Urinary Incontinence, Stress: Treatment Options (cont.)

MODERATOR:
Doctor Miller, can you please explain "weights" and "electrical stimulation?"

MILLER:
There are several conservative options, particularly for people with mild problems or who cannot currently have surgical treatment. Electrical stimulation is a small device placed in the vagina to assist at the exercise. Cone weights are less commonly used but are tampon-shaped weighted devices placed in the vagina that reflexively cause the pelvic floor muscles to contract. Used 15 to 30 minutes per day, they are just another way of improving the success of the pelvic floor exercise.

MEMBER QUESTION:
Is the Kegel method effective alone or do you have to use it with biofeedback?

MILLER:
That's another good question. Kegel exercises have been widely used since 1949. They're not harmful and may be of small benefit. My experience has been that for people with significant bladder problems they are very unlikely to be successful as a sole treatment. We are much more likely to recommend a biofeedback program or a highly successful, minimally invasive surgical procedure, known as TVT. TVT stands for tension-free vaginal tape (by GYNACARE).

MEMBER QUESTION:
What other pelvic floor exercises are there?

MILLER:
In addition to simple Kegel exercises, there is a physical therapy program that can go by the name biofeedback or pelvic floor rehab (all of which mean the same thing). That involves exercising multiple groups of the pelvic floor muscles, and is taught and reinforced by a specially trained bladder therapist. The exercises in a pelvic floor rehab program work better because you're using modern principles of exercise physiology: sets, reps, targeted exercises by a specially trained therapist.

You can find these programs through most hospitals or most independent therapy centers. However, it will ultimately require a physician's order for you to participate in the program.

MODERATOR:
Bonnie, it's great that you were able to have the surgery and that it went so well. But you said you couldn't have it until you were done having children. What did you do between your first and second child?

BONNIE:
Between my first and second child and after my second child was when I was doing the biofeedback, the weights, the electrical stimulation and gaining little to no ground and discussing with my husband that we were done having children, we realized it was time to have surgery.

MODERATOR:
Dr. Miller, can you explain the surgical options for treating SUI? You mentioned TVT. Can you explain what that involves?

MILLER:
There are multiple surgical procedures that have been available for over 50 years. The current standard of care and state-of-the-art procedure is the TVT. With seven years of data to back up its high rate of success, it is currently the only procedure advocated by most experts. TVT is a minimally invasive outpatient procedure that involves no incisions in the abdomen and requires the placement of a small mesh tape under the urethra to create a supportive sling. During movement or exercise the mesh supports the urethra, allowing it to maintain its seal and prevent urine loss during those movements or exercise.

MODERATOR:
And if you change your mind about having more children, is it reversible?

MILLER:
No. The procedure should not be done in a woman who is uncertain about future childbearing. The reason why you must be absolutely certain about the end of childbearing is because this procedure is not reversible or removable. Subsequent surgery may cause a return to incontinence and make future treatment more complex. You are always wise to consider the conservative measures, such as exercise, until you are absolutely certain about childbearing.

MODERATOR:
Are there any medications you can take to treat SUI if you are not a candidate for surgery?

MILLER:
There are no current medications available and FDA-approved for SUI. Women can suffer from two different conditions of the bladder. In addition to SUI, there is also Overactive Bladder. Overactive Bladder is treatable with medication but presents with a different set of symptoms, characterized by excessive frequency and urgency of urination.

MEMBER QUESTION:
What are the risks of surgery of this kind?

MILLER:
The fortunate thing about a minimally invasive procedure like TVT is that it is associated with an exceptionally small risk of complication; 700,000 procedures have been performed worldwide with only a small number of reported serious complications. When they occur, they would include injury to a blood vessel or organ such as the bowel during the performance of the surgery. In addition, under rare circumstances, the sling could be inserted too tightly and would need to be released. In general, however, the procedure is performed with an exceptional safety record. In my practice, I have performed over 1,100 of these procedures without serious complications.

MEMBER QUESTION:
Can your partner feel the mesh when you are having sex?


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