible side effect. Other applicable medications include enablex, oxytrol (dermatologic patch) and vesicare.
Fnding the Right Treatment
It is important for patients to understand that there may be a "trial and error" process involved in finding an effective drug and dosage. The reason this occurs is because all patients react differently to pharmacologic manipulation of their bladders. For some one drug might work well while another does not. Patients must understand that it will take a while before adequate dosing is achieved.
Similarly, intermittent pelvic floor electrical stimulation has also been shown to be an effective method of treating women experiencing overactive bladder syndrome. Recent clinical trails revealed that intermittent electrical stimulation of pelvic floor nerve and muscle tissues resulted in an impressive 50% success rate of detrusor instability. The procedure is used widely in Europe, but has now been widely acceptance in the United States. Though it is an excellent non-invasive approach, a motivated patient is required to take full advantage of its benefits.
Finally, there’s a promising new surgical procedure developed by Interstim, Medtronic Inc. that involves the Neuromodulation of the sacral nerve roots via electrodes implanted in a patient’s sacral foramina that has been shown to be an effective treatment for urge incontinence, urinary retention, pelvic pain and urgency/frequency syndrome. Patients first have a temporary test stimulator implanted. If a significant reduction in symptoms occurs, a permanent device will be implanted about a week later. However, given the high cost and invasive nature of this option, it should be reserved for patients who haven’t responded to more conservative treatment alternatives.
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