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What is Urinary Stress Incontinence?

Posted Sep 02 2012 12:00am

Today’s post is a guest post by Dr.David Ghozland, a board certified Ob/Gyn who has been certified by the American Academy of Cosmetic Gynecologist and specializes in vaginoplasty , labiaplasty and perineoplasty.

The two most common types of urinary incontinence are urge and stress incontinence. Urge incontinence occurs when the bladder muscles contract at the wrong time. As the muscles contract, it results in the familiar feeling associated with the urge to urinate.

Urine may leak out before a toilet can be reached or often leading to nighttime incontinence. Urinary stress incontinence is the involuntary leakage of urine while lifting, sneezing, coughing, or laughing. Anyone may suffer from urinary incontinence and it affects 13 million people in the United States alone.

More than 85% of those affected are women, and even though there are highly effective treatment options available, embarrassment often prevents women from seeking treatment. Of those women who experience urine leaks, more than 60% suffer from stress incontinence.

Stress incontinence can occur at any time. However, there are certain conditions that make women more susceptible. These include having multiple children, prior pelvic surgery such as hysterectomy, and the decrease in estrogen caused by menopause.

Other risk factors include obesity, age, and smoking. All of these weaken the pelvic floor and the urethral sphincter. When these structures weaken the bladder may shift downward and push out slightly from the bottom of the pelvis toward the vagina. This displacement prevents the muscles that would normally keep the urethra squeezed shut from working effectively.

There are several different incontinence treatment options available to women. The least invasive procedures and often the first ones prescribed range from natural and homeopathic remedies to exercises such as Kegels to strengthen the pelvic floor.

While each of these may help those whose leaking is minimal, they usually do not result in long-term resolution. Other non-invasive treatments include behavioral changes such as drinking fewer fluids, especially at night, losing weight, quitting smoking and limiting alcohol and caffeine.

Several medicines are used to treat urinary stress incontinence. Anticholinergic drugs help to control an overactive bladder and alpha-adrenergic agonists help increase sphincter strength but since there is a possibility of heart related side effects, these are rarely prescribed.

Antimuscarinic drugs help to block bladder contractions and are often the first prescribed medication in treating incontinence. Estrogen therapy helps to tone and improve the blood supply to the urethral sphincter; however, women with a history of breast or uterine cancer should never receive estrogen therapy.

The preferred surgical method of treatment for Urinary Stress Incontinence is the single incision bladder neck sling.  This quick and minimally invasive procedure allows our surgeons to make a small approximately 1 cm on the midurethral area and then placement of a small synthetic sling to hug the bladder neck.  This type of bladder sling has very few complications with minimal downtime and very few side effects.

A large majority of patients notice a tremendous difference in their quality of life within 48 hours.  Rejuvenic’s urinary incontinence procedure is done as an outpatient and women can return to normal activities within 48 hours.

Like any other surgery incontinence surgery carries risks and possible complications. Some swelling of the urethral and vaginal tissue post surgery may cause urinary retention and a catheter may be necessary to empty the bladder. This is a short term side effect that disappears as soon as the swelling goes down. Other possible complications include developing an overactive bladder which may lead to urge incontinence, difficulty urinating or completely emptying the bladder, urinary tract infection, pelvic organ prolapse and difficult or painful intercourse.

Untreated urinary stress incontinence can lead to a loss of self-esteem, reduced quality of life, and recurring skin irritations. But there is hope, A recent study found that in a survey of women two years after surgery, 86% of women who had traditional bladder sling surgery were satisfied with their results while 78% of women who had undergone suspension surgery were also satisfied with their experience. While urinary stress incontinence is common in women it is also highly treatable with a majority of women reporting positive results.

Dr.David Ghozland is a board certified Ob/Gyn who has been certified by the American Academy of Cosmetic Gynecologist and specializes in vaginoplasty , labiaplasty and perineoplasty. He is a member of the American Academy of Minimally Invasive Surgeons, the American Laparoscopic Surgeon Association and the Los Angeles County Medical Association.

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