Bladder drips and gullywashers improve after anti-incontinence surgery

When a woman has bothersome bladder leakage and is seeking to get her bladder back under her control, the first thing her provider will diagnose is whether the leakage is stress-type incontinence ("drips" small amount of urine with cough, sneeze, exercise), or urge-type incontinence (loses large volume of urine, "gullywashers" soaking pads and clothing). Stress-type drip patterns are more common, but urge incontinence can put a huge dent in your quality of life and can be terribly bothersome. Urge incontinence is also called overactive bladder, and may involve a spectrum of symptoms with urinary frequency, urgency, and leakage. Many women have a combination of symptoms and both types of leakage patterns, i.e. mixed-incontinence, and this situation can pose a dilemma to providers since the treatments for stress or urge incontinence are different - which to treat first?

Stress-incontinence is due to a weak urinary sphincter and lax pelvic floor support. Stress incontinence treatment options aim to reinforce, strengthen, lift, tighten, and re-establish normal support. Urge-incontinence is due to the nerves and muscles responsible for bladder holding and emptying being uncoordinated or overactive. Treatments for urge incontinence are aimed at relaxing bladder muscles and retraining the brain-bottom sensory and motor controls for normal holding and emptying. Many women will experience stress-incontinence after delivery, with aging, menopause, after pelvic surgery, or may be associated with musculoskeletal knee, hip, or spine problems that impact the nerves and muscles of the pelvic floor and vaginal support.

Historically, providers have been leery of diving into a surgical option to treat women with mixed incontinence for concern that the urge incontinence will worsen or even worse, she won't be able to empty at all and would need a catheter. Typically, conservative options for urge incontinence are recommended such as physical therapy and oral medications, and often with limited success. Both patient and provider can become discouraged, and patients often fail to follow-up thinking nothing more can be done - far from the truth!

A recently published study in the August 2015 edition of Obstetrics & Gynecology reported that out of a group of 1,600 women, most found "significant improvement" from their urge symptoms after a surgery for stress incontinence. This is good news for both providers and patients, adding confidence in expecting relief from urge-type symptoms after surgery for incontinence. The study analyzed data from three multicenter urinary incontinence surgical trials and included four primary forms of surgery to reconstruct support for the urethra and area of the urethral sphincter, the muscle that opens and closes to control the flow of urine from the bladder. The majority type of surgeries reviewed in the study are called a sling procedure, which included both non-mesh and mesh urinary incontinence surgeries. Along with relief from stress incontinence, all four types of surgery also relieved a bothersome urinary urgency in a majority of the women.

Most women seeking surgery for stress urinary incontinence also have overactive bladder symptoms, according to the study. After one year, each surgery group of women reported improvement in their symptoms (amounting to 57 percent to 71 percent of the total number), and five years later about half to two-thirds (46 percent to 65 percent) of participants still reported a 70 percent decrease from their baseline urine loss/urge symptoms. There is no proof that the surgeries themselves reduced the symptoms, according to the study, but the measurement of the patients’ satisfaction with fewer urgency symptoms is significant. This information can be used to counsel women considering a surgical treatment for their mixed incontinence, that the majority of women will have improvement in their leakage and urge symptoms for many years after their sling procedure.

If you are having bothersome urine leakage, tell your primary care provider and request a referral to a specialist in treating women's bladder control. The new specialty of Female Pelvic Medicine and Reconstructive Surgery (FPMRS), also known as urogynecology, focuses exclusively on treating women's pelvic floor disorders in bowel, bladder and sexual function. Specialists in FPMRS can offer a variety of medical and surgical treatment options for treating urinary incontinence. Some providers in gynecology or urology also focus on women's pelvic health. Regardless of where you seek your care, know there are options to get dry and anti-incontinence therapies are well-covered by most insurance plans.