Choosing a treatment for female incontinence

There are a variety of treatments for female incontinence, and the best treatment for an individual patient depends on the type of incontinence, the severity of the incontinence, the presence of other types of pelvic prolapse, and a woman's feelings about the balance between invasiveness and effectiveness of treatments. The following is an overview of how the doctors at MBUA counsel woman regarding treatment.

Urge Incontinence

Woman with solely or mostly urge incontinence are usually not treated with surgery. If a woman is post-menopausal and has vaginal atrophy we will usually recommend a 3 month trial of vaginal estrogen cream. If the amount of incontinence is moderate or severe we will usually also recommend a trial of medication. There are several effective medications for urge incontinence, including Enablex, Vesicare, Detrol LA, Ditropan XL, and Oxytrol patches. Patients are usually given samples of a medication and can expect results within 1-2 weeks.

Woman with fairly minor urge and stress incontinence should consider a 6 week trial of pelvic floor biofeedback therapy because it is non-invasive, does not require medications, and has a reasonable chance of significant improvement. Patients with more severe urge and stress incontinence may want to consider surgery to correct the stress incontinence, since the urge incontinence will also go away in 2/3 of cases.

Patients with urge incontinence that does not improve with these treatments should strongly consider a trial of Interstim® sacral nerve route modulation. This is an innovative procedure which uses a small pacemaker-like device to stimulate the nerves that go to the bladder and decrease bladder overactivity. We have had many patients whose lives were dramatically changed after successful treatment with this innovative device.

Stress Incontinence

Stress incontinence is not usually curable with medication, but patients with mixed urge and stress incontinence are usually given a trial of medication to see if they get much improvement. Many women will also get some improvement with estrogen vaginal cream, and vaginal estrogen will make surgery easier and safer. Woman with smaller amounts of stress incontinence will frequently get significant improvement from a 6 week course of pelvic floor biofeedback therapy.

Women with more severe incontinence and those with prolapse (bulging) of the bladder and uterus will usually be happiest with surgery to correct the weakness in urethral support. In addition, women who want the treatment with the highest chance of long-term cure of stress incontinence will usually choose surgery. For women with stress incontinence but no problem with significant bulging of the bladder or uterus, we perform an operation using the SPARC or Monarc female sling system from American Medical Systems. These outpatient operations are performed through a small (1 inch) incision in the vagina and use a synthetic mesh sling to hold the urethra in place and prevent incontinence. More than 90% of women are dry after this surgery and return to normal living within days of the surgery. Learn more about this state-of-the-art surgery by clicking here.

For women with stress incontinence and bulging of the bladder and/or uterus we will perform a vaginal surgery to correct all of the problems in one surgery. Hysterectomy can be performed by a woman's gynecologist, and we can repair the support of the bladder and urethra during the same operation. We usually use a surgical system that uses a piece of strong mesh to fix bulging of the bladder or rectum, hold the urethra in place, and correct the stress incontinence. Women who require these more complex operations usually spend one night in the hospital but are back to normal activities within 1-2 weeks from surgery.