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


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 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:

Phone (888) 689-UCSF or (888) 689-8273

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