Urogynecology Expert Forum
Stress urinary incontinence, physical therapy, exercises.
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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Stress urinary incontinence, physical therapy, exercises.

I've had SUI for 4-5 years, leaking urine with coughing, sneezing, heavy lifting, etc.  My gynecologist explained the testing she does for it and the surgery for a sling, but first referred me to a urologist.  The urologist did an exam and when she asked me to cough, there was no leakage at that time (that figures, the one time I want it to happen). She said that upon the exam, she noted my urethra moved backward/forward (not sure how she explained that) but said it's called urethral hypermobility and is most commonly seen in women who have given birth, but I have not.  She has now referred me for physical therapy evaluation and treatment.  I have been doing Kegal exercises but they haven't helped. She said if PT doesn't help or I choose not to go, she also explained surgery with sling.  Is PT very successful in SUI?  I'm not optimistic at all but am going to try it.  What about an MMK procedure for SUI?  Which is better?  I know I should consider myself lucky that I don't have worse SUI like lots of woman and should just live with this, but it is very embarrassing when it happens and I'm not sure I can handle this for the rest of my life.  Age is 52, premenopause, and will SUI get worse after menopause?  Thanks for answering all my questions.
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Hi, The physical therapy for SUI works for some women, but the effect seems to wear off over time. One of the more common procedures for treating SUI is called a suburethral sling, and it can be made from your own tissue, a synthetic material, cadaveric donor materials, or animal collagen. The sling can be done in 30-60 minutes, and is believed to work in about 90% of patients. It is done through a small vaginal incision, and 2 tiny incisions just above the pubic bone.

The MMK (Marshall Marchetti-Krantz) procedure was previously used along with the Burch procedure for SUI, but this requires a 4-6 cm incision in the abdomen in order to do the traditional procedure. Burch can also be done laparoscopically, but that is not as effective. These procedures are used much  less in current practice, although they still have their place in selected patients.

Urethral hypermobility is usually associated with childbirth, but it can also occur in cases of obesity, chronic constipation or chronic cough/wheezing. Sometimes it can occur without any explanation.

SUI probably gets worse with increasing age.
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