Incontinence

 

Urinary incontinence is a condition that affects both men and women. 
Some estimates suggest that one in three women may have some form of  
incontinence. In general, there are two common types of  incontinence: 
stress incontinence and urge incontinence. 
Detection and Diagnosis
Stress urinary incontinence occurs when there is a sudden increase in 
pressure to the bladder due to a mechanical change of  the pelvis. When 
bladder pressure is greater than the urethral pressure, leakage of  urine may 
occur. This could happen while coughing, sneezing, laughing or running. 
The pelvis is composed of  muscles called levator ani muscles that act as 
a supportive “hammock.” Increased urethral mobility occurs when these 
muscles and other structures are weakened, which leads to urinary leakage 
called type II stress urinary incontinence.
Treatment Options
Multiple treatments are available to improve stress urinary incontinence. 
These include Kegel exercises, pelvic floor therapy, and minimally invasive 
surgical procedures that may be up to 85-95% successful.
Kegel Exercises
Stress urinary incontinence involves a completely separate pathway of  
therapy versus other forms of  incontinence. Few medications are available 
with FDA approval for improving symptoms. Kegel exercises applied 
appropriately may be performed 50-60 times per day. For instance, 15-20 
squeezes can be performed at one time. Kegel exercises improve stress 
urinary incontinence 50-70%, especially if  pelvic floor therapy is applied. 
Minimally Invasive Treatments
Urethral Injections
If  Kegel exercises are not successful, minimally invasive forms of  therapy 
are available. Urethral injections using collagen, Coaptite® (calciumbased material), or silicone may offer 60-70% improvement with an 
initial injection. Minor complications include transient urinary retention, 
frequency, urgency, burning, or failure whereby a second or third injection 
is needed. Typically, this method is applied for a poor surgical candidate or 
for someone who would like to avoid the use of  a sling. Injections may also 
be utilized following a sling if  further therapy is needed. 
Stress Urinary Incontinence
Northern Virginia
Pelvic Continence 
Care Center
The Urology Group 
Dr. Darlene Gaynor-Krupnick
Dr. Nicholas G. Lailas 
Julie Spencer, CUNP 
19415 Deerfield Avenue 
Suite 112
Lansdowne, VA 20176 
703-724-1195
1860 Town Center Drive 
Suite 150 
Reston, VA 20190 
703-480-0220
www.virginiapelvicare.comStress Urinary Incontinence  cont.
Pessary
Pessary placement, which is like a large 
doughnut shaped diaphragm, may be 
used to possibly decrease stress urinary 
incontinence as well as vaginal prolapse. 
It is a foreign body and risk to vaginal 
tissue may occur, even with frequent 
changes and care. 
Urethral Slings
Urethral slings presently have the greatest 
success rates and are now considered by 
many the gold standard for treatment of  
stress urinary incontinence. Minimally 
invasive slings and virtually noninvasive 
slings with only one vaginal incision 
are available to improve stress urinary 
incontinence to greater than 85-95%. 
Studies have shown that pubovaginal slings 
can maintain continence 85% long-term. 
The procedure typically involves needles 
placed at the labia. A synthetic sling, which 
is the same material used in a general hernia 
surgical repair, is connected to the needles 
after a small vaginal incision is made. 
There is also a risk, as with any surgical 
procedure, of  bleeding, infection, pain, 
and sling extrusion. Sling extrusion is 
easily repaired in the office. Occasionally, 
with type III incontinence, a person may 
still experience incontinence. Mid urethral 
injections may be used to bulk the urethra 
and further decrease urinary incontinence 
following a sling procedure, if  necessary. 
Postoperative restrictions include: 
• lifting limited to 10 pounds during a 
6-week period. 
• no strenuous activity for 6-weeks.
• no straining, including avoiding 
constipation (over-the-counter 
MiraLAX® may be used for 1-4 weeks in 
order to avoid constipation depending on 
use of  narcotics).
Only light activities, such as sitting with 
light arm weights, walking, and slow stair 
climbing. You may feel lethargic due to your 
body’s healing process or anesthetic effects 
which may also affect the bladder following 
surgery and delay its function. There is also 
a possibility that you may still need a pad 
for protection in individual cases, as we 
cannot guarantee a 100% cure, but we can 
realistically improve your present situation. 
Although some cases are not as direct 
as others, successful treatment depends 
on an understanding of  the diagnosis 
and providing a proper examination with 
appropriate tests that direct the best form 
of  therapy. 
This information is provided as general health guidelines and may not be appropriate for your actual condition. Your individual health circumstance and 
any necessary medical treatments can only be properly addressed and diagnosed by a professional healthcare provider. The Urology Group, Northern 
Virginia Pelvic Continence Care Center and any other contributors are not liable for the content or any errors or omissions in the information provided.
Copyright © 2009. The Urology Group – Northern Virginia Pelvic Continence Care Center. All rights reserved.

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Stress Urinary Incontinence

Northern Virginia Pelvic Continence Care Center
The Urology Group

Dr. Darlene Gaynor-Krupnick Dr. Nicholas G. Lailas
Julie Spencer, CUNP

19415 Deerfield Avenue Suite 112
Lansdowne, VA 20176 703-724-1195

1860 Town Center Drive Suite 150
Reston, VA 20190 703-480-0220

www.virginiapelvicare.com

Urinary incontinence is a condition that affects both men and women. Some estimates suggest that one in three women may have some form of incontinence. In general, there are two common types of incontinence: stress incontinence and urge incontinence.

Detection and Diagnosis

Stress urinary incontinence occurs when there is a sudden increase in pressure to the bladder due to a mechanical change of the pelvis. When bladder pressure is greater than the urethral pressure, leakage of urine may occur. This could happen while coughing, sneezing, laughing or running. The pelvis is composed of muscles called levator ani muscles that act as

a supportive “hammock.” Increased urethral mobility occurs when these muscles and other structures are weakened, which leads to urinary leakage called type II stress urinary incontinence.

Treatment Options

Multiple treatments are available to improve stress urinary incontinence. These include Kegel exercises, pelvic floor therapy, and minimally invasive surgical procedures that may be up to 85-95% successful.

Kegel Exercises

Stress urinary incontinence involves a completely separate pathway of therapy versus other forms of incontinence. Few medications are available with FDA approval for improving symptoms. Kegel exercises applied appropriately may be performed 50-60 times per day. For instance, 15-20 squeezes can be performed at one time. Kegel exercises improve stress urinary incontinence 50-70%, especially if pelvic floor therapy is applied.

Minimally Invasive Treatments

Urethral Injections

If Kegel exercises are not successful, minimally invasive forms of therapy are available. Urethral injections using collagen, Coaptite® (calcium-
based material), or silicone may offer 60-70% improvement with an
initial injection. Minor complications include transient urinary retention, frequency, urgency, burning, or failure whereby a second or third injection is needed. Typically, this method is applied for a poor surgical candidate or for someone who would like to avoid the use of a sling. Injections may also be utilized following a sling if further therapy is needed.

Stress Urinary Incontinence cont.

Pessary

Pessary placement, which is like a large doughnut shaped diaphragm, may be used to possibly decrease stress urinary incontinence as well as vaginal prolapse. It is a foreign body and risk to vaginal tissue may occur, even with frequent changes and care.

Urethral Slings

Urethral slings presently have the greatest success rates and are now considered by many the gold standard for treatment of stress urinary incontinence. Minimally invasive slings and virtually noninvasive slings with only one vaginal incision

are available to improve stress urinary incontinence to greater than 85-95%. Studies have shown that pubovaginal slings can maintain continence 85% long-term.

The procedure typically involves needles placed at the labia. A synthetic sling, which is the same material used in a general hernia surgical repair, is connected to the needles after a small vaginal incision is made.

There is also a risk, as with any surgical procedure, of bleeding, infection, pain, and sling extrusion. Sling extrusion is easily repaired in the office. Occasionally, with type III incontinence, a person may still experience incontinence. Mid urethral injections may be used to bulk the urethra

and further decrease urinary incontinence following a sling procedure, if necessary.

Postoperative restrictions include:

lifting limited to 10 pounds during a 6-week period.

no strenuous activity for 6-weeks.

no straining, including avoiding constipation (over-the-counter MiraLAX® may be used for 1-4 weeks in order to avoid constipation depending on use of narcotics).

Only light activities, such as sitting with light arm weights, walking, and slow stair climbing. You may feel lethargic due to your body’s healing process or anesthetic effects which may also affect the bladder following surgery and delay its function. There is also a possibility that you may still need a pad for protection in individual cases, as we cannot guarantee a 100% cure, but we can realistically improve your present situation.

Although some cases are not as direct
as others, successful treatment depends on an understanding of the diagnosis
and providing a proper examination with appropriate tests that direct the best form of therapy.

This information is provided as general health guidelines and may not be appropriate for your actual condition. Your individual health circumstance and any necessary medical treatments can only be properly addressed and diagnosed by a professional healthcare provider. The Urology Group, Northern Virginia Pelvic Continence Care Center and any other contributors are not liable for the content or any errors or omissions in the information provided.

Copyright © 2009. The Urology Group – Northern Virginia Pelvic Continence Care Center. All rights reserved.