Dec 27, 2011
Urinary incontinence affects 10-70% of women. Including over 200,000 women world-wide. Prevalance increases gradually during young adult life, has a broad peak around middle age and then steadily increases in the elderly. Prevalance in the United States is increasing. Women are often reticent to volunteer information about symptoms, so prevalance data may under-estimate the true extent of the problem.
Incontinence can be divided into three broad categories. Urodynamic stress incontinence, (leaking with coughing, sneezing or positional changes) affects 29-75% of symptomatic women. Urge incontinence, or detrussor instability accounts for 7-33% of patients. The remainder have mixed incontinence with some component of both types.
Although the multiplicity of symptoms associated with urinary incontinence can severely erode the quality of life, historically, most women have not sought medical care. Possibly because sufferers are embarrassed to report symptoms to their physicians, or are unaware of other treatment options, absorbent products (eg. disposable pads or undergarments) are the most commonly used management method.
The first line of therapy for incontinence sufferers who do seek medical intervention is lifestyle modification. Often physicians will ask patients to keep a "voiding diary". Studies have shown that 3-7 days of recording paramenters (such as fluid intake, number and volumes of both voluntary voids and leaks) is sufficient. Recommendations can then be made. Usually recommendations include reducing caffeine and alcohol, stopping smoking, weight loss, and therapy for chronic cough, timed or prompted voiding, "bladder training", bladder emptying prior to planned activity, etc. These simple changes can reduce or eliminate symptoms in some women. Pelvic muscle rehabilitation with targeted exercise (such as Kegel's) can play a role in improving all three types of incontinence.
For patients who have failed to improve dramatically with first line therapy there are few non-surgical options. Most of these involve an effort to mechanically obstruct the urethral opening temporarily. Pessaries (vaginal inserts) or urethral bulking agents (collagen injections) are two options. Medications are sometimes helpful, particularly for sufferers of urge or mixed forms of incontinence. Newer agents have fewer side-effects than older medications which may cause dry mouth, blurred vision, and other untoward effects.
Surgery for incontinence is probably best resevered for more severe cases. Surgery is typically more effective for correcting the pure urodynamic stress form of incontinence. Surgical modalities, similar to conservative therapies, attempt to obstruct the urethral orifice temporarily during episodes of increased intra-abdomnal pressure, by placing a "sling" or "tape" beneath the urethra near its exit point from the bladder. Success rates as well as complication rates vary with the type of procedure. The "gold standard" surgical procedure remains the Burch colposuspension. Pubo-vaginal sling procedures can be done in cases of treatment failure. Recently the transvaginal tape procedures have become increasingly popular. This type of procedure can be done in a day surgery type setting. Unfortunately, long-term cure rates for any of the surgical procedures have been disappointing.
As the United States population ages, the number of sufferers of urinary incontinence is predicted to increase. Disposable products are widely available, but most symptom sufferers would prefer another option if such were available. In 1988, our clinic developed a new option for treatment called Genityte. In the next segment of this blog article, I hope to introduce and describe this new non-invasive procedure as well as our experience with it to date.