Genuine Stress Incontinence (GSI), or the involuntary leakage of urine, is a medical condition that affects 16.5 million women in the U.S. Treatments for GSI range from coping with the medical condition by using pads or diapers to undergoing major urinary incontinence surgery. Information on many of the conventional treatment approaches for GSI follows. In addition, a minimally invasive surgical procedure to treat GSI is now available which offers a lower risk of complications than traditional implant-based surgery. The SURx procedure is done on an outpatient basis and utilizes the heating and shrinking of your body's own tissues to restore support to the continence mechanism.
Absorbent Products (Diapers and Pads)
More than 90% of women with genuine stress incontinence use absorbent products to cope with their symptoms. Women with moderate to severe GSI often use 2 to 4 pads or diapers per day.
Kegel Exercises
Developed in 1948 by A.H. Kegel, Kegel exercises strengthen and control pelvic muscles under and around the urethra. Kegels are easy to learn, require no equipment and can be effective. It usually takes 4-6 weeks to see some improvement. If Kegels are not done daily, however, the benefits of controllng incontinence diminish rapidly.
Biofeedback
Biofeedback, often used in conjunction with muscle conditioning exercises, offers a woman real time visual feedback of her muscle contractions. Biofeedback uses a small vaginal or rectal probe to measure the strength of pelvic muscles as they contract and relax. Multiple biofeedback sessions are necessary to achieve significant results. After 6 to 8 weeks, success rates vary from 50%-80%, but quickly diminishes when the training stops. Biofeedback is most often used for urge incontinence and mixed incontinence.
Electrical Stimulation (ES)
ES uses low power electricity to stimulate contractions in the pelvic floor muscles with a vaginal or rectal probe. ES often requires 15-minute treatments twice daily for approximately 20 weeks before significant results are achieved. A recent study reported improvement rates of 73% immediately after a 20-week treatment period, but only 23% of women treated were completely dry. Improvement rates dropped to only 27% in one year when electrical stimulation treatments stopped.
Wearable plugs and patches
A plug is a small device that is inserted and worn in the urethra. Some plugs have a tube that runs the length of the urethra. A small balloon is inflated in the bladder to anchor the system in place. To urinate, the balloon is deflated and the plug is removed. A new plug is inserted after urination. A patch is a small piece of foam material that is placed over the urethra to form a seal. Both plugs and patches reduce leakage but do not cure incontinence.
Surgical Procedures
The two basic types of GSI surgery, slings and suspensions, use either open surgical techniques or laparoscopic techniques to elevate the bladder neck and urethra. Like all major surgeries, these types often require a hospital stay and extensive recovery periods. The success rates of these surgeries are often impacted by the experience of the surgeon.
Slings
Just as a sling supports a broken arm, the bladder neck sling creates a hammock-like backstop for the urethra. In sling surgeries, artificial mesh or cadaver tissue is slid under the urethra and attached to the pelvic bone with surgical staples or bone screws. Complication rates (excluding fever) of over 30% were reported in several studies. In addition, up to 11% of the women reported urge incontinence after surgery that they did not experience before the sling procedure. Recent new techniques in slings such as the TVT or TOT sling have resulted in cure rates > 95% with complication rates <1%. They can be done in under 30 mins. under local anesthesia on an outpatient basis. The risk of needing a catheter after surgery is very low and most patients return to regular activity except for postoperative restrictions within days.
Suspensions
The Burch or MMK suspension procedures are clinically known as retropubic urethropexy and colposuspension procedures. Think of the Burch procedure as building a urological suspension bridge. Pelvic wall tissue forms a suspension support for the urethra when the tissues are lifted and tacked by sutures to the sides of the pelvis. In one study, a large number of patients reported complications such as injury to the urethra, urinary tract infection and wound infection. Major complications needing additional surgery occurred in approximately 7% to 8% of patients. Serious complications such as urinary retention occurred in 5% to 8% of surgical cases, requiring a woman to use self-catheterization to void.
Send Feedback to: 
