Selecting Treatment

No matter how easy, simple, or safe today’s treatments may seem to be, you must always remember that there are risks with any treatment, especially surgery. Although infrequent, a patient may have an adverse reaction to the anesthetic or be affected by complications after surgery such as blood clots, infection, poor healing, or scarring.

The following treatment options are available at UT Southwestern for women with urinary incontinence:

• Behavioral Therapy
• Exercise
• Biofeedback
• Drug Therapy
• Palliative Measures
• In-Office Procedures
• Incontinence Surgery

Behavioral Therapy - Doctors at UT Southwestern can help train patients in ways to behaviorally control mild to moderate incontinence. For example, certain foods and beverages contribute to urgency or increased frequency (i.e., urge incontinence). Therefore, many women find that reducing or eliminating their caffeine intake lessens these symptoms.

Also, timed voiding and bladder retraining, which involve urinating on a set schedule during the day regardless of the need or urge to void, is often helpful. This is practiced in an attempt to preempt the urge incontinence episodes before they occur.

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Exercise - For women with mild stress or urge incontinence, pelvic muscle exercises (sometimes called “Kegel exercises”) are easy to perform, although they require consistency and commitment. When properly performed, these exercises are designed to strengthen the sphincter muscles.

These exercises involve muscle contractions that are held for at least five to ten seconds, followed by an equal period of relaxation, 30 to 80 times a day. Pelvic muscle exercises are recommended for pregnant women in preparation for childbirth and for women with minimal to moderate incontinence.

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Biofeedback - Exercise and behavioral training can be enhanced by biofeedback and thereby help women with both stress and urge incontinence. During biofeedback training, a probe inserted into the patient’s vagina sends images to a television monitor, which allows patients to watch the muscles’ response as they are squeezed. The monitor helps women know when they are contracting the proper muscles, and it guides the training sessions toward better muscle endurance. Generally, progress can be felt within several weeks.

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Drug Therapy - Among drug therapies that may benefit women with stress incontinence are stimulants that enhance urethral closure pressure. If pelvic-floor muscles have atrophied, estrogen replacement may restore some strength although this is not recommended for women who have had breast cancer or those who are at increased risk for the disease. For women with urge incontinence, medications that cause bladder muscles to relax may be effective.

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Palliative Measures - For women who do not experience relief with non-surgical treatments but do not yet wish to undergo surgery, their physicians may suggest one of several options to alleviate incontinence temporarily. These include urethral plugs and patches, vaginal tampons, and pessaries (diaphragm-like devices that support the vagina).

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In-Office Procedures - Collagen is a naturally occurring protein found in humans and animals. When it is injected into the tissues around the urethra, it adds bulk to this tissue and helps it close tightly to prevent urine leakage, especially leakage associated with sphincter weakness. Typically these injections are performed in the office and may be repeated when indicated.

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Incontinence Surgery - Although there are many surgical procedures to repair incontinence, the experts at UT Southwestern prefer to perform surgery through the vagina rather than through an abdominal incision. These types of procedures are shorter, there is less pain involved, and recovery time is quicker.

Typically, surgery is performed to strengthen the pelvic muscles, lift the urethra back into its normal position, tighten the urethral sphincter, or repair whatever is causing the incontinence. Often, these surgeries can be performed in conjunction with other gynecological surgery, such as hysterectomy, so that there is only one operation and recovery period.

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If cure for incontinence means that a woman becomes totally 100% dry, then over two-thirds of patients report being “cured.” The cure rate is higher if the problem is reduced to a drip now and then. Sometime there is a fine line between whether the surgeon’s primary objective is to improve quality of life or to improve function; sometimes it is the same.

For more information about the Department of Urology, contact:

Phone: 214-648-4765, FAX: 214-648-4789

Mailing Address:  5323 Harry Hines Blvd., J8.148, Dallas, Tx  75390-9110