SUI and POP – or Stress Urinary Incontinence and Pelvic Organ Prolapse – are common, distressing, and costly conditions for women. It is estimated that 25 million Americans suffer from urinary incontinence, with stress urinary incontinence as the predominant type. This can lead to social isolation and depression. In many cases, pelvic organ prolapse and stress urinary incontinence occur concomitantly.
In a recent study done by Doctor Miklos and Doctor Moore, they discuss nonsurgical and minimally invasive outpatient treatments for stress urinary incontinence as well as pelvic organ prolapse. Current nonsurgical options for the management of stress urinary incontinence include behavior modification, physiotherapy, pharmacologic therapy, and mechanical devices.
Behavioral Modification
A clinician can discover some remarkable behavioral contributors to incontinence. Asking the patient to decrease her fluid intake, especially the intake of carbonated and caffeinated beverages, may decrease symptoms of SUI, urinary urgency, and frequency. Obesity and heavy smoking are also common modifiable lifestyle factors that are associated with urinary incontinence. Additionally, smoking cessation should be encouraged. The doctors discovered that there could also be transient causes of urinary incontinence, such as side effects of medication, urinary tract infection, or an upper respiratory infection, which should all be assessed.
Physiotherapy
Physiotherapy has been used for decades to treat incontinence. This is because weak or damaged pelvic floor muscles play a significant role in stress urinary incontinence. Common forms of physiotherapy include pelvic floor muscle exercises, vaginal cones, biofeedback, and electrical stimulation.
Kegel exercises are a great way to help regain bladder control. Ensuring that you are adequately instruction in the use of the correct muscles is crucial to success, however. Doctor Miklos and Doctor Moore note a fair correlation between success and the intensity of training. Vaginal cones are a series of tampon-sized weights that are held in the vagina for approximately 15 minutes once or twice per day, which requires contraction of the pelvic muscles with the goal of performing physically demanding daily activities while holding the cone in place.
Similarly, biofeedback is widely practiced to help patients gain awareness and control of their pelvic muscles. A variety of instruments are used to record small electrical signals that are produced when the pelvic muscles are squeezed during contractions. These contraction-related signals are instantly converted into audio and visual cues that patient can recognize and use to control muscular activity.
Functional electrical stimulation has success rates ranging from 35% to 70%. A vaginal probe is used to electrically stimulate the nerves ad cause contraction of the pelvic floor.
Pharmacologic Therapy
As of Doctor Miklos and Doctor Moore’s study, there are no medications approved by the US Food and Drug Administration to treat stress urinary incontinence. However, there are a number of drugs used off-label to help manage the condition, however, most of these medications have limited effectiveness due to annoying and sometimes life-threatening side effects. The role of estrogen therapy in the treatment of urinary incontinence has been studied for decades, and remains controversial. Also, a new antidepressant (duloxetine) is currently being explored specifically for the treatment of SUI; The results obtained so far suggest that it may be useful, and clinical trials are ongoing.
Mechanical Devices
Pessaries have been used throughout history for the treatment of various gynecologic conditions, including prolapse, cervical incompetence, and uterine retrodisplacement. Specific pessary types have been developed that are designed for the treatment of SUI. Proper insertion and follow up are recommended to avoid complications such as ulceration and vaginal erosion. These prevent urine loss by obstructing the external urethral meatus.
The success of these many available treatments for incontinence and prolapse depend on several factors, the most important being the patient’s motivation and compliance. Compliance is better when the patient has the best understanding of the rational behind therapy and what to expect, and all of these factors work together to produce the best possible outcome for the patient.
If you are experiencing stress urinary incontinence or pelvic organ prolapse, know that there are non surgical and minimally invasive procedures available to help provide relief. Doctors Miklos and Moore are experts in the urogynecology field, and are here to answer your questions and provide the support you need. Contact them today for more information about which procedure is best for you.