Female Incontinence

Approximately 15-20% of women between the ages of 20 & 64 experience urinary incontinence.  26% of women between 30 & 60 are inconvenienced or disabled by this problem.  In many women, urinary incontinence is related to problems of pelvic muscle support of the bladder.

Patients frequently use absorbent pads,  locate a toilet upon arrival at an unfamiliar place or urinate in given intervals, particularly when leaving home, shopping or visiting.  Urinary incontinence significantly impacts psychological and social well being.  It reduces social activities, many physical activities and also restricts freedom of sexual relationships.

In order to determine the cause of the problem, a careful history is needed and this includes a voiding diary.  This is a record of how often and under what circumstances a person voids or loses urine.  Treatment for incontinence can include medical management in the form of pills that can relax the bladder or the bladder outlet.  Also biofeedback  (a form of training) can be used to develop certain pelvic muscle groups.  This includes pelvic floor exercises known as kegel exercises which can be important in improving control in some women.  Injectable material such as collagen can be placed in the urethra underneath the lining tissues in the region of the control mechanism or the sphincter.  This can make wet patients dry, if they are carefully selected for this treatment. 

Many cases of urine loss are related to physical stress, such as coughing or straining and are the result of poor pelvic support.  This support can involve either the bladder only, known as the cystocele, the rectum called rectocele, and/or the uterus known as uterine prolapse.  These defects can usually be repaired by a vaginal surgical approach. The net result is improved pelvic support as well as urinary incontinence.

There are many techniques but those that approach the problem through the vagina are effective and associated with minimal need for hospital care after the procedure.