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Incontinence, the involuntary loss of urine, is a commonplace condition that affects nearly 25 million Americans, the vast majority of them women. Most common among the elderly, incontinence typically strikes women during or after menopause. The majority of men with incontinence are over 65 years old.
Urge vs. Stress Incontinence
There are two types of urinary incontinence. Urge incontinence occurs when an involuntary contraction of the bladder muscles cause a sudden desire or “urge” to urinate. This muscle contraction can overcome a person’s ability to hold back urine.
Urge incontinence can be caused by aging of the bladder muscles, or may develop after stroke, spinal cord injury, neurological problems like multiple sclerosis, prostate enlargement, radiation therapy, or chronic urinary tract infections. Urge incontinence is common among men with incontinence.
Stress incontinence results from weakness of the urinary sphincter muscle, or poor pelvic muscle support of the bladder. With stress incontinence, there is no urge that precedes leakage of urine. Urine
typically seeps out during instances of coughing, sneezing, or other general muscular contractions.
Causes of stress incontinence in women are varied. Many women are affected simply because of aging; in these cases, the decrease in estrogen causes the pelvic muscles to weaken. Others develop it after a hysterectomy or after giving birth.
Until recently, treatments for incontinence have typically included a combination of behavior modification and pharmacological therapy. Surgery has also been an option in more severe cases. However, these treatments have proven less than perfect in curing the condition. Medications only cure about 50% of urge incontinence cases, and 30-40% of stress incontinence cases. However, when behavior modification is added, the cure rates increase to 70-80%.
Thanks to recent medical developments, new treatments and procedures have proven remarkably more promising for curing the condition, especially for women with stress incontinence.
“I am extremely excited about the latest advances in treatments,” said MKMG Urologist Dr. Warren Bromberg. “They are much easier and less invasive than ever before.
Biofeedback for Stress & Urge Incontinence
This new treatment, now available at MKMG, is one of the most promising advances in Urology to date. With an improvement rate of 85-90% after just six weeks, biofeedback is now recognized as a covered expense by the government’s Healthcare Financing Administration in the treatment of urinary incontinence.
Biofeedback assists patients in exercising their pelvic muscles (using Kegel exercises), to rehabilitate and strengthen the pelvic floor. Many patients have difficulty “singling out” the precise muscles they need to exercise; biofeedback identifies and reinforces use of the proper muscles using sensors which go from the pelvic area to a computer system. The computer shows patients how to perform the exercises, monitors progress, and stimulates the muscles to contract on their own.
Treatments last about ten minutes, with patients practicing at home a few times a day. Typical treatment programs involve six to eight weekly biofeedback treatments in the doctor’s office. After that, patients continue exercises on their own. For women, treatment programs are offered jointly between MKMG’s Urology and Gynecology departments. Biofeedback has also been effective in treating men with urge incontinence.
“Strengthening the urinary sphincter muscle and recognizing how to do this can sometimes stop involuntary bladder contractions. Biofeeback can also treat bedwetting and conditions occurring
after prostate removal,” Dr. Bromberg said.
The TVT Procedure for Women with Stress Incontinence
Surgery has also been used as a treatment for more severe cases of stress incontinence, its primary goal to create a bladder opening that remains closed during increases in abdominal pressure. Bladder neck suspension, the most common procedure, involves abdominal or vaginal incisions, the latter being less invasive and allowing for quicker recovery. During surgery a “sling” is placed underneath the bladder opening or urethra, to suspend and lift it, allowing gentle pressure to close it. The procedure requires spinal or general anesthesia and necessitates a hospital stay of one to three days. Patients use a urinary catheter used for a few days after surgery and recover completely within three to six weeks.
“Though bladder neck suspension is very effective for moderate to severe cases of stress incontinence, a new procedure, TVT, can offer women a more effective, less invasive option,” Dr. Bromberg said.
The insertion of TVT, or tension-free vaginal tape, is a 30-minute procedure with a remarkable track record of results: 86% of patients are cured completely, and an additional 11% are significantly improved. Patients require only local anesthesia, and 95% of women can go home the same day without the need of a catheter.
During TVT surgery, three 1/2 inch incisions are made to place a thin, permanent mesh tape under the urethra for support. The tape anchors itself within the pelvic tissue with no sutures. Patients may resume most normal activities within days, exercise and sexual activity in a month.
“We’ve been using TVT at MKMG since the beginning of 2001, with phenomenal results and patient satisfaction,” said Dr. Bromberg. “While it is a fairly new procedure, with studies only being done for five years or so, the good results appear to endure over time.”
To learn more, contact MKMG’s Urology Department at 241-1050, or the Ob/Gyn Department at 242-1380. | 
