Feature Archive

New Relief for Stress Incontinence

'Tension-Free' Relief

By Carol Sorgen
WebMD Feature

Reviewed By Brunilda Nazario

Women who suffer from stress urinary incontinence (SUI) worry about coughing, sneezing, even laughing in public for fear of having an accident. For some the fear of embarrassment is so great that they become virtual recluses, staying at home and avoiding any social contact.

Even with this anxiety, however, 62% of women sufferers wait a year or longer before discussing the condition with their doctor, reports a new Multi-sponsor Surveys' Gallup Study of women with SUI.

"It's usually when something really embarrassing happens to them in public that they finally seek help," says Jill Peters-Gee, MD, director of the Continence Care Program for Women's Health Connecticut. Most women cope with SUI by wearing pads, says Peters-Gee, because they don't know that SUI can now be easily treated with a simple surgical procedure.

First though, a definition. SUI is the involuntary loss of urine due to any physical activity that puts strain on the bladder, says Peters-Gee. The most common type of incontinence, SUI affects nearly 8 million women in the U.S, and occurs when the pelvic muscles supporting the bladder and urethra have been damaged or weakened. Some of the physical changes that can lead to SUI include childbirth, pelvic or gynecologic surgery, menopause or estrogen deficiency, obesity, and chronic constipation

Up to 80% of cases of female incontinence are treatable, says Peters-Gee, with treatment options including:

  • Kegel exercises to strengthen the pelvic muscles.
  • Electrical stimulation to help return injured muscles to fitness, and biofeedback to record progress in strengthening treatments and exercises.
  • Medical devices that block or capture urine.
  • Hormone cream to restore the tissue of the vagina and urethra to their normal thickness (the thinner the tissue gets, as estrogen levels decline, the more chance there is for leakage).
  • Surgery to repair or lift the urethra or bladder neck to provide support during straining or sudden movement.

At one time surgery to treat SUI was much more invasive, painful, and required a lengthy recuperation. That's one reason many women with SUI hesitate before seeking treatment, says Peters-Gee. A minimally invasive procedure that has been offered for the past seven years, however, is proving very successful.

Gynecare TVT Tension-free Support for Incontinence is used in a simple, outpatient procedure that usually can be completed within 30 minutes. The Gynecare TVT device uses a mesh sling to provide support to the middle of the urethra, the section that is strained during physical activities. The positioning of the device provides support only when needed and creates a "tension-free" treatment solution that reduces the risk of over-correcting.

Five-year data gathered in the United States, Europe, and Australia, and published last year in the International Uro-Gynecology Journal, has indicated that four to six years after treatment, 85%of the more than 200,000 women worldwide treated with this procedure no longer suffer from SUI, and an additional 11% remain significantly improved.

"The biggest advantage of this procedure is that it can be performed under local anesthesia," says Peters-Gee, explaining that this allows a doctor to test the ability of the sling to create continence and to know on the spot that the condition has been treated. "The ability to make adjustments right then and there also reduces the need for using a urinary catheter," says Peters-Gee. An additional advantage is that women who may not be candidates for surgery that requires general anesthesia are candidates for this procedure.

SUI is the most common form of incontinence. Other urinary incontinence can be classified as:

  • Urge -- an abrupt and uncontrollable desire to void.
  • Mixed -- a combination of stress and urge urinary incontinence.
  • Overflow -- the involuntary loss of urine resulting from an overfilled bladder without any corresponding feeling or urge to void.

While most cases of incontinence are not caused by serious problems, it's important to consult a urologist who can perform a complete workup, says Milton Krisiloff, MD, former chief of urology at St. John's Medical Center in Santa Monica, California.

"All cases of incontinence have to be evaluated to rule out infections, neurological problems, and bladder cancer," says Krisiloff, hastening to add that 95%of cases are not caused by these conditions.

Treatment for these other types of incontinence -- often called overactive bladder -- includes prescription medications such as Detrol LA, which works to help control involuntary contractions of the bladder muscle, the cause of strong, sudden urges. Drug therapy is often paired with behavioral techniques and bladder training, which together can help patients regain control over their bladder.

Before turning to medications, however, Krisiloff suggests a very simple approach that he has been using with patients for more than 20 years. His recommendation? "Change your diet." Eliminate all caffeine (that means coffee, tea, chocolate, caffeinated sodas), alcohol, and hot, spicy food.

Claiming almost a 90% success rate in curing these forms of incontinence (this won't work for SUI though, Krisiloff emphasizes), Krisiloff has compiled his recommendations and findings in a book, The Krisiloff Diet.

"By eliminating these irritants from your diet, you reduce the inflammation action on the neck of the bladder," Krisiloff explains. He concedes that many urologists don't believe this treatment works, but many of his patients see a remarkable difference in four to six weeks. An added bonus he's been finding is that this dietary change has also improved conditions for his patients who also suffer from irritable bowel, esophageal reflux (GERD), prostatitis, and even bedwetting among children.

"This is a purely natural approach," he says. "Why not try it first? If it doesn't work, the conventional urological approaches are always available."

Published Dec. 16, 2002.


SOURCES: Gallup Organization • Jill Peters-Gee, MD, director of the Continence Care Program, Women's Health Connecticut • International Uro-Gynecology Journal • Milton Krisiloff, MD, former chief of urology, St. John's Medical Center, Santa Monica, Calif.

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