by Pleas Copas, MD
If you leak urine at inappropriate times, you are not alone. More than a third of U.S. women report urinary incontinence. Urinary incontinence can have many causes, but one of the more common causes is stress or strain.
Stress urinary incontinence is urine leakage with activities. Activities can include coughing, sneezing, lifting, exercising, during sex, or even getting up from a sitting position. The amount of leakage may be small, just a squirt, but may happen frequently during the day. The most common cause for stress incontinence is loss of support of the vagina that holds up the urethra or bladder neck. This is commonly the result of pregnancy. When the symptoms are severe enough and conservative treatments such as physical therapy of pelvic muscles (Kegel exercises) or weight loss have not given the desired results, surgery is available.
In the distant past, many of the surgeries required an abdominal incision to achieve the best results. This is no longer necessary. Newer procedures that are done through a small vaginal incision are available for many patients. These can be done in the outpatient setting with much less pain and discomfort. The success is as high as older surgeries (80-85%) but with a lower complication rate. Even though the discomfort is much less, heavy physical activities must be avoided for about a month to allow healing. Small incisions take as long to heal as larger incisions. Sexual intercourse must also be avoided during this time.
Several different procedures are available for “minimally invasive” treatment of stress incontinence. The doctors at Women’s Care Group mainly use the TVT procedure from the Gynecare division of Johnson & Johnson. This has been used for more than 15 years in millions of patients around the world with a low complication rate. In fact, most large studies by experienced surgeons report major complications in less than 1% of patients with a success rate of 80-85%. The long-term results are available and reveal that 97% of the patients initially cured remain dry after 11 years of follow-up. This procedure uses a small, permanent sling made from polypropylene mesh. The mesh is made of the same material as sutures used in most heart surgeries.
Some patients require lab evaluations to check their bladder and urethra before surgeries, but many only need a regular consult office visit to schedule the surgery.