 |
MARCH 2008
Proven Therapies Available for Incontinence
Janis Luft, N.P., M.S.
Women’s Health Specialist
UCSF Women’s Continence Center
Urinary incontinence (UI) affects an estimated
25 million women of all ages nationwide, but less than half of them seek treatment from their primary care physicians, according
to research. Many women are embarrassed and suffer in silence, thinking that UI is a normal part of aging and that nothing can be
done for it, even though there is a wide range of proven therapies available.
To detect UI, physicians often must ask patients directly about possible symptoms and associated problems.
UI has profound medical, psychosocial and economic implications. It is associated with decubitus ulcers, urinary tract infections,
sepsis, renal failure and increased mortality.
Incontinent women, particularly the elderly, are more prone to debilitating accidents. A UCSF study of 6,000 women found
that symptoms associated with UI — such as frequent urination and a sense of urgency to urinate that causes them to rush
to the bathroom — increases a woman's risk of falls by 26 percent and fractures by 34 percent.
The most common types of UI include
stress incontinence;
urge incontinence that
is often called overactive bladder; and a combination of both, known as
mixed incontinence.
Factors that may contribute to UI include:
- Childbirth, in which tissues, muscles and nerves supporting the urethra are damaged
- Hysterectomy, which increases the risk of incontinence by 30 percent to 40 percent
- Illness, including diabetes, lung disease and stroke
- Obesity
- Oral estrogen use
- Recurrent bladder infections
Treatments
Diagnosis and treatment is offered at the Women's Continence Center at UCSF Medical Center, the first
and only continence specialty center in the San Francisco Bay Area. The center — a national leader in UI treatment,
research and training — has a team of experts including uro-gynecologists, colorectal specialists, nurse practitioners
and physical therapists.
Stress Urinary Incontinence — Therapies include:
- Behavorial therapies, such as pelvic muscle exercises and bladder training, can be initiated effectively by primary
care providers
- Electrical stimulation
- Pessaries
- Surgery
Urge Incontinence Therapies — Therapies include:
- Behavorial therapies, such as pelvic muscle exercises and bladder training, can be initiated effectively by primary care providers
- Electrical stimulation
- Interstim therapy
- Medication
- Tibial nerve stimulation
Surgery
Surgery for urinary incontinence restores the normal anatomic position of the bladder neck and urethra. There are two main
types — bladder neck suspension procedures and sling procedures. Within the medical community, the comparative effectiveness of
these approaches is still debated. It is important that the decision be based on each woman's individual circumstances.
Bladder Neck Suspension Procedures — These procedures involve placing sutures between the
ligaments and tendons that support the pelvic organs and then tying them to the pubic bone to stabilize the bladder and urethra.
These procedures can be performed through the vagina with a long needle or through an incision in the stomach. Vaginal bladder
neck suspension procedures tend to be more popular because recovery time is shorter and other pelvic support problems
(prolapsed organs) can be corrected at the same time. Pubovaginal Sling Procedures — These procedures use a piece of strong connective tissue from
another part of the body, typically from the abdomen, to create a supporting "hammock" underneath the urethra and bladder neck. Tension-free Support (TVT) — This procedure to support the urethra is a new minimally-invasive approach
for stress urinary incontinence. The procedure can be performed under local anesthesia and takes about half an hour to complete.
Patients who undergo treatment have a very short recovery period and experience minimal scarring after surgery. As TVT is
relatively new, it is not known whether the short term success of the procedure will last over many years.
For more information, contact the Physician Referral Service at UCSF Medical Center:
Other Resources
Primary Care Connections — March 2008 Table of Contents
Click here to subscribe.
|
|
