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Women’s Health

Stress Urinary Incontinence Diagnosis & Treatment Options

It is important to diagnose your incontinence correctly to ensure the appropriate treatment option is selected.  Your physician will want a complete medical and surgical history, a list of all medication and supplements, as well as information about your urinary habits and all fluids consumed.  It’s important to accurately describe the problems you are having, such as when and under what conditions leakage occurs. Withholding information because you are uncomfortable or embarrassed may limit how well you can be cared for by your doctor.

It may be beneficial to track your voiding habits in a journal to share with your physician. Your voiding diary should include information such as what and how much you drink, number of times you urinate and if you have episodes of leakage.

There are a number of tests to aid in diagnosis of incontinence:

  • Urinalysis – testing of the urine sample
  • Stress test – fluid inserted into the bladder to check for leaking
  • Post-void residual – measures the amount of urine left in your bladder after urinating
  • Cystoscopy – use of a scope to examine your bladder
  • Urodynamics – testing that measures:
    • Amount of urine in the bladder before urinating
    • Force of the urine as it leaves the body
    • Internal pressure of the bladder as it fills with urine
    • Control of the urethral sphincter muscles

Treatment Options for Stress Urinary Incontinence

There are many options for treating or managing your incontinence. It is important that you discuss your options with your doctor and gain an understanding of what each treatment might mean for your future. By treating your incontinence successfully, you can return to the active lifestyle you have always enjoyed.

Management Options

Some women choose to pursue management options intended to manage current symptoms while working to improve mild cases of stress urinary incontinence – delaying or avoiding more permanent treatment. Protective undergarments or catheters can be used in conjunction with pelvic muscle exercises and behavioral therapies to manage leakage while strengthening pelvic floor muscles

Non-Surgical Treatment Options

If you have been diagnosed with Intrinsic Sphincter Deficiency (ISD) as the cause or a contributing factor to your stress urinary incontinence, there are non-surgical options for treatment known as bulking agents.

Durasphere® is a bulking agent that is injected into the layer of tissue surrounding the urethra (called the submucosa) that helps the weak muscles of the bladder neck by adding bulk to the area, increasing the ability to resist urine leakage during exercise or other activities.  When you decide to empty your bladder, the urethra expands, allowing urine to pass.  This minimally-invasive, non-surgical treatment is often performed in an office setting and can be completed in 15 minutes allowing you to return to normal activity the same day.

Important Safety Information

Treatment through the use of a bulking agent should not be performed if there is inflammation of the bladder or urethra or you have another infection. Treatment may be considered once the infection has healed. Narrowing of the bladder neck or urethra is called stricture. If you have strictures when treated, you may be unable to pass urine. Bulking agent safety and effectiveness has not been evaluated in women who are pregnant or in women who have become pregnant after treatment. Conditions/symptoms such as urinary tract infection, retention of urine, urgency to urinate, painful urination and blood in the urine are common and expected events following treatment with bulking agents.  Six out of ten patients will experience mild and brief (less than 24 hours) symptoms.

Surgical Treatment Options

If you have been diagnosed with female stress urinary incontinence, one surgical option your doctor may recommend is a biologic or synthetic graft sling procedure. There are different types of slings including the Aris® Trans-obturator, Supris® Retropubic, or Altis® sling—each of which is implanted using a different approach.

A sling procedure corrects stress incontinence by supporting your urethra to keep it in its correct position. The operation is minimally invasive but may require an overnight hospital stay. Stress incontinence can occur when weak pelvic-floor muscles, or pressure from other organs, shift or weaken the bladder neck. When the bladder neck is out of place, the urethral sphincter may not be able to keep the bladder neck closed under physical stress. The surgically implanted sling corrects stress incontinence by supporting and repositioning the bladder neck and urethra in their correct position which can help the urethral sphincter function properly.

The end result is that after a sling procedure, most women can once again regain control of their bladder. It is important for you to know that following a sling procedure, future pregnancies may negate the effects of the surgical procedure and you may once again become incontinent.

Important Safety Information

Every surgical procedure carries some risk. You may experience an increase in the need to urinate or your urine flow may be slower. You may also not be able to urinate naturally following the procedure. This result may be temporary but it may last a month or longer. If this occurs, you may need to have a catheter inserted to help you urinate or you may need another operation. You may have a reaction to the sling material itself which may require full or partial sling removal. Another potential complication is infection which may require treatment with antibiotics. You should ask your doctor to discuss all these matters with you, as well as any other potential risks and complications.

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