Helping Women with Urinary Issues without a Scalpel
Many patients may be resistant to visit the specialist for their leakage problems out of fear of being told, “You need surgery.” Moreover, primary care providers are sometimes hesitant to refer their patients to a specialist, since there is an assumption that referral to the specialist is synonymous with surgery. The fear of undergoing pelvic floor surgery is understandable, considering the recent media driven flood of negativity associated with “slings and mesh.” While the safety and efficacy of mid urethral slings for stress urinary incontinence (SUI) has been clearly documented and supported by the FDA, it is justifiable why so many women are fearful of pelvic surgery. Surgery, no matter how “benign” or “minimally invasive,” always has inherent risks. Thus, it makes sense that the American Congress of Obstetrics and Gynecology (ACOG), as well as most governing bodies of medical guidelines, support and recommend alternatives to surgery as first line options. In order to provide women with the best medical care possible, it is crucial that patients are aware that there are many safe, non-surgical and effective treatment options for leakage.
Urinary incontinence may not require medications or surgery to manage. One therapy that treats both urgency related leakage and stress related leakage (coughing, sneezing, laughing) is pelvic floor rehabilitation. Whether this is done by a physical therapist or using rehabilitation devices the results can be quite profound. Up to 80% of patients will see some improvement with these programs. Pelvic floor rehabilitation is unlike other therapies because there are no significant side effects with the therapy. Cost is an important consideration but because of the high success seen all major insurances cover pelvic floor rehabilitation therapy.
There are additional options for nonsurgical and non medication therapy depending on the type of leakage a woman is experiencing. Neural modulation is an option for women with urge leakage, urgency, frequency, and frequent night time urination. In this instance the bladder is not receiving the correct information from the brain and spinal cord and has frequent spasms. Percutaneous Tibial Nerve Stimulation (PTNS) can be used to treat these symptoms without medications or surgery. This is done by stimulating the tibial nerve (near your ankle) which then enters the back at the same place the nerve for the bladder exits. This stimulation then causes the bladder to become more relaxed and responsive to the signals coming from the spinal cord. The stimulation is done by placing a small needle (like an acupuncture needle) in the skin at the ankle. Then for 25-30 minutes, once a week for 12 weeks, a low voltage electrical stimulation is run through the needle. This feels like “pins and needles” when your foot falls asleep. PTNS has no significant side effects or major risks besides a woman’s time.
When a woman has leakage with coughing, sneezing, laughing we call this stress incontinence. Besides muscle rehabilitation this type of leakage can be treated with different vaginal inserts such as “poise - impressa” or an incontinence pessary. These devices, like exercising your pelvic floor, will provide a mechanical support for the urethra which becomes hypermobile in this type of leakage. Lastly, therapies that offer “vaginal rejuvenation” such as Thermiva and Vivive are beginning to show some evidence that they may be beneficial to treat stress leakage. The studies showing this though are still underway and these therapies are not FDA approved with leakage or covered by insurance.