Stress Urinary Incontinence
This site is not intended as a substitute for professional medical advice. Only your physician can diagnose; advise you, and appropriately treat your symptoms. Be sure to speak with your doctor about today’s treatment options and help you choose the one that is right for you.
Frequently Asked Questions
Stress urinary incontinence is a sign of an underlying condition often characterized by one or more of the following:
- Poorly functioning urethral sphincter muscle, the smooth muscle which helps to form a seal at the neck of the bladder.
- Excessive movement of the female urethra, the muscular tube that allows urine to flow from the bladder to the outside of the body.
- Weakened muscles which no longer adequately support the bladder and other organs of the pelvic area.
- pregnancy and/or natural childbirth
- strenuous exercise
- loss of pelvic muscle tone
- previous gynecologic surgery
While SUI is common in older people, it is not a natural or inevitable part of the aging process. In fact, millions of older people naturally maintain their continence while millions more have been helped with successful procedures.
Pregnancy and childbirth may take a toll on a woman’s body. The months of extra weight in the pelvis and the stretching and possible tearing of tissues during delivery have been known to have the potential to damage structures that help support the bladder and maintain control of urine flow. Having babies may contribute to incontinence. Today’s treatments offer excellent success rates; and many women who started leaking after childbirth are dry today.
Absolutely. Different treatment options have helped hundreds of thousands of women restore continence. And it doesn’t preclude the possibility of having surgery at a later date. Treatment options include things such as non-surgical (medications and muscle retraining (Kegel) as well as surgical options (bulking agents or slings).
You’re never too old to receive medical attention for incontinence. The types of incontinence older people have, and their responses to treatment are quite similar to those of younger patients.
Only a trained specialist like a gynecologist, urologist or uro-gynecologist can diagnose SUI. However, if you can answer "Yes" to any of the following questions, you may be experiencing urinary incontinence.
- During a typical day, do you leak even small amounts of urine?
- Do you leak urine when you sneeze, cough, laugh or exercise?
- Do you often have such a strong urge to urinate that you experience leakage before you reach the toilet?
- Are you experiencing leakage after surgery?
Your primary care physician can refer you to a gynecologist, uro-gynecologist or urologist who can help diagnose and treat urinary incontinence.
Questions to Ask Your Doctor
- What type of incontinence do I have?
- What will happen if my incontinence is not treated?
- What treatment choices do I have?
- What is the likelihood that I'll be dry after treatment?
- How many treatments will I need?
- What type of anesthesia, if any, will I need for this procedure?
- What is the risk for complications and what types of complications are associated with this particular procedure?
- How much will my treatment(s) cost?
- Will I need to stay overnight in the hospital?
- How much time will I need to fully recover?
- Is there anything I won't be able to do after treatment, like sports?
- How many of these types of procedures have you completed? What's your success rate?
UNDERSTANDING THE DISEASE
What Type of Urinary Incontinence Do I Have?
There are 4 types of urinary incontinence that are most common in women:
- Stress urinary incontinence: leakage of urine during physical activity such as coughing, sneezing, laughing and exercise.
- Urge incontinence: experiencing a strong, intense urge to urinate, followed by leakage of urine. This can occur even after just going to the bathroom.
- Mixed incontinence: when women have symptoms of both stress and urge incontinence.
- Overflow incontinence: leakage occurs because the bladder never completely empties.
If you suffer from any of the symptoms above please consult your doctor to find out how you can restore your lifestyle.
The best treatment option depends on what type of urinary incontinence that you have. This brochure focuses on stress urinary incontinence. Your doctor can help you become more knowledgeable about your specific type of incontinence, its causes, and the best course of treatment for your particular condition.
What is Stress Urinary Incontinence (SUI)?
SUI, the most common type of urinary incontinence, is the body’s inability to prevent accidental leakage when pressure (stress) is exerted on the abdomen— usually when there is coughing, sneezing, laughing, or strenuous lifting. Unlike what its name implies, this type of incontinence is not related in any way to emotional or psychological stress.
What causes SUI?
SUI affects women of all ages — young mothers, women in menopause, and senior citizens. It is important for you to know that SUI is not an inevitable part of aging. It can be related to a number of factors:
- Pregnancy and natural childbirth put some degree of stress on a woman’s pelvic muscles and ligaments, and the impact of this stress may become more evident with aging, sometimes resulting in the condition of SUI.
Strenuous activity or exercise
Vigorous exercise or any form of physical straining can put additional stress on the pelvic area, resulting in SUI if the pelvic and urethral muscles are already somewhat weakened.
Menopause hormone changes
As your hormone balance changes through the various stages of menopause, this can lead to a weakening of the muscles that control urine leakage.
Prior gynecologic surgeries
Certain types of gynecologic surgery may have an effect on the overall strength of pelvic and urethral muscles, leading to a woman having difficulty holding urine when pelvic muscles are strained or stressed.
What Treatment Options are Available?
Treatment for SUI is determined by a number of factors, including the severity of the incontinence you suffer from and your general state of health. Your doctor’s goal is to determine which treatment approach is best suited to your specific condition.
- Muscle Retraining/Behavioral Therapy – A series of exercises is sometimes used to help strengthen and learn to control the muscles involved in urination.
- Medication - In most cases, SUI is not effectively treated with medication. This option is usually reserved for other types of incontinence.
- Bulking Agents - This involves the injection of a “bulking” agent (such as CONTINGEN® Implant) into urethral tissues to maintain closure of the urethra (the tube leading from the bladder to discharge urine outside the body) and, thereby preventing accidental leakage. This can be effective for those who are not good candidates for surgery.
- Urethral Sling - This involves the implantation of a urethral sling to help restore the body's natural functioning of the urinary tract.
Urethral Support Systems
When the tissues of the urethra become weakened and are not functioning properly, urine can sometimes leak out through the urethral opening because those muscles are unable to close tightly. Without the needed support for those weakened urethral tissues, urinary incontinence is inevitable.
A surgical approach that is widely used today to restore continence involves the implanting of a urethral sling. A sling is a narrow strip of material that the surgeon positions under the urethra to support its natural tissues, allowing it to function as intended. The implanted sling acts much like a hammock, providing extra support of the urethra to prevent accidental leakage.
There are two basic types of urethral slings used today; man-made and natural tissue. Both types work very well in restoring continence, so your doctor’s choice of sling is generally based upon what he or she believes is the right material for your anatomy.
Overview of the Urethral Sling Procedure
In most cases, a urethral sling can be implanted within about 30 minutes. Placement of a sling is a minimally invasive surgical procedure, often requiring only a single vaginal incision. With some devices, tiny incisions in the abdomen or inner thigh may also be required. Your physician will choose the anesthesia best suited to your condition and general health: either local, regional, or general anesthesia. The sling is inserted under the urethra to provide the necessary support to prevent involuntary leakage of urine, and it then self-anchors securely in place.
After the procedure
You may be able to return home in just a few hours after the procedure is performed. All incisions will be small and should heal quickly. Your physician will most likely advise you that for approximately four to six weeks, you should avoid sexual intercourse, heavy lifting and strenuous exercise. Your physician will provide you with specific information on how to care for yourself after the procedure.
Are there risks with a procedure using a urethral sling?
As with any surgical procedure, the sling procedure itself has the risk of certain complications such as the use of anesthesia, the surgical approach used, and how pre-existing conditions may affect the outcome. Your physician can further explain your specific risks and can provide a list of warnings associated with the procedure.
Like any surgical procedure, there are risks associated with the use of a permanent mesh, man-made or natural tissue implant. Complications can include localized fluid collection (blood, pus, clear serous fluid), erosion of the graft into surrounding tissues, infection, inflammation, pain (including pain with intercourse), perforation of neighboring tissues or organs, difficulty urinating, and failure of the procedure resulting in recurrence of incontinence. Given the permanency of a mesh implant, post-procedure removal of the implant may be difficult. Additionally, repair of stress urinary incontinence using a mesh implant should not be undertaken if you are pregnant or may become pregnant.
If you experience any complications, please notify your physician immediately. Speak with your physician regarding his/her experience with this procedure, and the anticipated probability of any of these complications.
Are there benefits to a procedure using a urethral sling?
Urethral slings have been used safely in medical procedures for decades and despite the risk of complications, the use of a urethral sling for stress urinary incontinence has been shown to be an effective, long-term method of repair. The sling incorporates easily and permanently into your own tissues and acts to strengthen and restore continence function, helping reduce the risk of a recurrence.
What results can be expected?
Urethral slings have had an impressive performance record over the years. They have been used successfully in hundreds of thousands of patients in the U.S. Each patient is unique, however, and your physician can give you a more specific view of what your expectations should be.
What Products Does Bard Offer?
BARD® Urethral Support Systems
AJUST® Single-Incision Sling
The AJUST® Single-Incision Sling allows your doctor to place the sling through only a single vaginal incision. The implant is made from a synthetic mesh material that is uniquely knitted to provide exceptional strength and durability, providing support required for urethral tissues after the procedure.
ALIGN® Urethral Support System
The ALIGN® Urethral Support System utilizes the same durable mesh used in the AJUST® Single-Incision Sling. Once in place, the ALIGN® sling self-anchors into the tissues without a need for sutures or other types of anchoring devices. The body’s own tissues begin to grow into, and become part of, the mesh sling in a matter of days.
PELVILACE® Biourethral Support System
The PELVILACE® System utilizes an implant that is a natural collagen material that comes from pigs specially bred and raised under carefully controlled conditions. This natural porcine collagen has a structure nearly identical to that in human tissue, so it is readily accepted by the body after implant. The porcine collagen used in the PELVILACE® sling has been implanted successfully in tens of thousand of patients worldwide.
After implant, the PELVILACE® sling, just like the ALIGN® sling, self-anchors into the patient’s own tissues without the need for mechanical anchoring devices.
The following terms will help you understand what your doctor tells you about your urinary incontinence, and your possible treatment.View glossary terms