Sprock, M.D., F.A.C.O.G., F.P.M.R.S board certified
Incontinence (SUI) is the involuntary leakage of urine
with activity, sneezing or coughing. In other words
leakage when you are trying to walk or do jumping jacks
to get your weight under control. It has nothing to do
with the stress of keeping the family happy or all your
work done, unless it involved a lot of running and
SUI affects 4-35% of
women to varying degrees. A leak once a year when
you forgot to empty your bladder and your family makes
you laugh very hard, may not be desirable, but usually
does not make you think of requiring treatment. If you
can’t walk without leaking in your pants or do an
exercise class without putting on a pad or needing a pad
on a daily basis, it becomes a more pressing matter.
Continence is usually
achieved when the urethra, which is the tube connecting
the bladder to the outside, has a stable base to rest
on. When the intra-abdominal pressure increases, for
example with coughing, the urethra should be compressed
against the stable base, thereby closing and preventing
leakage from the bladder.
Loss of the support of
the urethra could be because of aging, pregnancy,
childbirth, genetic factors and stresses on the pelvic
floor, like a chronic cough (time to quit smoking),
obesity or repetitive heavy lifting.
The pelvic floor or
pelvic support muscles are important muscles pertaining
to continence as well as support of the pelvic organs.
Pelvic floor muscle training is often the first
recommended treatment for stress urinary incontinence,
however may not be enough for your particular severity
of incontinence. Studies show about 60 % of patients
will be significantly improved with pelvic floor muscles
exercises and about 90% with surgery; however there is
little risk to training muscles and it should be the
When pelvic floor
muscle training is taught with biofeedback, in other
words you see and feel what to do, it works a lot better
than someone telling you to squeeze harder. You can’t
squeeze harder if you do not know what to squeeze.
Central Florida UroGynecology has short effective pelvic
muscle instruction courses, with often very striking
The sling and mesh
controversy of the last couple of years has given the
surgical treatment for SUI some negative publicity.
The American Urogynecologic Society (AUGS) and Society
of Gynecologic Surgeons (SGS) state that the sling is
the preferred surgical treatment for stress urinary
incontinence. Different materials can be used as a
sling; most often it is polypropylene, which is
permanent gauze/tulle like band. Slings are inserted
underneath the urethra, to recreate the base/support and
prevent the unwanted leakage of urine. Different options
are minislings (incision only in the vagina), Trans
obturator tape (incision also in the groin) or
retropubic (insertion also above the pubic bone).
Slings have been around
since the end of the last century and are the
recommended surgical treatment for SUI. Other options
are pessaries with an incontinence knob or urethral
inserts, which are less effective. In women who have a
stable urethra or in whom the surgery has not achieved
total cure of the SUI, urethral bulking (insertion of a
material in the urethra) may help to achieve continence.
Recently a modified tampon has also been introduced,
which has not been a real help. Medications are not
effective for SUI, however if you have mixed
incontinence or urgency it may make a difference.
UroGynecology has the Incontilase® laser available for
SUI and has excellent results with this office based,
non-invasive treatment. The Incontilase®
reinvigorates the collagen and elastase and reinforces
your own tissue. We are one of the few advanced
urogynecology clinics to have this option available.
Pelvic floor muscle
training should be the start to treat SUI if necessary
followed by other treatments. The sling has been
around for a long time and is the recommended surgical
If you want to join
Central Florida UroGynecology in walking a mile a day
and improve your health, remember there are no excuses.
If leakage prevents you from walking or exercising
there’re non- and minimally invasive treatments
available. Also remember there are different forms
of incontinence as well as mixed forms; your
incontinence may not be SUI. It may be a good idea to
start treatment for your incontinence and start getting
your confidence back.
Marja Sprock is a
board certified urogynecologist as well as a board
certified obstetrician and gynecologist and practices in
Rockledge at Central Florida UroGynecology. Call us at
Florida UroGynecology where high tech and common sense