What are the treatments available for stress incontinence?
After assessment of the degree and type of stress incontinence, a stepwise plan can be made to treat an individual patient.
A.) Lifestyle interventions: These include weight reduction, dietary/fluid modification e.g caffeine intake.
B.) Supervised pelvic muscle training and biofeedback to improve muscle tone and inhibit unwanted bladder contractions.
C.) Drug treatment for UTI, antimuscarinics for overactive bladder and duloxitene for milder degrees of incontinence.
D.) Estrogen supplementation preferably as local treatment as per gynaecologist’s advice.
This initial treatment is tried for 8-12 weeks and can improve or cure a number of patients, particularly those with milder intermittent incontinence. Severe cases and those not responding to conservative treatment are offered surgical treatment. A number of surgical treatments are available which are minimally invasive. The most popular are :
a.) Retropubic suspension – procedures are used when urethral descent is the main defect, e.g. MMK, Burch colposuspension, Raz, etc.
b.) Sling procedures – popularized by Mcguire which involve placement of pubovaginal slings of fascia or synthetic materials and can be used for both types of defects.
c.) Mid urethral slings – these essentially increase urethral support and are useful even in cases of prolapse. They are tension free vaginal tapes(TVT) and the relatively safer TVT-O (that passes through obturator foramen on either side). They are best used in previously unoperated patients.
It is important to treat significant genitourinary prolapse at the time of doing sling surgery to prevent urinary obstruction.
d.) Injection of periurethral bulking agents is a good option in sphincteric type of defect but may not be permanent.
e.) An artificial urinary sphincter is another useful but very expensive device in sphincter deficient patients.