Urinary Incontinence - Treatment

Although Dr. Mark McClure and Dr. Daniel McRackan of Landmark Urology and Complementary Medicine are accomplished surgeons, they employ their surgical skills on behalf of their patients as a last resort, when other healing avenues have been thoroughly exhausted.

As urologists, many of their patients are men, but they also see women on a regular basis. "Some of the happiest patients we have are women who were dealing with the very difficult problem of incontinence, and are now busily engaged in leading full and normal lives," they say.

"While men have the problem of incontinence, as well, it is more common among women, due to many factors, such as childbirth, and chronic coughing from smoking or from chronic bronchitis. Obesity is a factor also linked to incontinence.

"We work with our incontinent patients to do a very complete history and physical exam, so we have a good understanding of the patterns of the problem. Some women experience what is known as urgency incontinence, which simply means that they have a very sudden and strong urge to urinate that is difficult to control. Many times, there's an involuntary loss of urine, and they may lose most of what is in their bladder before they can get to a bathroom. That is, of course, very disconcerting.

"Urinary stress incontinence is similar to but different from the urgency problem. Typically, we assign the stress condition to one of three categories or classes, in terms of its severity. The stress relates to the pressure that is put on the urinary system as the result of coughing, laughing, and often, lifting.

"Once we and our patients have a good understanding of the nature of their problem, we discuss its impact on their lives, and management techniques that may be helpful to them. We have a good 'risk-benefit' talk, as well. It is our view that the benefits need to far outweigh the risks before proceeding with corrective surgery."

Drs. McClure and McRackan have observed that after being plagued with the problem of incontinence for years, "women will usually assume the relatively minor risks of surgery to obtain an 85% chance of cure and 10% chance of improvement in their condition. For some women, the problem has become so intrusive in their lives that they are no longer able to run, to play with their children, to schedule normal social events, or pursue hobbies that they love, because of the fear of loss of urinary control and embarrassment."

Click here to download the PDF "Surgery for Incontinence Is Sometimes Best Option" written By Mark McClure, MD

Exercises

Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Most Kegel exercises do not require equipment, however one technique involves the use of weighted cones within the vagina. Women of all ages can learn and practice these exercises, which are taught by a health care professional.

Click here to download a PDF with instructions about how to perform Kegel exercises, new window will open.

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Electrical Stimulation

Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles.

Biofeedback

Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles.

Timed Voiding or Bladder Training

Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. In addition, bladder training can alter the bladder's schedule for storing and emptying urine.

Medications

Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally. However some medications can produce harmful side effects if used for long periods so talk to your doctor about the risks and benefits.

Pessaries

A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage.

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Implants

Implants are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. A permanent implant called Macroplastique® can cure or improve urinary incontinence in up to two thirds of women.

Surgery

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. A midurethral tension free sling can cure urinary incontinence 85% of the time and improve the condition in another 10% of women. Drs McClure and McRackan specialize in the surgical correction of urinary stress incontinence.

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The Sling Procedure

While there are a number of surgical options for treating urinary incontinence, Drs. McClure and McRackan have achieved the most consistent success with a procedure called a mid urethral tension free sling.

This technique involves a number of steps. First, the patient is sedated, but not put completely asleep. Next a small one inch two incision is made in the vagina lying beneath the urethra. Then a small biocompatible graft made of synthetic material is positioned beneath the mid portion of the urethra. Each end of the graft is specially designed so that it permanently remains in place once it is inserted into muscle tissue lateral to each side of the vagina. Most women are able to be discharged without a catheter the same day of surgery. They are advised to limit activity for a week postoperatively. Heavy lifting and sexual intercourse can be resumed six weeks after surgery.

Catheterization

If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine.

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Other Procedures

Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers--especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation before resorting to absorbent pads or undergarments.

Other Resources

Click here to visit American Medical Systems Pelvic Health Condition website and learn Solutions for Urinary Incontinence.

Click here to visit American Medical Systems Pelvic Health website and learn more about Fecal Incontinence.

Click here to visit American Medical Systems Pelvic Health website and learn more about Female Urinary Incontinence.

Click here to visit American Medical Systems Pelvic Health website and learn more about Female Urinary Incontinence Treatment - MiniArc Monarc.

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