Urinary Incontinence

A. Urogynecology is a subspecialty within obstetrics and gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and constipation. After completing a residency in obstetrics and gynecology, urogynecologists complete fellowship training where they spend several years focusing only on these disorders.

Q. How common is urinary incontinence among women?

A. Many women incorrectly assume that urine leakage is normal. While the problem of urine leakage is very common, it should never be considered normal. The most commonly quoted study estimates that 11 million American women currently suffer from leakage of urine. However, this estimate may be low. A study of 2,800 postmenopausal women with an average age of 67 found that 56 percent of women experienced urinary incontinence at least weekly.

Q. What causes urinary incontinence?

A. Urinary incontinence is a symptom, not a disease, with many possible causes. The key to treatment is identifying which type of urinary incontinence you have through a careful medical interview and physical exam. Sometimes doctors need to perform tests called urodynamics to diagnose the problem. Urodynamics are necessary if a woman is considering surgery to correct incontinence.

The two most common types of urinary incontinence are stress incontinence and urge incontinence.

Stress incontinence is urine leakage that happens during an activity that causes pressure (or "stress") on the bladder such as laughing, lifting, coughing or sneezing.

Urge incontinence is urine leakage that occurs before a woman has a chance to urinate. Women with this type of leakage may also experience frequent urges to urinate and frequent nighttime waking to urinate.

Q. What treatment options are available?

A. Stress incontinence can be effectively treated with pelvic floor exercises, devices that "block" the loss of urine, or surgery. There is also a new medication called Duloxetine that will soon be available for the treatment of stress incontinence. Urge incontinence is commonly treated with medications, biofeedback, or electrical stimulation to the nerves that control the bladder. A new treatment for urge incontinence places an electrical stimulator, similar to a pacemaker, under the skin.

Q. I've heard that surgery doesn't work for very long. Is that true?

A. There is no surgery for incontinence with a 100 percent success rate, but two procedures – the retropubic urethropexy and the suburethral sling – work 75 to 95 percent of the time.

A suburethral sling called "Tension Free Vaginal Tape" (TVT) is considered by surgeons to be the best option for most women and can be positioned on an outpatient basis under local anesthesia.

Some potential complications of surgery for incontinence include difficulty emptying the bladder and the development of urge incontinence.

Q. I’ve heard that slings made of synthetic mesh can be harmful or cause problems. Is that true?

A. Most of the negative press about sub-urethral slings can be traced back to one or two poorly-designed products that are no longer on the market. The best synthetic slings are made of a loosely-woven polypropylene mesh designed especially for placement under the female urethra, providing the necessary support, while still allowing for excellent “tissue-in-growth.” In other words, your body will grow into the sling material within a few weeks after surgery. While problems with this approach can occur, they are very rare. It is recommended that you consult with your doctor for more information about the type of sling he or she will use.