Incontinence affects 25 million Americans. In the senior population, one in three women may have problems. Severe urinary leakage can be embarrassing at first; later, however, it can prevent a woman from enjoying life or even from leaving her home. In many cases, incontinence can become a major disability and expense.
Today, urologists possess many tools to treat, control and even cure incontinence, aside from the messy and costly diapers and pads advertised on television and in magazines. After a thorough evaluation, which would include a medical history and a physical examination, the urologist may order special studies (cystoscopy, urodynamics or pressure studies) to measure muscle and nerve functions.
Incontinence can be divided into numerous categories, depending upon the underlying cause:
Problems may be caused by infections, or weakness in bladder muscles or nerves. Other complications, such as stones or tumors, also may produce urinary leakage.
Conservative management had focused on non-invasive measures, such as antispasmodic drugs and pelvic floor muscle training. Biofeedback is playing an increasing role in teaching a woman to control and contract her sphincter muscles.
New drugs with extended half-lives and reduced complications also are available to produce bladder relaxation and control symptoms of urge incontinence, also called an "overactive bladder."
It was in 1995 that Contigen was released -- a cross-linked bovine collagen that can be injected through the urethra into the region of the bladder neck and sphincter. This acts as a "bulking agent" to reduce to size of the urethra and thus reduce urine leakage. Contigen injections are simple and safe, and can be performed as an outpatient in the ambulatory surgery setting, with minimal local anesthesia or sedation. In properly selected patients, more than 75 percent report benefit or improvement, while 50 percent are clinically cured and dry. Most importantly, the procedure is extremely safe, with a complication rate of less than one percent.
For women requiring surgical intervention, numerous operations have been developed since the original Marshall-Marchetti-Krantz suspension in 1947. In fact, there are more than two dozen types of anti-incontinence operations to support the bladder region, using varied approaches and equipment, including:
- Bone anchors
- Vaginal tissue islands
- Artificial sphincters
Though all of these techniques provide greater than 80 percent short-term success, by five years, nearly one-half of the women have recurring symptoms of leakage and are disappointed.
Lately, a new operation has proven to have long-term success: the pubo-vaginal -- or pelvic sling -- procedure. Instead of just elevating the bladder neck with sutures, the pubo-vaginal procedure actually supports the urethra using a hammock of fascia, secured to the abdominal wall or pelvic ligaments. This tough tissue will not erode or loosen with time, and provides the necessary support and strength to prevent urine leakage when a woman strains, exercises, sneezes or laughs.
Five-year success rates have been near 90 percent, and these have proven to be durable and reproducible. Complication rates remain low, and the procedure can be performed with just an overnight, 23-hour stay. The pelvic sling operation is the newest procedure that urologists have to treat incontinence. The result is a happy woman, able to function actively. The most common remark is: "Doctor, I should have had this operation years ago."
Disclaimer: TEXT by Dr. Richard A. Blath, Christian Hospital. Phone: 314.362.WELL or toll-free 800.392.0936 for information on Christian Hospital urological procedures and treatment options.